Final Exam Flashcards
LTC/LTSS
Array of services provided in a range of settings to people who have lost some capacity of independence because of an injury, chronic illness, or condition.
Focused on helping people with basic activities and routines of daily living and may also include skilled and therapeutic care for tx and managing these conditions
Activities of Daily Living
- Eating
- Bathing
- Dressing
- To and and using bathroom
- in and out of bed or chair
- mobility
Instrumental Activities of Daily Living
- Going outside of home
- Keeping track of money or bills
- Preparing meals
- Doing light housework
- Using the telephone
- Taking medicine
How many people in the US need LTC?
11-12 million
How much of the 11-12 million people who need LTC are under age 65?
45-50%
How many of the 11-12 million people who need LTC are severely disabled?
50%
2 reasons why the need for LTC services are likely to increase in the coming years
1) Aging Population
2) Medical advances: more lives sustained but patients require LTC services; longer lifespans for congenital, other conditions than in the past
How much does LTC cost the US?
$200 billion/yr
Who pays the estimated $200 billion/yr for LTC?
1) Medicaid - 34%
2) Medicare - 28%
3) Private LTC - 8%
4) Out of pocket - 22%
5) Other - 8%
Who provides LTC?
1) Unpaid caregivers - 73%
2) Formal/informal providers - 22%
3) Formal providers - 5%
How many people provide informal LTC for a relative or friend?
7 million
What does an average caregiver in the US look like?
Woman, older than 65 and in poor health
How much care do unpaid caregivers provide in a week?
20 hrs
What is the economic value of unpaid caregivers?
$450 billion/yr
Case management
Devo and implementation of a comprehensive care plan for a person with impairments or disabilities
Homemaker/home health aide
assistance in the home with light housekeeping; assistance with medications and other health-related functions
Personal care
Assistance with self-care activities such as bathing, dressing, eating
Adult day health
Provision of meals and supervision, incl. rec therapy, in an out-of-home setting
Habilitation
For persons with mental retardation and developmental disabilities; designed to help them acquire, retain, and improve the self-help, socialization, and adaptive skills necessary to reside successfully in community-based settings
Respite care
Care provided on a relief basis for a disabled person by special caregivers in order to provide a respite for that person’s full-time caregiver
How much does care from a skilled nursing facility cost out of pocket per year?
$80,000
Top 3 source of Payment for Nursing home care
1) Medicaid (46%)
2) Private (out of pocket/private funds) - 40%
3) Medicare - 38%
What is Medicare coverage for nursing home care?
Only for acute medical problems that requires skilled nursing as part of tx
-coverage limited in duration and ends once patient “plateaus”
e.g. stroke, tx with IV antibiotics
What is the “spend down” process?
Things people do in years before Medicaid eligibility to become qualified for Medicaid for skilled nursing home care coverage
1) cannot give away assets to family members to become Medicaid- eligible = Look back
2) Recent protections agains spousal impoverishment
Policy Proposals to Address Issues in LTC Service Delivery and Financing
1) Class Act
2) Social insurance program (like Medicare) specifically for long-term care
Community Living Assistance Services and Supports (CLASS) Act - Part of ACA
Would have established a public, optional LTC insurance for employees - paid for by payroll deductions
Why did the CLASS Act not work?
1) Many complexities not addressed in ACA
2) Obama admin wouldn’t implement - 2011
3) repealed by Congress in 2012
Why is End of Life Care a concern for Medicare?
Medicare spending was higher for people at the end of life
End of life care
All health care provided to someone in the days or years before death, whether the cause of death is sudden or the result of a terminal illness that runs a much longer course
Palliative Care
Care given to improve the QoL of patients who have a serious or life-threatening disease. Goal is to px or tx, as early as possible, the symptoms and side effects of the disease, and its tx, in add’n to the related psychological, social, and spiritual problems. Goal is not to cure”
Hospice Care
Coordinated care intended to maximize comfort for a terminally ill person by reducing pain and addressing physical, psychological, social, and spiritual needs.
- typically associated with patients thought to be in their final six months of life
- generally provided in patient’s home, when possible
Does Medicare provide hospice coverage?
Yes; standard benefit
Does Medicaid provide hospice coverage?
Optional (up to individual states)
Does VA provide hospice coverage?
Yes; standard
Does TRICARE provide hospice coverage?
Yes; standard
Does private insurance provide hospice coverage?
Optional
Who are the top three payers of Hospice benefits?
1) Medicare - 85.5%
2) Managed care/private - 7%
3) Medicaid - 5%
How much is Medicare Hospice Benefit costing the US/year?
$15 billion
How does one qualify for the Medicare Hospice Benefit?
1) Consult w/ PCP and hospice physician –> patient accepts palliative care instead of curative care
2) Hospice physician + PCP certify patient’s LE is 6 month or less
