Topic 1 - The Implications of Long Term Care Flashcards
Mortality Trends
What is the Mortality measurement?
What are life expectancy rates?
How many people aged over 65 and 80 are there? What is the expected trend for 2050?
Mortality looks at the likelihood of dieing at a specific age.
Life Expectancy Increases and trends
1980-82 - 70.8 Male - 76.8 Female
2015-17 - 79.2 Male - 82.9 Female
10m people aged over 65. 3m people aged over 3m
Will increase to 19m and 8m respectively by 2050.
15m have long term health condition - one that can’t be cured but only controlled by medication and therapies.
Gerontology
What is Gerontology?
Whats the difference between Gerontology and Geriatrics?
Study of ageing and associated problems
Studies demographics, environment, lifestyle, health and well-being.
Studies not the individual impact but also the social, economic and policy implications of ageing.
Geriatrics is more about the care of the elderly
What does morbidity measure?
What are the two competing theories of Howse’s analyssis of the impact of improving the mortality on morbidity rates?
Morbidity meausres how likely someone is to become ill and from what disease. Essential in pricing products.
Two competing theories of effects when improving mortality on morbidity rates. Discussed in Howse (2006)
- Expansion of Morbidity - People survive longer with advanged degenerative diseases and so increases time spent in state of chronic ill-health and disability “an epidemic of frailty”.
- Compression of morbidity - If life expectancy increases and diseases are being delayed due to medical advances then morbidity rates should compress meaning length of time people will spend in chronic state of illness will contract.
Improving Mortality Factors
What are the factors that could be helping to increase mortality rates?
What are some factors that could be helping to reduce mortality rates?
- greater understanding of ageing processes & development of effective anti-ageing strategies;
- better understanding of carcinogenic processes leading to reduced mortality from cancer;
- medical advances leading to previously life-threatening diseases becoming containable;
- progress in preventive medicine;
- better information about health;
- a continued decrease in smoking prevalence;
- increasing mental and social activities in old age; and
- effective and easily affordable new technologies.
Factors that diminish or reverse increase in life expectancy:
- increasing drug resistance to infectious diseases;
- impact on health from increased stress levels;
- increasing immigration from countries with higher mortality than the UK.
Long Term Care Needs
What are factors that are contributing to increasing long term care needs?
Quality of life expectations have never been higher.
Rising needs for long term care are:
- Longer working lives
- Changes in way people live - Previously different generations used to live together or close by
- Changes in working patterns - Economic conditions mean need to work longer to maintain standard of living. Both partners also often work, previously one member could look after elderly relative as part of duties.
What are the 8 different Types of Care?
Residential Care - Long stay home for elderly who are frail rather than ill and needs assistance with everyday activities. Social care not Health Care and Privately Funded not Local Authority Funded.
Sheltered Accommodation - Independnet living with resident warden available to provide assistance.
Domiciliary Care - Own home by nursing and care professionals.
Intermediate Care - Short-term therapy or treatment in home after or to avoid hospital stay. Normally free and available for up to 6 weeks
Respite Care - Limited time to give respite from routine to carer and cared for. Such as some additional help.
Nursing Care - In nursing home or hospital ward.
Hospital Care - Care in NHS or private hospital related to specific medical conditions to cure or stablise.
Integrated Care - Closes gap between health and social care and make it more flexible and personalised.
What is the Cost implications for the following:
- Domiciliary Care
- Residential Care
- Assistive Devices
- Home Adaptions
Domiciliary care - £15 per hour is typical which equates to £11,000 per year for 14 hours per week (2 hours per day)
Home help may be avaialble by local authorities but have reduced so adviser should research these.
Residential Care - Depends on care required and quality of accommodation. Costs range from £31,200 to £43,732 when nursing help is required. Will need to contribute towards cost if able to.
Assistive Devices - Equipment can be used to help with specific tasks and normally provided free unless large items. Some charities provide loans for such things.
Home Adaptions - Disabled facilities grants form local authority may be able to help with this but subject to means testing.
What legislation which provides care by the state?
What are the different ways care provided by the state?
What do the different organisations help with?
Care Act 2014 - Statutory duty of well-being.
Provided by local authorities who deliver policy and NHS who work with government to develop policy.
NHS used where primary need is health need, patient eligible for continuing healthcare under NHS Service Act 2006
Local Authorities have general duty to promot well-being under Care Act 2014. Broad based and includes personal dignity, physical and mental health, emotional well-being, protection from abuse and neglect, day to day activities and suitability of living acommodation.
What are the Dilnot Report Recommendations
- Lifetime Contributions currently unlimited should be capped. Should be between £25-50k with £35k ideal.
- Means tested threshold increased from £23,250 to £100k.
- National eligibility and portable assessments introduced to ensure greater consistency.
- National eligibility criteria and portable assessments should be introduced to ensure greater consistency.
- Those who enter adulthood with care and support need should be immediately eligible and not subject to means test.
- Estimated cost of recommendations would be £1.7bn
Who is the regulator for care services?
What are the regulated activities care providers must be registered for?
Care Quality Commission independent regulator of all health and social care services in England.
Care providers undertaking ‘regulated activities’ need to be registered with CQC.
- Personal care
- Nursing care
- Accommodation with nursing or personal care.
What the CQC Standards of Care?j
Fundamental standards of care are:
- Care & treatment must be appropriate, meet service users’ needs and reflect their preferences.
- Service users must be treated with dignity and respect.
- Care and treatment can only be given with consent.
- Care and treatment must be provided in a safe way.
- Users protected from abuse and improper treatment.
- Nutritional and hydration needs must be met.
- Premises & equipment must be clean, secure, suitable and properly used.
- A proper complaint handling system must be in place.
- Systems must be put in place to ensure compliance with the fundamental standards.
- Staff should be suitably qualified, competent, skilled and sufficient in number.
- Those employed should be fit and proper persons.
- A duty of candour is imposed upon registered persons (ie a requirement for openness and transparency).
How does the regulator monitor the standards being delivered?
What enforcement powers does the CQC have?
What questions does the CQC ask when inspecting care homes?
CQC uses intelligent monitoring system to assess standards being met with quality and risk profile delivered by planned visits or responding to concerns.
Have enforcement powers such as warnings, imposition or variation of conditions, cancellation or suspension of registration, fines and prosecution.
The CQC asks five questions on which its assessment is based when inspecting care homes. They are:
- safe;
- effective;
- caring;
- responsive to people’s needs; and
- well led?
What must be included in the Introductory Pack provided to prospective members?
All care homes regulated.
Must provide details of home and introductory pace
Includes details on:
- Overall care, services and food covered by fee
- Fees payable and by whom
- Additional services to be paid above normal fee
- Rights & obligations of user and provider and who is liable in breach of contract
- Terms & conditions of occupancy
Competition and Markets Authority have duty to consider complaints about unfair contracts
Briefly describe the different types of Long Term Care Insurance?
Prefunded LTCI policies: Bought before customer needs them and can be:
- Pure Protection Insurance - No investment element
- LTCI Investment Bonds - Linked to pure protection contract. Bond recieves lump sum contributions. Premiums for protection is taken from the bon fund.
Immediate Care Policies - Bought at point of care need. Investment based products often with form of impaired life annuity.
LTCI Regulatory Definition
- Contract that provides benefits if health deteriorates to extent they can’t live independently without assistance and is not expected to change.
- Contract where benefits capable of being paid for all or part of period that the policyholder cannot live without assistance.
- Contract where benefits are services, accommodation or goods for continuing care of policyholder as they cannot live independently without assistance.
