LTC lecture, part 2

Question 1

Legislation with home and community based svcs

Answer 1

Older Americans Act (1965), federal funds to states
-Nutrition programs, case mgmt, homemaker svcs, and adult day care svcs
The 1981 HCBS waiver program
-Enable states to expand community-based LTC under Medicaid
Title XX Social Svcs Block Grants from DHHS
-Used for community-based LTC
Meidcaid Personal Care Svcs Progam
-Limited assistance in some states

Question 2

Unmet need in home and community-based svcs

Answer 2

Inadequate svcs for some acute health problems and mental health issues
Inadequate workforce
Transportation barriers
Limited supportive housing
Inconsistency across states and geographic areas within states

Question 3

Types of home and community-based LTC svcs

Answer 3

Home health care
Adult day care
Adult foster care
Senior centers
Home-delivered and congregate meals
Homemakers svcs
Continuing care at home
Case management

Question 4

Adult day care role and funding

Answer 4

Provides partial respite to families
Primary funding: Medicaid and private out-of-pocket payment

Question 5

Adult foster care role and funding

Answer 5

Primary room and board, supervision, and light ADL assistance
Primary funding: Medicaid, private insurance, and private out-of-pocket payment

Question 6

Senior centers role and financing

Answer 6

Wellness programs, education, counseling, recreation, health screenings, etc.
Financing: some public funding, United Way, private donations

Question 7

Continuing care at home: role and how to guarantee future LTC care

Answer 7

Extension of the continuing care retirement center (CCRC) model into home health
Initial lump-sum fee and monthly fee will guarantee future LTC

Question 8

Who is the single largest payer for home health care svcs? Who is the 2nd largest payer?

Answer 8

Medicare
Medicaid

Question 9

What is the most common svc provided to home health care pts?

Answer 9

Skilled nursing care

Question 10

Settings of institutional LTC

Answer 10

Residential and personal care facilities
ALF
SNF
Subacute care facilities

Question 11

Aspects of residential and personal care facilities

Answer 11

Physically supportive dwelling
Monitoring/assistance with meds, oversight, and personal or custodial care
No nursing care or medical svcs
Private-pay, SSI payment, other gov’t assistance

Question 12

Role and financing of ALF

Answer 12

Personal care svcs
24-hr supervision
Social svcs
Recreational activities
Nursing and rehab svcs
86% of the residents pay privately

Question 13

What are the 3 types of subacute care facilities

Answer 13

LTCHs (certified as acute care hospitals)
Transitional care units in hospitals: SNF certifications
Skilled care nursing homes: SNF certification

Question 14

What absorbed much of the nursing home care?

Answer 14

Community-based svcs and assisted living

Question 15

What was a drastic cut back on SNF?

Answer 15

On behalf of hospitals

Question 16

What is the fastest growing institution with LTC?

Answer 16

ALFs

Question 17

What has increased, and what has decreased with LTC?

Answer 17

Nursing home costs
Share of personal care expenditures

Question 18

What type of financing is declining with LTC?

Answer 18

Private

Question 19

What type of spending is rising for nursing home care?

Answer 19

Medicare

Question 20

Why is there a slow growth of private LTC insurance?

Answer 20

Affordability issue
Too many options can be confusing
Many mistakenly think that Medicare will pay for LTC
Few public policy incentives