The Longterm Care Training Series

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The Long-term Care Training Series

• The Basics of Long-term Care
• July 2008

? Health Assistance Partnership, July 2008
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This Training Will

• Define long-term care
• Explain who needs long-term care
• Explain the types of long-term care
• Discuss the various providers of long-term care
  services
• Present case scenarios to help apply the
  information learned in this presentation

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What is Long-term Care?

• As individuals grow older or become disabled,
  they often experience a gradual or sudden
  inability to care for themselves.
• Long-term care includes
• A variety of medical, psychosocial and personal
  care services that meet the needs of individuals
  who have limited physical or cognitive
  functioning
• Help with personal care such as bathing, dressing
  or eating, or other activities, such as cooking,
  cleaning or shopping

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Long-term Care is NOT

• Usually covered by Medicare or most private
  health insurance plans, but may be when skilled
  care needs exist
• Only provided to older adults, but is used by the
  permanently disabled of all ages
• Always provided in a nursing home or institution,
  but can be delivered at home or in the community

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Commonly Used Terms

• Activities of Daily Living (ADLs)
• functional activities of self-care such as
  eating, grooming and bathing
• Instrumental Activities of Daily Living (IADLs)
• activities that include social interaction with
  the environment such as grocery shopping or
  banking
• Informal Caregiver
• person who provides help with at least one
  activity of daily living to a friend, relative or
  member of the community without receiving
  financial compensation

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Commonly Used Terms (cont.)

• Cognitive Impairment
• Diminished memory and mental capacity, including
  the ability to reason and understand
• Dual Eligibles
• Medicare beneficiaries who also are eligible for
  Medicaid benefits
• Psychosocial Services
• Services that provide psychological and social
  support to promote overall physical, mental and
  emotional health and well-being

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Who Needs Long-term Care?

• Those who experience a gradual or sudden
  inability to care for themselves
• Due to age or disability
• Older adult population is growing
• Life expectancy after age 65 has increased by
  17.9 years since 19401
• Aging of the baby boom generation (those born
  between 1946 and 1964)

1National Association of Insurance Commissioners.
A Shoppers Guide to Long-Term Care Insurance.
March 2006
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Mini Midterm ExamLets test our knowledge to see
what weve learned so far.

• 1. Long-term care provides services only for
  older adults who can no longer care for
  themselves independently.
• True or False
• 2. Long-term care services are almost always
  covered by Medicare.
• True or False
• Long-term care services can be provided in
• Nursing homes b. Adult Day Centers c. At home
  d. All of the above
• Individuals who experience either physical or
  cognitive deficiencies may be in need of
  long-term care services.
• True or False

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Mini Midterm Exam

• 1. Long-term care provides services only for
  older adults who can no longer care for
  themselves independently.
• True or False
• 2. Long-term care services are almost always
  covered by Medicare.
• True or False
• Long-term care services can be provided in
  Nursing homes b. Adult Day
  Centers c. At home d.
  All of the above
• Individuals who experience either physical or
  cognitive deficiencies may be in need of
  long-term care services.
• True or False

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Types of Long-term Care

• Skilled Nursing Care Facility
• Intermediate Care Facility
• Custodial Care
• Home-based Care
• Hospice and Palliative Care

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Skilled Nursing Care Facility

• 24-hour medical care from licensed professionals
  such as physicians, nurse practitioners or
  various physical and occupational therapists
• Facilities located in hospitals, nursing homes or
  other health facilities
• Offer short-term, acute care to individuals
  recovering from an illness or surgery

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Intermediate Care Facility

• Provides daily medical and nursing services
• Less specialized than skilled nursing facilities
• Provide assistance with personal care such as
  bathing, dressing, eating and toileting

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Custodial Care

• Generally describes non-skilled assistance with
  personal care
• Provided in nursing homes, assisted living,
  boarding or private homes
• Includes help with activities such as bathing,
  dressing, toileting and feeding
• Does not typically include skilled or
  intermediate care

