Sir_Excellence

Unit 1: Week 1 - Chapter 1 Outline

CHAPTER ONE: LONG-TERM CARE TODAY – TURBULENT TIMES

LEARNING OBJECTIVES

After completing this chapter, readers will be able to:

1.   Define the current long-term care system, including how it developed, and key strengths and weaknesses in the system.

2.   Define the term "continuum of care."

3.   Identify and define the consumers and providers of long-term care.

4.   Define institutional and non-institutional care, and the strengths and shortcomings of each approach.

5.   Identify the changes taking place in long-term care today.

CHAPTER HIGHLIGHTS

Introduction – provides an overview of the long-term care system, how it came about and its components.

·         Long-term care has changed in the past several decades, but not as rapidly as some other fields,

·         It has had to catch up with environmental and organizational changes

Defining the Long-Term Care System

·         The term “long-term care” is usually defined by the providers who provide specific types of care (e.g., assisted living),

·         It can be seen as synonymous with “chronic care”,

·         It is often used to describe nursing homes only. That is inaccurate. It includes all forms of long-term care.

.c2.How the Long-Term Care System Came About

·         .c3.The Growing Role of Government in Long-Term Care Financing – the system has had to change as financing changed, particularly government financing (Medicare & Medicaid)

·         The Impact of Regulations on Development of the Long-Term Care System – as financing changed, regulation changed with it

·         The Results of Past Successes – improvements in medical care and their impact on length of life have added to the demand for long-term care and the need to treat ongoing chronic conditions

·         Efforts to Reduce Health Care Costs and Their Impact on Long-Term Care – the availability (or lack thereof) of financing has largely determined the services available

.c2.The Components of the Long-Term Care System

·         .c3.The Consumers of Long-Term Care; - who uses the various types of long-term care?

·         .c4.Elderly Users of Long-Term Care – the largest group, especially those over age 85

·         .c5.The Elderly as a Political Force – they have begun to realize their political clout in recent years

·         .c4.Nonelderly Long-Term Care Users – not as large a group, but important

·         .c5.The Physically Handicapped – are able to do more and live longer with various medical advances, but will need some care longer

·         .c5.The Mentally Ill/Mentally Retarded – not always thought of as part of long-term care (unfortunately), but are an important part of the system

·         .c4.The Baby Boomers: Future Long-Term Care Consumers – the fastest growing segment of the population, they will have a huge impact in the near future

·         .c3.Providers of Long-Term Care – includes the following (more detail in chapters 4 – 8)

·         .c4.Nursing Facilities

·         Subacute and Postacute Care

·         .c4.Assisted Living

·         Elderly Housing

·         Community-Based Services

·         Home Health Care

·         Hospice Care

·         Adult Day Care

The Argument Over Institutional Vs. Non-Institutional Care

·         Community-based (noninstitutional) services:

·         Are generally less expensive

·         Are less restrictive for the consumer than institutional services

·         Are not always the best for each individual

·         The “Olmstead Decision” rules that denying that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability, that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities, and that states have an obligation to move individuals with disabilities from institutional settings into more integrated settings in the community (Mathis, 2004).

.c2.Long-Term Care as Part of a Continuum

A continuum of care is an integrated, client-oriented system of care composed of both services and integrating mechanisms that guides and tracks clients over time through a comprehensive array of health, mental health, and social services spanning all levels of intensity of care. It has the following characteristics:

·         .c3.The continuum is client-oriented – it must be focused on the consumers, not on the providers or payers

·         .c3.The continuum is comprehensive – it contains a full range of services needed

·         .c3.The continuum is integrated – it is more than a group of individual parts

.c2.Strengths and Weakness in the Long-Term Care System

·         .c3.Strengths:

·         .c4.Response to Changing Needs – providers (and payers) have responded by providing new services

·         .c4.Its Uniquely American Nature – Americans do not want a “one size fits all” system, but one that works for the different segments of the population

·         .c4.The Dedication of Caregivers – caregivers, both formal and informal (family and friends) are dedicated to caring for those close to them or entrusted to their care

·         .c4.Increasing Focus on Customer Service – consumers are becoming better educated and increasingly want good customer service, just as they expect from other businesses

·         .c4.Development of Innovative Types of Care – providers have developed innovative types of care to meet identified needs, including:

·         Aging in Place – based on the concept of bringing the care to the consumer rather than having consumers move to access a different level of care

·         Multi-Level Facilities – closely related to Aging-in-Place, it involves having numerous levels of care (e.g., skilled nursing, assisted living, etc.) available in a single facility

·         Adult Day Care – providing daily supervision and some medical care of dependent consumers so their families can work

·         .c4.Integration Efforts – integration of services has grown rapidly, providing better, more coordinated care

·         .c3.Weaknesses:

·         .c4.A reimbursement-driven system – availability of reimbursement determines if care is available and how much is provided

·         .c4.Inequitably distributed services; - long-term care services are not uniformly available geographically

·         .c4.A fragmented and uncoordinated system – the long-term care “system” consists of many components that do not always work together, to the detriment of consumers

·         .c4.A mix of health and social services – social services (e.g., housing, transportation) are not always included in segments of the system

·         .c4.Multiple entry points into the system – there is no single way for consumers to get into the long-term care system, making it confusing and uncoordinated

·         .c4.Overshadowed by the acute system – the acute system, with its urgency and ability to resolve emergency and life-threatening situations is given more attention than the long-term care system

·         .c4.Poor public image; - long-term care has long suffered from a poor public image, in part (but only in part) due to its own poor performance in the past

·         .c4.Inadequate support for informal caregivers – while informal caregivers are critical to the success of the system, there is seldom any support (financial or otherwise) for them

·         .c4.A confusing and “user-unfriendly’ system – due to all of the above, the long-term care system is not easy for consumers to use

LECTURE OUTLINE

A.  Identify learning objectives for the session

B.  Introduce the lecture topic

C.  Define and explain the terms involved in defining the long-term care system

D.  Discuss the factors impacting development of the long-term care system:

1.   Financing: The growing role of government

2.   Development: The impact of government regulations

3.   The results of past successes

4.   cost-reduction efforts

E.   Identify and discuss the various consumers of long-term care

F.   Briefly discuss the providers of long-term care (They will be discussed in much more depth in later chapters):

1.   Identify the providers

2.   Identify the differences between institutional and non-institutional care, discussing similarities, differences, and why there is an argument over how they are used.

