Long'Term"Care"

Week"12"
April"2,"2015"

1"

Agenda"
Overview"of"the"main"LTC"services"
IdenBfy"who"needs"LTC"and"why"
IdenBfy"the"dierent"types"of"LTC"
Nursing"home"industry"
Learn"about"sources"of"nancing"

2"

1"

Projected"U.S."PopulaBon"Age"65"and"Older:"
2010"to"2050,"in"millions"

3"

4"

Bigger proportion of ppl being sicker, needing long term care,

more money being spent

2"

5"

IntroducBon"
LTC"encompasses"a"variety"of"insBtuBonal"and"
community'based"services"
Most"of"the"LTC"services"are"used"by"the"
elderly"
But,"most"elderly"do"not"need"LTC"

6"

3"

Inter'linkage"between"services"for"those"in"need"of"LTC"
Independent"living"

Community'based"
long'term"care"

ReBrement"center"

Home"

Adult"day"care"

Informal"care"

Adult"foster"
care"

ResidenBal"Care"
Assisted"Living"

Home"health"
care"

Skilled"nursing"care"

Social"support"

Subacute"care"

Case"
Management"

Hospice"
Specialized"care"

OutpaBent"services"

Primary"Care"

Community"
Hospitals"

Psychiatric"
Hospitals"

InsBtuBonal"
long'term"care"

Acute"care"

7"

Nature"of"Long'Term"Care"
Variety"of"services"
Peoples"needs"vary"and"they"change"over"Bme"

Individualized"services"
Services"are"delivered"according"to"an"individual"
plan"of"care"based"on"assessed"needs"

Well'coordinated"total"care"
LTC"providers"take"responsibility"for"obtaining"
needed"non'LTC"services"
8"

4"

Nature"of"Long'Term"Care"
PromoBon"of"funcBonal"independence"
Dependency"due"to"disability"creates"the"need"
for"LTC"
The"goal"is"to"enable"the"individual"to"
maintain"funcBonal"independence"to"the"
maximum"level"that"is"pracBcable"

Extended"period"of"care"
Most"LTC"is"needed"over"a"relaBvely"long"
period"of"Bme"
9"

Nature"of"Long'Term"Care"
HolisBc"care"
Physical,"mental,"social,"and"spiritual"needs"
must"be"met"

Quality"of"life"
A"loss"of"self'worth"o`en"accompanies"
disability"
PaBents"remain"in"LTC"for"long"duraBons,"
with"liale"hope"of"recovery"
10"

5"

Long'Term"Care"Services:""
Medical"&"Mental"Health""
Medical"Care,"nursing,"and""rehabilitaBon"
Post'acute"conBnuity"of"care" What happens when released from hospital...
Management"of"chronic"condiBons"
RestoraBon"or"maintenance"of"physical"funcBon"

Mental"health"services"
Anxiety"disorders,"depression,"delirium,"demenBa"
Can"range"from"problemaBc"to"disabling"to"fatal"
Diagnosis"among"the"elderly"is"challenging"
11"

Long'Term"Care"Services:"Social"Support"
Coping"with"changing"life"events"
AdaptaBon"to"new"surroundings"
Help"deal"with"conict"
CoordinaBon"of"total"care"

Living alone, family members far away, moved to residential care

facility....

12"

6"

Long'Term"Care"Services:""
PrevenBve"&"TherapeuBc"
Prevent"and"postpone"disease"and"disability"
nutriBon"
rouBne"medical"care"
vaccinaBons"and"u"shots"

Prevent"or"delay"insBtuBonalizaBon"
community'based"support"

RestoraBon"of"temporary"loss"of"funcBon"
return"paBent"to"community"as"soon"as"possible"
"
"

13"

14"

7"

Long'Term"Care"Services:"Informal"Care"
Informal:"Non'reimbursed"care"(family"and"
friends)"
Nursing"home"care"is"delayed"
Issues:"

Shrinking"pool"of"informal"caregivers"
Stress"and"burnout:"Respite"care"(for"
temporary"relief)"
"
"
15"

Long'Term"Care"Services:"Formal"Care"
Community'based"and"InsBtuBonal"Services"
Community'based"LTC:"Variety"of"services"are"
provided"by"formal"agencies;"important"prevenBve"
funcBon"
InsBtuBonalizaBon:"When"high"levels"of"physical"or"
cogniBve"impairment""
help"with"AcBviBes"of"Daily"Living"(ADLs)"
prevenBon"of"further"degeneraBon""
coordinate"total"care"
16"

8"

%"of"people"with"an"acBvity"limitaBon"

People"with"mulBple"chronic"condiBons"are"more"
likely"to"have"acBviBes"of"limitaBons"and"need"formal"
help"to"live"independently"
80%"
70%"
60%"
50%"
40%"
30%"
20%"
10%"
0%"
0"

1"

2"

3"

4"

5+"

Number"of"chronic"condiBons"

17"

Long'Term"Care"Services:"Housing"
Health"and"housing"concerns"are"interrelated"
Congregate"housing:"support"services"and"
companionship"(meals,"housekeeping,"
transportaBon,"social"acBviBes,"etc.)"
Funding"from"the"Department"of"Housing"and"Urban"
Development"

18"

9"

