Long-Term Care

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Long-Term Care

• Chapter 10

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Learning Objectives

• Comprehend the concept of long-term care (LTC)
• Identify who needs LTC and why
• Identify the different types of community-based
  LTC
• Name the types of LTC institutions and levels of
  service
• Understand the demographics of nursing homes and
  residents
• Observe industry trends
• Learn about sources of financing

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Introduction

• LTC
• informal care with family
• home delivered meals
• minimal assist in residential settings
• not confined to the elderly
• elderly are the predominant users
• LTC services built with elderly in mind

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Introduction

• LTC
• must be closely related to the health care
  delivery sys
• associated with chronic conditions
• persistent and recurring health consequences
  lasting over a long period
• the leading cause of illness, disability and
  death

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LONG-TERM CARE

• Range of
• health care, mental health, social support, and
  residential services,
• provided temporarily or chronically impaired
  persons over time
• to enable them the highest level of
  independence

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LONG-TERM CARE

• Range of Health Care Services
• A need for
• 1) a variety of services
• 2) various levels and types of services
• 3) coordination of many service
• transition of service
• changes of service
• done quickly, seamless
• 4) range of services based on function to help
  restore, preventing further decline
• LTC must be well integrated and linked to the
  health care delivery sys

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LONG-TERM CARE

• Key Characteristics of a LTC System
• LTC is
• 1) integrated with the health care system
• 2) appropriate placement based on assessment
• 3) accommodating based on the clients changing
  needs
• 4) compensating for impairment
• 5) promoting independence

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LONG-TERM CARE

• Range of Health Care Services
• can be classified according to
• where the services are provided
• who provides the services
• the level of services provided
• LTC can be
• preventative versus therapeutic
• institutional versus community
• formal versus informal
• light versus intense

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NATURE OF LTC

• 1) Preventative and Therapeutic
• prevent and postpone disease and disability
• maintain health, independence and mobility
• Goal
• prevent or delay institutionalization
• Prevention
• good nutrition
• access to preventative services and medical care
• pneumonia and flu shots
• Upon arriving to a nursing homes, emphasis on
  restorative
• return patient to community as soon as possible

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NATURE OF LTC

• 2) Informal versus Formal Care
• Informal
• usually done by family and friends, receive no
  payment
• 2 out of 5 elderly depend on informal care
• 70 of caregivers are adult children and spouses
• 1/3 of elderly have unmet needs due to impairment
• number of caregivers will shrink versus growing
  number of elderly

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NATURE OF LTC

• 2) Informal versus Formal Care
• Elderly with support live longer in the community
• Family caregivers experience
• physical, emotional, social and financial
  problems
• Respite care
• an intervention to help caregiver stress
• give caregiver time off
• adult day care, home health, temporary institution

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NATURE OF LTC

• 3) Institutional and Community-based Services
• Institutions for
• frail, vulnerable, terminally ill,
  functionally/cognitively impaired
• LTC objectives for these clients are
• a) help with Activities of Daily Living (ADLs)
• b) prevention of further degeneration
• range of motion
• ambulation of patients
• prevention of falls
• turning of bed-bound patients
• bowel and bladder training

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NATURE OF LTC

• 3) Institutional and Community-based Services
• Employ paraprofessionals
• nursing assts
• therapy aides
• Quality of Life
• integration of social, environment, personal
  factors, including
• safety, comfort and pain management
• personal preference
• dignity
• interpersonal relationships
• secure
• comfortable living

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NATURE OF LTC

• 4) Levels of Intensity
• ADL and Independent Assistance of Daily Living
  (IADLs) determine functional disability
• Look at Fig 10-8, page 390
• Personal Care
• assistance with basic ADLs
• Custodial Care
• basic care to maintain patients essentials for
  daily living
• routine assistance with ADLs
• Restorative Care
• Rehab patients reach their maximum
• Physical therapy, occupational therapy, speech
  therapy

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NATURE OF LTC

• 4) Levels of Intensity
• Skilled Nursing Care
• medically oriented by a licensed nurse under a
  physicians direction
• assessment, reassessment of patient
• monitor of acute / chronic conditions
• treatment (wound care, tube care, IV, oncology,
  HIV, neurology, phlebotomy
• skilled nursing offered by home health and
  skilled nursing facilities
• Subacute Care
• often require during post acute care
• including tech complex services
• including medical, surgery, oncology, rehab,
• care offered in LTC units of hosp, skilled
  nursing facilities, home health

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Coordination of Various Needs

• Housing
• key aspect of LTC
• End of Life Care
• maintaining dignity and comfort re terminal
  illness and death

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Clients of LTC

• People with Disabilities
• MR and developmentally disabled
• People with AIDS
• Acute episode patients
• Older patients

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Types of Community-Based LTC Services

• Home Health
• Adult Day Care
• Adult Foster Care
• small, family-run homes, giving room and board,
  with oversight, supervision, and personal care
• Senior Centers
• Home-delivered and congregate meals
• Homemaker Services
• Emergency response and telephone reassurance
• Case management
• Hospice

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Institutional LTC

• Nursing homes
• room, board, nursing and medical care
• skilled nursing facility
• subacute care
• Asst living
• ADL asst, light incontinent
• Residential Care
• meals, prescription asst, supervision
• Retirement centers
• most independent, no nursing or medical services
• Customer terms residents versus patients

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Specialized Facilities

• Intermediate Care Facility for the MR (ICF/MR)
• Alzheimers Facilities
• Continuing Care Retirement Community
• different level of service in different buildings
  on 1 campus
• independent living units (cottages, apartments)
• residential and asst in adjoining facility
• skilled nursing facility gives intermittent care
• requires prepayment, entrance fee, monthly fees
• a contract last more than 1 year

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Sources of Financing Nursing Home Care

• Medicare
• covers only 10.3 of nursing homes care
• skilled nursing facility covered under Part A
• Medicaid
• Private Pay
• Private Health Insurance