G.  Discuss the concept of a continuum of care, identifying its characteristics:

1.  The continuum is client-oriented

2.  The continuum is comprehensive.

3.  The continuum is integrated

H.  Strengths of the long-term care system:

1.   Response to changing needs

2.   Uniquely American nature

3.   Dedication of caregivers

4.   Increasing focus on customer service

5.   Development of innovative types of care

6.   Integration efforts

I.  Weaknesses of the long-term care system:

1.   Reimbursement-driven system

2.   Inequitably distributed services

3.   Mix of health and social services

4.   Multiple entry points into the system

5.   Overshadowed by the acute system

6.   Poor public image

7.   Inadequate support for informal caregivers

8.   Confusing and “user-unfriendly” system

J.    Summarize the discussion, recapping the key points of the lecture.

VOCABULARY TERMS

· AARP (formerly the American Association of Retired Persons) - advocacy organization representing seniors.

· Activities of daily living (ADLs) - Those activities that impact a person's functional ability or disability; including bathing, transferring, toileting, eating, and communicating.

· Adult day care - A community-based group program providing supervision and some services for a period of a few hours per day.

Affordable Care Act (ACA) – Passed in 2010 to greatly expand coverage of millions, as well as adding many new mandates and regulations. Also known as “ObamaCare”.

· Aging in place - The concept of allowing a person to progress through different levels of long-term care services without having to move to another facility. Services are brought to the consumer instead of taking the consumer to the services.

· Americans with Disabilities Act - A law passed in 1990 mandating equal treatment of individuals with disabilities.

· Assisted Living/Residential Care - A residential setting that provides personal services and care, 24-hour on-site support and assistance, activities and health-related services.

· Baby boomers - People born between 1946 and 1964, representing a post-World War II population boom and a potential large increase in the elderly in the future.

· Centers for Medicare & Medicaid Services (CMS) - The government agency overseeing operation of the Medicare and Medicaid programs - formerly the Health Care Financing Administration.

· Certificate of Need (CON) - A government program, begun in the 1960s, designed to limit the expansion of expenditures for health care building and renovation, by requiring prior approval of any such projects.

· Chronic care - Health care given over an extended period of time. Often used synonymously with long-term care.

· Clients - Term used to describe consumers in some forms of long-term care (e.g., home health care).

· Community-based care - A term used to include noninstitutional long-term care, it usually includes services such as home health care, hospice, and respite care.

· Continuum of care - term used to describe the range of services provided to consumers of health care, including preventive care, acute care, and all of long-term care.

· Functional disability - Limitation in one’s ability to perform certain functions associated with everyday life, such as walking or dressing oneself.

· Home health care - Health services provided in the consumer’s home by a nurse, occupational, speech or physical therapist, social worker, or home health aide.

· Hospice care - the concept of providing palliative care to enhance the life of dying person in the last six months of life, emphasizing comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family.

· Informal caregivers - family, friends, and volunteers who provide various levels of care for an individual, but are not reimbursed for that care.

·         Institutional care - Health or personal care provided in an institutional setting, such as nursing facilities, and assisted living.

·         Integrated health system (IHS) - System of health care containing numerous health care providers that are organizationally integrated and coordinated.

·         Integration - Organizing of individual provider organizations into a larger organization.

· Long-term care - Extended care of people with chronic disabling conditions.

· Long-term services and supports - refers to the broad range of services and infrastructures to help frail older people and younger people with disabilities remain independent.

· Managed care - Term covering a variety of health care systems or organizations (e.g., HMOs, PPOs) that combine the provision of care with payment for that care.

·         Medicaid - Title XIX of the Social Security Act. Passed in 1965, it provides health insurance for those who cannot afford it, the "medically indigent."

·         Medicare - Title XVIII of the Social Security Act. It provides health insurance for the elderly, and some disabled people.

· Multilevel facilities - Long-term care facilities that provide more than one level or type of long-term care, such as skilled care, nursing facility care, and assisted living.

· Multiple entry points - Ways in which consumers access the long-term care system.

· Noninstitutional care - Any care provided in the community or in the consumer’s home.

·         Nursing Facilities - long-term care facilities that offer room, board, nursing care and certain other therapies.

·          “Quicker and sicker” discharges - Refers to the practice of hospitals discharging patients who are still quite ill and requiring heavy levels of care to long-term care providers.

· Residents - Persons receiving care in residential long-term care setting, such as a nursing facility or assisted living facility.

·         Social Security Act (SS) - Passed in 1935, this act created a social/financial safety net for Americans without adequate resources to care for themselves, primarily providing income for elderly and retired individuals.

·         Subacute care - Comprehensive, goal-oriented care given following, or in place of, acute hospital care to treat a specific condition or to administer one or more technically complex treatments.

·         Utilization Review - Process of certifying that all Medicare patients or residents are at the proper level of care.

REFERENCE BOOKS

Long-Term Care: Managing Across the Continuum, 4th Ed By: John Pratt

The Medicare Part D Drug Program, 1st Ed By: Fincham, John