SPEA –H 124 1nd EditionExam # 5 Study GuideChapter 9: Long Term Care - Used for optimal functioning: not used to cure a disease, but allows a person to function at their highest levelo Goes against the warehouse idea: putting people in an institution where they get neglected because of low regulations and mass amounts of people o I.e. dementia patient loses appetite and begins losing weight; it is not okay to allow that person so lose weight and die off because it is preventable Defined: long term care = the variety of services which help meet the medical needs of people with a chronic illness or disability who cannot care for themselves for long periods of time, typically longer than 30 days -services for infants to older adults depending on need of person-formal vs informal= institution operation or care by family and friends -coordination between informal and formal caregivers very important for the health of thepatient\Changing Socio-demographic Impact Need- Increasing lifespan changes the amount of people needing long-term care; more people will have chronic conditions o By 2030 19% of the population will be 65+ - Delayed retirement for many people in order to afford basic living necessitieso Nursing homes aren’t an option for many because it is expensive as well as doesn’t provide a diverse community with upscale meals, things to do that the new older population would find enjoyable Development of Long Term Care Services Colonial era: almshouses started by European colonist 19th-20th century: city and county operated homes and infirmaries Great Depression: Private citizens boarded older adults for financial benefit; quality issues Social Security (1935): Entitled older adults and those with disabilities to purchase long-term care service; entitlement program that doesn’t restrict what money can be used for 1950s: government loans aided not-for-profit nursing homes; Hill Burton hospitals needed repair at this point; retirement homes attached to Hill Burton’s 1965: Medicare and Medicaid stimulated growth of for-profit long-term care business-entrepreneurs came in and built nursing homes to start business -before Medicare, nursing homes were a “labor of love” –Abuses1970s; Congressional hearing on inhumane treatment in nursing homes; attention gained at the poor treatment of individuals in nursing homes; what they found was:- Untrained, inadequate staffo More profit by hiring lower qualified people - Hazardous and unsanitary conditions - Over and under medication o People with dementia were often over medicated to sedate them; this is now illegal - Discrimination against minorities - Thefts of belongingso Typically by the low-wage staff stealing from residents - i.e. Residents were put in chair restraints to keep them from needing help; now putting a resident in a lock chair requires an order by a doctor that expires every 4 hours Reforms - Churck Grassley, a senator, visited his mom’s nursing home in the 80s and called for a reform that put more pressure on the federal government; o State inspectors were often friends with administrators so deficiencies were overlooked more easily - 1980s: Nursing homes now required to be licensed as well as administratorso At this point nursing homes had more regulations than hospitals - Medicare and Medicaid certifications; lots of rules and regulations- Laws against elder abuse; citations ranged from a on depending on how bad they violatedpolicies; a larger violated would be a letter further down the alphabet o On buzzman: advocate for residents in long-term care facilities employed by the state to keep nursing homes in check; residents could report to this person; person subject to show up at unscheduled times for inspections Current Long Term Care Businesses - Stand alone or chainso For profit around 62% of all o Not-for profit around 31%o Government and other 7%Types of Long Term Care Delivery 1. Skilled nursing facility 2. Assisted living facility 3. Home care 4. Hospice 5. Respite 6. Adult day care 7. Innovations Skilled Nursing Facility (SNF)Defined: round-the-clock nursing or rehabilitative care for residents who have significant deficiencies with activities of daily living (ADLs), under the direct care of a licensed nurse - Activities of daily living are : eating, grooming, toileting- Continuous process of assessing resident conditions/needs and revising care plans- Nurse is responsible for the well-being of resident- Cost is mostly covered by Medicare or Medicaid; very expensive to live in (80k a year)o 62% Medicaid o Medicare pays first 100 days of SNF after a hospital stay, after that it is out-of-pocketo A person who has some money and does not qualify for Medicare can do a “spend-down” where they burn through their money and then qualify for Medicare- Administrator in training (AIT): a 9 month program that allows for eligibility for the administrative licensing exam upon completiono Usually not done by small, stand alone business owners; done more by corporations that are looking for new-hires Assisted Living Facilities Defined: A combination of housing, personalized supportive services and health care designed to meet both scheduled and unscheduled needs of those needing help with activities of daily living-person can eat, dress and toilet by themselves Resident may need help with activities of daily living, but corporation is not responsible for giving those services; a place to live with supplemental help where it is needed -in skilled nursing, nursing are responsible for giving medications, but in assisted living the resident may only need to be reminded to take medications -Not covered by Medicare because it not a medical necessity; average monthly cost is $3,131 Facility may or may not have an RN; primary medical care happens outside of facility - Projected to grow in demand by double by 2025 Home Care Services - Origin in 1900s as a social welfare response to immigrants in industrialized cities o Could have been short or long term - Formal vs informal: o Formal:  Private agencies and local health departments  Medicare predominant payer  Mostly for-profit businesses o Informal home care:  Delivered by family members or friends  Mostly women who give services Informal Home Care Recognition Family and Medical Leave Act (1993): first step; required businesses to offer 12 weeks of unpaidleave in an emergency and leave the position open when they come back, at the same pay -not