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Health Policy > Final Exam > Flashcards

Final Exam Flashcards

1
Q

LTC/LTSS

A

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

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2
Q

Activities of Daily Living

A
  • Eating
  • Bathing
  • Dressing
  • To and and using bathroom
  • in and out of bed or chair
  • mobility
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3
Q

Instrumental Activities of Daily Living

A
  • Going outside of home
  • Keeping track of money or bills
  • Preparing meals
  • Doing light housework
  • Using the telephone
  • Taking medicine
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4
Q

How many people in the US need LTC?

A

11-12 million

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5
Q

How much of the 11-12 million people who need LTC are under age 65?

A

45-50%

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6
Q

How many of the 11-12 million people who need LTC are severely disabled?

A

50%

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7
Q

2 reasons why the need for LTC services are likely to increase in the coming years

A

1) Aging Population
2) Medical advances: more lives sustained but patients require LTC services; longer lifespans for congenital, other conditions than in the past

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8
Q

How much does LTC cost the US?

A

$200 billion/yr

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9
Q

Who pays the estimated $200 billion/yr for LTC?

A

1) Medicaid - 34%
2) Medicare - 28%
3) Private LTC - 8%
4) Out of pocket - 22%
5) Other - 8%

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10
Q

Who provides LTC?

A

1) Unpaid caregivers - 73%
2) Formal/informal providers - 22%
3) Formal providers - 5%

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11
Q

How many people provide informal LTC for a relative or friend?

A

7 million

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12
Q

What does an average caregiver in the US look like?

A

Woman, older than 65 and in poor health

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13
Q

How much care do unpaid caregivers provide in a week?

A

20 hrs

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14
Q

What is the economic value of unpaid caregivers?

A

$450 billion/yr

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15
Q

Case management

A

Devo and implementation of a comprehensive care plan for a person with impairments or disabilities

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16
Q

Homemaker/home health aide

A

assistance in the home with light housekeeping; assistance with medications and other health-related functions

17
Q

Personal care

A

Assistance with self-care activities such as bathing, dressing, eating

18
Q

Adult day health

A

Provision of meals and supervision, incl. rec therapy, in an out-of-home setting

19
Q

Habilitation

A

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

20
Q

Respite care

A

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

21
Q

How much does care from a skilled nursing facility cost out of pocket per year?

A

$80,000

22
Q

Top 3 source of Payment for Nursing home care

A

1) Medicaid (46%)
2) Private (out of pocket/private funds) - 40%
3) Medicare - 38%

23
Q

What is Medicare coverage for nursing home care?

A

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

24
Q

What is the “spend down” process?

A

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

25
Q

Policy Proposals to Address Issues in LTC Service Delivery and Financing

A

1) Class Act

2) Social insurance program (like Medicare) specifically for long-term care

26
Q

Community Living Assistance Services and Supports (CLASS) Act - Part of ACA

A

Would have established a public, optional LTC insurance for employees - paid for by payroll deductions

27
Q

Why did the CLASS Act not work?

A

1) Many complexities not addressed in ACA
2) Obama admin wouldn’t implement - 2011
3) repealed by Congress in 2012

28
Q

Why is End of Life Care a concern for Medicare?

A

Medicare spending was higher for people at the end of life

29
Q

End of life care

A

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

30
Q

Palliative Care

A

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”

31
Q

Hospice Care

A

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
32
Q

Does Medicare provide hospice coverage?

A

Yes; standard benefit

33
Q

Does Medicaid provide hospice coverage?

A

Optional (up to individual states)

34
Q

Does VA provide hospice coverage?

A

Yes; standard

35
Q

Does TRICARE provide hospice coverage?

A

Yes; standard

36
Q

Does private insurance provide hospice coverage?

A

Optional

37
Q

Who are the top three payers of Hospice benefits?

A

1) Medicare - 85.5%
2) Managed care/private - 7%
3) Medicaid - 5%

38
Q

How much is Medicare Hospice Benefit costing the US/year?

A

$15 billion

39
Q

How does one qualify for the Medicare Hospice Benefit?

A

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

Health Policy (3 decks)

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