Long Term Care

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Chapter 10

• Long Term Care.

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Defined...

• Much more than just SNFs
• Necessary in cases of Functional Impairment
• Inability to perform certain key ADL or IADL
• ADL IADL
• Eating Bathing Cooking
• Dressing Toileting Shopping
• Transfer Continence Housekeeping
• management

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Key Characteristics

• Healthcare
• Chronic conditions
• Functional impairments
• Coordination of needs
• Mental Health
• Psychological / psychiatric
• Behavioral (wandering / combativeness)
• Mental retardation

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Key Characteristics

• Social support
• Interaction
• Recreation
• Spiritual needs
• Money, wills, estate
• Housing
• Assistive Safety Meals
• Comfort / cleanliness Privacy

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Key Characteristics

• Duration of care
• Extended / permanent
• Acute (lt 90 days)
• Integration of care
• Linked with PC
• Acute care
• Mental health

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Level of Intensity

• Personal care
• Basic ADL performed by paraprofessionals
• Custodial Care
• Personal care basic functional maintenance
• Restorative Care
• Professional therapies basic maintenance
• Skilled Nursing
• Provided and directed by nurses

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Skilled Nursing Facilities

• Truly an industry in crisis
• BBA drying up revenues
• Liability insurance issue
• 20 of Floridas 362 Skilled Nursing Facilities
  operating under Chapter 1113
• One facility 108,000 premium in 1999 to
  380,000 in 2000 (for 100,000 coverage!)
• NHC pulling out of 13 facilities due to insurance
  laws14
• Same staffing issues as hospitals

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Nature of LTC

• Preventive
• Preventive medicine, nutrition, socialization
• Therapeutic
• Medical, physical, nursing, Rx, Rehab
• Formal
• Community based or institutional
• Informal
• Family, friends

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Community Based Services

• Home Health
• 3 day hospitalization, MD cert., homebound
• Must need SNF type care
• Adult Day Care Adult Foster Care
• Senior Centers Meals on Wheels
• Homemaker PERS

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Continuum of Care

• Retirement living
• Residential care
• Assisted living
• Nursing facilities
• Subacute care
• Other
• ICF, Continuing Care Retirement Community