Lecture 6/Chapter 10 Flashcards
long term care: learning objectives
-concept and features of long term care (LTC)
-discuss the various types of LTC services
-describe who needs long term care and why
-home and community based LTC services, and who pays
-LTC institutions and levels of services provided
-Specialized LTC facilities and continuing care retirement communities
Institutional trends, utilization, and costs
-Explore the aspects of private LTC insurance
long term care
- long term care (LTC) is a complex subsystem
- numerous sources of financing (medicare)
- community based services- more economical and preferred by older people
- individuals may require LTC from functional deficits arising from chronic conditions
activities of daily living (ADL)
- people with multiple chronic conditions are more likely to have activity limitations
- low activity of daily living -> low quality of life
functional limitations
- cognitive impairment may lead to functional decline
- 2 indicators assess functional limitations:
- activities of daily living (ADLs) scale
- instrumental activities of daily living (IADLs)
nature of long term care
- variety of services
- individualized services
- well coordinated total care*- different medical and maintenance services are properly coordinated (ex. social worker)
- maintenance of residual function
- extended period of care
non-long term service
-surgery
nature of long term care
- holistic care- focuses on everything (spiritual, mental, physical…)
- quality of life- loss of self-worth accompanies disability; pts remain in LTC settings for long periods
- use of current technology- personal emergency response system (PERS) -> life alert
- use of evidence based practices
long term care services
- medical care, nursing, and rehabilitation
- mental health services and dementia care- caring for dementia pts is a major focus in LTC
- social support
- preventive and therapeutic long term care
- informal and formal care
- respite care- giving burnt out family members a break (home care aids, day care)
- community based and institutional services
- housing- private and public housing
- end-of-life care- hospice
functional limitations according to where you live
- more ADL limitations more support needed (nursing homes or housing with support services)
- medicare enrollees age 65 and older with functional limitations
user of long term care
- 50% of LTC users are younger than the age of 65
- developmental disability (DD)
- intellectual disability (ID)
- patients with HIV/AIDS
range
- palliative care*- pain management
- adult day care
- adult foster care
- meals-on-wheels
- home health care
- social support
- hospice
- case management
- residential care
- assisted living
- skilled nursing care
- subacute care- when youre about to be discharged
- specialized care
level of care continuum
- personal care- paraprofessionals -> help to bathroom, doing laundry (doesnt have to be a health care professional)
- custodial care- bathing, medication, appointments (doesnt have to be a health care professional)
- restorative care- rehabilitation (home or pt office)
- skilled nursing care- rehabilitation is an important component
4 levels of subacute care service
- extensive care
- special care
- clinically complex care
- intensive rehabilitation
home and community based services
- home health care
- adult day care- medicaid provides funding
- adult foster care- housed with another family
- senior centers
- home delivered and congregate meals- elderly nutrition program (ENP) and meal-on-wheels
- homemaker services
- continuing care at home
- case management (coordination of care)- brokerage model and managed care/integrated model
- recent policies related to community based services- money follows the person and community first choice
home health care financing
- 41.5%- medicare- largest payer
- 36%- medicaid
- government is covering
- 9.9% private insurance
- 8.9%- out of pocket
- other- 3.9%
