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Long-Term Care Major Paper by: Connor Rawe

Long-Term Care

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Page 1: Long-Term Care

Long-Term CareMajor Paper by: Connor Rawe

Page 2: Long-Term Care

Long-Term Care Defined

• “Long-term care refers to regular assistance for people with chronic illnesses or mental or physical disabilities, both in nursing homes and at home. Unlike other health care services, long-term care is primarily intended to help with activities of daily living (ADLs) rather than to treat medical conditions.”

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ADL Definition

• ADL- Activities of Daily Living. These activities are those performed to those residents that cannot perform these tasks themselves. These activities include:

• 1. Personal hygiene - bathing, grooming and oral care2. Dressing - the ability to make appropriate clothing decisions and physically dress oneself3. Eating - the ability to feed oneself though not necessarily to prepare food4. Maintaining continence - both the mental and physical ability to use a restroom5. Transferring - moving oneself from seated to standing and get in and out of bed

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Who is LTC applicable to?

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Who is LTC applicable to?

• From the graph on the previous slide, it is easy to see that majority of the Long-term care audience are those people age 65 and older. There are, however, others who use long-term care to fulfill their needs. Disabled persons who require assistance in the activities of daily living are a large audience of the long-term care industry.

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History of Long-Term Care

• In the 1900’s friends, family and the community care for the elderly.

• In the early 1900’s religious sponsored affiliates cared for the elderly. Rest homes also began to come forth.

• In 1935 the Social Security Act assisted with income of the elderly.

• In 1954 the Hill-Burton Act ammendments creates finances to help fund the building of nursing homes.

• In 1972: SNF’s or “Skilled Nursing Facilities are created/defined.

• In 1987 the Omnibus Budget Reconcilliation Act (OBRA ‘87) includes reformation of the nursing home.

• In 1995 Congress passes legislation repealing OBRA ’87

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Levels of Long-Term Care

Assisted Living

Nursing Home

Skilled Nursing Facility (SNF)

Rehab Hospital

Home Health Providers

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Home Health

• “Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).”

• The idea behind home health care is to provide independence as injury and illness is treated. It also helps maintain the patient’s self-sufficience.

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Assisted Living Facilities

• Assisted Living Facilities are an independent alternative for the elderly who require minimal assistance with daily living and personal care. The idea and purpose behind these facilities is to help adults live independently in an environment where help is readily accessible and where they may feel safe.

• Those who live in these facilities do not require the medical and nursing care that is provided in “nursing homes”

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Nursing Homes

• A Nursing home is a local or residential facility for individuals with a disability or chronic illness. Nursing homes usually are applicable to those who are older and not able to take care of themselves on their own. There are, however, exceptions to this. Those individuals with disabilities are able to live in nursing homes and receive care there.

Other names for nursing homes are “convalescent homes” or just simply, a “long-term care facility”.

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Skilled Nursing Facilities

• A Skilled Nursing Facility or (SNF) is a type of nursing home. This type of nursing home is recognized by CMS as a a type of facility that meets the medical needs of individuals who have the potential of functioning independently after a limited time of care. The staff that takes care of these residents are predominately RN’s and more professional caregivers than CNA’s.

• It is important to note that these residents have severe deficiencies in their ability to perform activities of daily living. They require constant care.

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Challenges of LTC #1 Finance

• A significant problem that is facing Long-term care facilities is its ongoing reliance on Medicaid funding. The cyclical nature of the state government revenues makes it difficult for these facilities to have a high profit margin. The reimbursement that Medicaid offers is very minimal. It is estimated that nursing homes lose, per medicaid patient, approximately $13 per day.

• Another problem facing LTC facilities is the difficulty in filling all the available beds. In recent years, there has been a vast increase in the elderly living in assisted living facilities. Because of this growth, other facilities are suffering in occupancy.

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Challenges of LTC #2 Quality Staff

• Another major problem of LTC facilities is finding and maintaining quality staff. The caregivers, or CNA’s are the face of the facility. How the CNA’s perform reflects the overall morale and reputation of the facility. If the goal is to have a “full house”, it is absolutely crucial to find competent, kind, and hardworking caregivers. What a blessing for the “The Homestead” that I am the face of their company.

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Funding Sources

• In the next slide, the graph portrays where the money is coming from that is paying for the residents of a long-term care facility. Notice that Medicaid/Medicare pays a significant amount of the cost, followed by out-of-pocket and then private insurance.

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Funding Sources #2

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Older Americans Act O.A.A of 1965

• “Congress passed the Older Americans Act (OAA) in 1965 in response to concern by policymakers about a lack of community social services for older persons. The original legislation established authority for grants to States for community planning and social services, research and development projects, and personnel training in the field of aging. The law also established the Administration on Aging (AoA) to administer the newly created grant programs and to serve as the Federal focal point on matters concerning older persons.”

• Some of the services that the OAA provides is in-home assistance, transportation, job training, home delivered meals, caregiver support, and protection from abuse. The purpose of the Act is to help older americans stay as independent as possible. In the year 2014, OAA funding from the government was 1.88 billion.

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The 1965 Medicare Amendment to the SS ACT

• July 30, 1965 marked the day that President Johnson officially signed the Amendments to the social security act which established Medicare and Medicaid, with a promise that they would "improve a wide range of health and medical services for Americans of all ages."

• These new services were to be of assistance to the elderly Americans who would not be able to afford quality healthcare and/or insurance. They were successful not only to the elderly, but to a vast audience of qualified participants.

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Advocacy Group for LTC

• Family Caregiver Alliance is the closest thing the Long-term care has for an advocacy organization. It’s purpose is to support all those involved in long-term care and provide the best possible assistance when it comes to educating others, researching, and advocating. Below is their “about us” found on their website and is similar to their mission statement.

• “FCA is first and foremost a public voice for caregivers. Founded in the late 1970s, we were the first community-based nonprofit organization in the country to address the needs of families and friends providing long-term care for loved ones at home. We illuminate the caregivers' daily challenges to better the lives of caregivers nationally, provide them the assistance they need and deserve, and champion their cause through education, services, research and advocacy.”

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My desire to work in Long-Term Care

• For about the past year or so, I have had a great desire to work in the healthcare industry, specifically Long-Term Care. I have been working at an assisted living facility for the past 8 months and have just loved working “where the tire hits the pavement”. It has been a great blessing to serve the elderly with their ADL needs and to get to know them personally. I have the leadership qualities and financial intelligence to run a Skilled-Nursing facility on my own hopefully someday soon.