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Home-based Care

• Skilled care or non-skilled care provided at home
  
• Skilled care part-time, skilled nursing,
  physical, speech or occupational therapy provided
  by a licensed professional
• Non-skilled care assistance with personal care
  or homemaking services
• Can be offered in the short-term or
  long-term

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Hospice and Palliative Care

• Provides comfort to those who are terminally ill
• Medical, emotional and spiritual services
  provided to patients and their families
• Performed by a team of doctors, nurses, social
  workers, health care workers and spiritual
  advisors
• Can be provided in a hospital, nursing home,
  inpatient hospice facility or private home

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Community-based Services

• Senior Centers-community centers that provide
  support services and social activities for older
  adults and their caregivers
• Adult Day Services-community-based programs to
  provide social and certain health services to
  older adults who need supervised daytime care
• Home Health Care-care provided in the home
  including physical or occupation therapy, skilled
  nursing or personal care
• NORCs-communities with a large proportion of
  older people residing within a defined geographic
  area services are designed and delivered to meet
  the needs of these aging communities
• Senior Villages-membership-based organizations
  that provides various services to older adults in
  the particular community that help them age in
  their homes

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Facility-Based Services

• Nursing Homes-facilities for individuals who do
  not need to be in a hospital but are unable to
  live at home nursing homes usually provide both
  skilled an non-skilled care
• Assisted Living- housing alternatives where
  individuals can receive some assistance with
  personal care but do not need concentrated
  medical care on a regular basis
• Domiciliary Care-housing where community members
  open their homes to individuals who need support
  and assistance with personal care and similar
  activities
• Board and Care Homes-group living arrangement
  where older adults receive assistance with
  activities of daily living
• CCRCs-residential community with a choice of
  services and living situations including
  Independent Living, Assisted Living, and Nursing
  Home Care

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Case Scenario 1

• Ms. Shirley Rodgers, 76, lives alone in
  her home. She does not have any significant
  cognitive or physical deficiencies that keep her
  from remaining independent. Over the Thanksgiving
  holiday, Ms. Rodgers fell at her daughters house
  and broke her hip. As ordered by her physician,
  Ms. Rodgers spent seven days in the local
  hospital on an inpatient stay. She then moved to
  a skilled nursing facility for two weeks to
  receive intensive physical therapy.
• 1. Which type of long-term care is Ms. Rodgers
  receiving while she is at the rehabilitation
  center?
• Will the services at the hospital and
  rehabilitation center be covered by Medicare? Why
  or why not?

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Case Scenario One Answers

• Ms. Rodgers is receiving skilled nursing care.
• 2. Yes. Ms. Rodgers services would be covered by
  Medicare. Both her hospital stay and her skilled
  nursing rehabilitation would be covered by
  Medicare Part A, as long as she received services
  from a Medicare approved facility and received
  skilled services on a daily basis. Medicare Part
  A covers skilled nursing care for illness or
  injury.

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Case Scenario 2

• Mr. Theodore Harper, 88, has recently been
  diagnosed with Alzheimers Disease. Although Mr.
  Harpers daughter manages his care needs from a
  different state, none of his family members live
  in the local area and can provide care on a daily
  basis. He, his doctor and his family feel Mr.
  Harper is in need of some daily help. He does not
  have any acute illness for which he needs care
  but does need assistance with bathing and
  dressing in the morning, toileting and some
  assistance with meal preparation.
• Which type of long-term care is Mr. Harper in
  need of receiving?
• What are some possible options for him to receive
  these services?
• Will Medicare pay for these services? Why or why
  not?

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Case Scenario 2 Answers

• 1. Mr. Harper is in need of custodial care,
  which is non-skilled help with ADLs IADLs.
• 2. Mr. Harper may be able to receive custodial
  care in a variety of settings including a nursing
  home, assisted living facility, adult day center
  or in his own home.
• 3. No, Medicare would not pay for these
  services. Medicare does not typically pay for
  custodial care services.

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Further Information

• The following national organizations provide
  helpful information on long-term care
• National Clearinghouse for Long-Term Care
  Information
• U.S. Department for Health Human Services
• National Long-Term Care Ombudsman Resource Center