Level"of"Care"ConBnuum"
Personal"carebasic"ADL"assistance"(e.g.,"bathing)"
Custodial"carenonmedical"care"to"maintain"funcBon"
RestoraBve"carehelp"regain"or"improve"funcBon;"
professional"therapies""
Skilled"nursing"careclinical"care"provided"by"licensed"
nurses"under"the"direcBon"of"a"physician"
Subacute"carepostacute,"technically"complex""services"
19"

Clients"of"LTC:"Older"Adults"
67%"of"the"elderly"had"no"acBvity"limitaBons"
Demographic"trends"have"serious"implicaBons"
for"nancing"and"delivery"of"LTC"
Elderly"in"the"lowest"socioeconomic"status"are"
at"the"greatest"risk"of"need"for"LTC"and"are"
the"least"able"to"pay"for"such"services"

20"

10"

Clients"of"LTC:"Children"and"Adolescents"
Birth'related"disorders"(cerebral"palsy,"
auBsm,"etc.)"
Developmental"disabiliBes"(DD)"
Intellectual"disabiliBes"
Care"available"in"special"pediatric"and"IID/
DD"faciliBes"

21"

Community'Based"LTC"Services"
Home"health"care""
Adult"day"care"
Adult"foster"care"
Senior"centers"
Home'delivered"and"congregate"meals"
Homemaker"services"
Case"management"
"

22"

11"

Home"Health"Care"
Community"or"hospital'based"agency"
Services"must"be"approved"by"a"physician"
Medicare"is"the"single"largest"payer"
Skilled"nursing"care"is"the"most"common"
service"provided,"followed"by"personal"care,"
homemaker"services,"help"with"physical"
therapy,"social"services,"medicaBon,"
nutriBon,"occupaBonal"therapy"
23"

Adult"Day"Care"
Clients"stay"with"family/
friends,"but"cannot"be"le`"
alone"during"the"day"
An"important"respite"
program"
Medicaid;"out'of'pocket;"
Medicare"for"rehabilitaBon"
services"

Adult"Foster"Care"
Family"environment"in"small"
community'based"dwellings"
Services"primarily"focus"on"
room"and"board,"
supervision,"and"light"ADL"
assistance"
Program"diers"widely"from"
state"to"state"
Medicaid,"private"insurance,"
out'of'pocket;"Medicare"for"
rehabilitaBon"services"
"
24"

12"

Senior"Centers"
Local"community"centers"
Socializing"
Many"oer"one"or"more"meals"
Other"services"such"as"wellness"programs,"
educaBon,"counseling,"recreaBon,"and"health"
screening"
25"

Home"delivered"(meals"on"wheels)"and"
congregate"meals"
"

Elderly"nutriBon"program"

Hot"noon"meal,"ve"days"per"week"
People"age"60+"and"their"spouses"qualify"
Area"Agencies"on"Aging"do"contracBng"
Home"delivery,"senior"centers,"and"other"
congregate"semngs"
Most"of"the"funding"is"authorized"under"the"Older"
Americans"Act"
26"

13"

Homemaker"Services"
Shopping"
Light"cleaning"
Errands"
Minor"home"repairs,"etc."
Medicaid,"Btle"XX"block"grants"

27"

Nursing"Home"Industry"Overview"
A"decline"from"52"beds"per"1,000"elderly"populaBon"in"
1999"to"48"beds"per"1,000"in"2004"
Community'based"and"assisted"living"alternaBves"have"
expanded"
93%"of"the"beds"are"dually"cerBed"

Medicaid and Medicare

Average"facility"size:"107.6"beds"
86%"occupancy"rate"
Most"faciliBes"are"operated"by"mulB'facility"proprietary"
chains""
28"

14"

Percentage"of"nursing"home"residents"
with"various"condiBons,"2009"
60%"
50%"
40%"
30%"
20%"
10%"
0%"
Bladder"
Depression" Alzheimer's"
Bowel"
Behavioral"
inconBnence"
type"demenBa" inconBnence" symptoms"

Psychiatric" Pressure"sores"
diagnosis"
29"

Nursing"Homes:""
Services"and"PaBents"Served"
90%"of"nursing"home"residents"are"elderly"
Nursing"home"populaBon"is"aging"and"is"becoming"
racially"diverse"
Main"ADLs"requiring"assistance:"Mobility,"inconBnence,"
eaBng"
Common"services:"restoraBve"care,"skin"wound"
treatment,""demenBa"care"
Bladder"inconBnence,"depression,"and"Alzheimers"are""
common"condiBons"
Over"66%"use"psychoacBve"drugs"
30"

15"

Financing"
NaBonal"expenditures"for"the"nursing"home"industry"
are"the"lowest"compared"to"other"main"sectors"
Rate"of"increase"has"been"the"lowest"compared"to"
other"sectors"
Medicaid"is"the"largest"payer;"private"payments"
cover"38%"
Medicare"payments"have"risen"rapidly;"Medicaids"
share"has"declined"
31"

Financing"
Medicaid"spends"far"more"on"nursing"home"care"
than"on"any"other"service"
Many"paBents"enter"nursing"homes"as"private"
payers,"but"once"they"reach"the"spend'down"limits"
they"qualify"for"Medicaid"
Private"long'term"care"insurance"has"seen"slow"
growth.""
Main"issues:"aordability;"too"many"opBons"can"be"
confusing"
32"

16"

Medicaid"is"the"primary"payer"for"long'
term"services"and"supports,"2011"

33"

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Want people to live more independently .... Goal, with increased quality of life

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