Discussion Topic- The Continuum of Care

Chapter 4 Nursing Care Facilities

Learning Objectives

1. Define and describe nursing facilities 2. Identify sources of financing for nursing

facilities 3. Identify and describe regulations affecting

nursing facilities

Learning Objectives (continued)

4. Identify and discuss ethical issues affecting nursing facilities

5. Identify trends affecting nursing facilities in the near future and describe the possible impact of those trends

What is a Nursing Facility?

Includes:  Facilities licensed by the states offering

room, board, nursing care and some therapies

 Those certified by Medicare as skilled nursing facilities (SNF) and what used to be called intermediate care facilities (ICF)

How Nursing Facilities Developed

 Early charity-based forms of care  Poor public image  Increased regulation  Significant improvement  Still under scrutiny

Philosophy of Care

 Medical vs. social model • “care not cure”

 Multidisciplinary approach  Family involvement

Ownership of Nursing Facilities

 Largely for profit (68%)  Nonprofit (25%)  Government owned (6%)  Growth in multifacility chains (55%)

Services Provided  Nursing  Physical therapy  Occupational therapy  Speech therapy  Medical and dental services  Medications  Laboratory and X-ray services  Room and board

Special Care Units By diagnosis or disability:

• Alzheimer’s disease • Mental health and intellectual disabilities • Brain injury • AIDS

By age: • Pediatric • Young adult

Those Served

 Elderly – over 90%  Female – two-thirds, male – one-third  Both physical and mental disabilities

• Two-fifths have dementia • Many have depression

Activities of Daily Living (ADLs)

 Bathing  Dressing  Eating  Toileting  Transferring

* Average resident needs help with 4 ADLs

Market Forces

 Need-driven admissions  Family- and physician-initiated admissions  Hospital Readmissions  Location relative to resident’s family  Alternative types of care (or lack of)

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Regulations

Purpose of regulations:  Care is safe and of high quality  Care is not unnecessarily expensive  Services are uniformly accessible  Rights of workers are protected

Types of Regulations

 Affecting residents  Affecting employees  Affecting building construction

and safety

Financing Nursing Facilities

Reimbursement sources: Medicaid – 66% Medicare – 13% Private pay and other sources – the remainder

Medicare Coverage

Restrictions: Covers only skilled nursing care Must follow 3-day hospital stay Limited to 100 days per “benefit period” Requires co-payment for days 21–100

Staffing and Human Resource Issues

 Nursing  Certified nurse aides (CNAs)  Medical coverage  Other specialists

• Often on contract basis

Legal and Ethical Issues

Responsibility to: Protect residents’ rights Act ethically

Types of Legal and Ethical Issues

 Day-to-day quality-of-life issues: • Autonomy (choice) • Privacy

 End-of-life issues: • Advance directives

• living will or power of attorney

• Patient Self-Determination Act of 1990 • Cognitive ability?

Management Qualifications

 Licensed by the states  Differing state regulations cover:

• Education requirements • Hands-on experience • Continuing education

• NAB

Management Challenges and Opportunities

 Balancing cost and quality  Integration of differing levels of service  Coordination with other facilities and

organizations

Significant Trends

 Rising acuity levels  Managed care  Prospective payment  Private long-term care insurance  Payment bundling  Rising liability insurance costs  Consumer choice

Summary

Nursing facilities have a long history but are evolving, as is the overall system. They have gone from being the dominant form of long-term care to one of many provider types.