Chapter 10: Long-Term Care Services

What is long term care?
essential characteristics:
-variety of services
-individualized services
-well coordinated services
-maximum possible indépendance
-extended period of time
-holistic approach
-quality of life
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-based on assessment
-individualized plan of care
-maximum possible functional independance
-assessed through the ADL and IADL scale
Quality of life
total living experience that results in overall satisfaction with one’s life
-recognizes at least four factors:
1. lifestyle pursuits (meaningful activities)
2. living environment (comfortable, appealing and safe)
3. clinical palliation (relief from pain or discomfort)
4. human factors (caring, compassion, patient dignity, privacy)
Which group of people are in need of LTC?
elderly (65 and above)

but younger people may also need this care

LTC services
-provided informally by family and friends
-it includes:
1. home health brought to a person’s home
2. home delivered meals
3. minimal assistance in residential settings
4. care in a nursing home
Remember
-the need for LTC is directly associated with a person’s ability to function independantly, the more chronic conditions the more an individual needs LTC
Examples of conditions and impairments requiring LTC
Chronic illness
-cancer
-heart disease
-cystic fibrosis
-alzheimer’s disease
Developmental disabilities
-cerebral palsy
-genetic/congetital defect
-seizure disorders
Impairments
-blindness
-hearing loss
-paralysis
Injuries
-burns
-paralysis from head or spinal cord injury
LTC is provided using a holistic approach which is:
-physical: technical aspects of care, such as medical/nursing car, rehabilitation, diet, etc clean and comfortable environment
-mental: addressing the person’s mental and emotional well-being, such as anxiety, depression and boredom. The living environment should promote mental stimulation and positive feelings
-social: warm friendships & social relationships are essential for maximizing health and well-being
-spiritual: delivery of services should incorporate the patient’s personal beliefs, values, and religious preferences.
An individual needs long term care:
-when he or she has functional issues
-but the main goal of LTC is to promote independence for the patient whether that is at home or at a facility
ADL’s (Activities of Daily Living)
-eating
-bathing
-dressing
-using a toilet
-maintaining bowel and bladder control
-transferring such as getting out of bed, and moving into a chair
-sometimes grooming and walking a distance of 8 feet are also included in the scale
IADL’s (Instrumental activities of daily living)
-necessary for independent living
-can be more easily supplemented
-examples: cooking, shopping, housekeeping, money management
Limitations in ADL’s & IADL’s
-know that severe limitations in these, indicate a need for an individual to be institutionalized
Hospice (end of life) care
-services for the terminally ill ( life expectancy 6 months or less)
-emphasizes dignity and comfort
-cluster of comprehensive services
Palliation
relief from pain or discomfort
Community based LTC
objectives of community based LTC:
1. to deliver LTC in the most economical & least restrictive setting
2. to supplement informal care giving
3. to provide respite to family members
4. to delay/prevent institutionalization

24 hour care is not part of the objectives of community based LTC so if that is what the patient needs they might have to be institutionalized

Examples of community based LTC?
1. Home health care-
2. adult day care
3. adult foster care
4.senior centers
5.home delivered & congregate meals
6. homemaker services
7.emergency response systems
8.care management
What is the primary purpose of senior centers?
-community senior centers provide an array of services such as socializing, meals, health education, but do not offer respite care (which is offered to the caregiver not the patient)
remember
medicare is designed to give the caregiver respite care otherwise they will end up having to pay for two people to be taken care of
Case management
-method of linking, managing, and coordinating services to meet the varied and changing health care needs of elderly clients

-to prepare a care plan to address those needs
-to identify services that are most appropriate
-to determine eligibility for services
-to make referrals and coordinate delivery of care
-to arrange for financing and
-to ensure that clients are receiving services

What is the concept of aging in place?
-physically, there is a continuum of the aging process
-one develops a career, works hard, ages in that process and retires
-after retirement, once might have trouble with maintaining a large house therefore a person can move into a retirement facility with people their age
-they stayed in this community and this is an example of how continuing care retirement facilities offer the concept of aging in place
Adult foster care
small, family-run homes to care for non related adults
-room, board, oversight, and personal care
-to maintain the family environment, most states license fewer than 10 beds per family unit
Assisted living facilities
-residential setting that provides:
-personal care services
-24 hour supervision
-scheduled and non-scheduled assistance with ADL’s
-socials activities
-some using care services
-help with meds

these facilities border between personal care homes and nursing homes

Nursing homes
-provide a full range of clinical long term care services
-skilled nursing home:
-medically oriented care provided by a licensed nurse
-the plan of treatment is authorized by a physician
-direct ADL care is delivered by paraprofessionals
-rehab, therapeutic diets and nutritional supplements are important components of skilled care
-patients treatment plan is highly individualized based on a multidisciplinary assessment
subacute care facilities
-subacute care: a blend of intensive medical, nursing, and other services that are technically complex

-cheaper alternative to hospital stay

specialized care facilities
-some facilities specialize in specific areas:
-ventilator care
-wound care
-alzheimer’s
-intensive rehab
-closed head trauma
Personal care facilities
-non medical custodial care: basic assistance in a protected environment
-focus in on providing routine assistance with ADL’s
retirement facilities
-emphasis on privacy, security, independence, active lifestyles
-nursing care services not provided
Continuing care retirement community (CCRC)
-concept of aging in place
-different levels of living services offered on one campus
-retirement living
-personal care
-nursing care
this is to address people’s changing as they age
skilled nursing
-care ordered by a physician and preformed by a nurse
Know:
CNA’s/paraprofessionals render direct care related to addressing activities of daily living issues
Licensing and certification of using homes
-nursing homes are heavily regulated through licensure and certification requirements
-it is illegal to operate a nursing facility without a license
Licensing of nursing homes
-license to operate a facility is issues by the state
-standards for licensure vary by state
-there is one exception: the life safety code is a national standard
-compliance with standards is verified yearly through inspections
-state’s department of health has the oversight responsibility
Certification of using homes
-it allows a nursing home to admit patients who are on public assistance (medicare and medicaid)
-nursing homes must first be licensed by the state
-to serve medicare and medicaid clients: the home must be certified by the center for medicare and medicaid services (CMS)
-a non-certified facility can only admit private pay patients
Three distinct federal certification categories
-SNF certification: medicare
-NF certification: medicaid
-most facilities have dual SNF/NF certification
-ICF/MR certification (MR/DD clients mostly medicaid)
Accreditation
-private function, its voluntary
-the joint commission on accreditation of healthcare organization (JC) a private non-profit organization — accredits:
hospital, nursing homes, and other healthcare facilities
if a nursing homes wants to provide care to medicare and medicaid patients what first must they have:
certification
What is life safety code?
follows national building and fire safety rules
-not local or state fire regulations
Who operated most nursing homes?
the industry is dominated by nursing home chains, and private for-profit nursing homes
respite care
-temporary services to help address family caregivers’ feeling of stress and burden
What is the main source of paying financing nursing home care?
-medicare, personal funds, private insurance, medicaid, etc.

but primary source is medicaid, remember in nursing homes you can find elderly and disabled people and medicaid covers both

To quality for home healthcare:
patient should be homebound, have a plan of treatment that is viewed by a physician and require part time skilled nursing or rehab therapies
state of nursing homes today:
number of nursing homes and beds has increased but the use of the beds has decreased

-industry is dominated by for-profit home chains

standards for licensing nursing homes:
-vary from state to state
-it is the states that issue the license
-and not the federal government of the US department of health and human services
retirement facilities:
do not deliver services, rather, emphasize privacies, security, and active lifestyles for its members or residents