Transcript Slide 1

Long Term Care in Older Adults
Seki Balogun, MD, FACP
Objectives
By the end of this session, students will be able
to:
 Recognize the two main types of long term care
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Recognize the differences between the nursing
homes and assisted living facilities.
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Discuss the different patient characteristics of both
institutions.
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Relate to older adults who are in long term care.
Long Term Care
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Nursing Homes
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Assisted living facilities
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Focus of care is to achieve and maintain an
optimal level of functioning
Interdisciplinary care
LTC: Historical background
Twelfth century
 “Gerocomeia” in ancient Greece
Early 1900
 Europe: special care units for the
chronically ill elderly
 United States: chronically ill and
disabled
 Poorhouses
Historical background
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1920s
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Mid – 1900s
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State licensure programs
Standards and oversight were minimal
Social Security Act
Private nursing homes
Run by nurses
Custodial care
Post- world war II: modeled after hospitals
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Minimum standard of care
Historical background
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1980s
Nursing Home Reform Act (OBRA ’87)
State regulations
Quality of care for the cognitively and
functionally impaired
Nursing homes
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1.5 million Americans (most aged 65 years
and older) reside in 17,000 nursing facilities
nationwide
43% of adults 65 years and older will stay in
a nursing home at some time before they die
55% have a lifetime use of at least 1 year
21% have a total lifetime use of 5 years or
more
Nursing Homes
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Skilled nursing care
Long term nursing
care
Hospice care
Case 1.
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Mr. TB is a 90 year old man with multiple
medical problems, who was admitted to the
hospital last week with community acquired
pneumonia.
He is now ready for discharge
He is deconditioned and is unable to
ambulate
He lives with and is the caregiver for his wife,
who has advanced dementia
Nursing Homes
Skilled nursing care
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Typically for those discharged from an inpt setting
with functional deficits and often medically complex
Require one or more forms of therapy (PT, OT,
speech)
High degree of nursing care: IV, wound care
Length of stay usually less than 6 months (few days
to months)
Paid for by Medicare
Case 2.
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Ms. TJ is an 85year old woman with paraplegia from
a spinal cord injury. She has severe neuropathic pain
and is wheelchair dependent.
She lives alone, has no relatives in VA.
She had a paid caregiver, 6hrs/day, who helped her
with self care (bathing, toileting) and her
instrumental ADLs (cooking, cleaning and shopping).
She can no longer afford to pay her caregiver
Nursing Homes
Long term nursing care
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For those who can no longer
live independently
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Require assistance for self
care and IADLs
Significant functional, cognitive
or psychosocial deficits
Paid for:
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Private pay
Long term care insurance
Medicaid
Nursing Homes
Hospice care
 Terminal conditions with less than 6 months
to live
 Usually in conjunction with an independent
hospice organization
 Team provides a network of services:
physicians, nurses, social workers, chaplain
 Paid for by Medicare
So what should happen to seniors who
need some help, but do not require 24 hr
nursing care?
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They should be admitted to the nursing home:
better safe than sorry.
Their family should care for them: it is their
responsibility
They could live in an assisted living facility
They should pay for a caregiver
Assisted Living facility
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Residents require some supervision
or physical assistance due to
functional or cognitive deficits
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Usually owned by private
organizations
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Provision of individual care needs
vary with facility
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Provides 3 meals and medication
administration
Costs about $2-4K/month
Paid for: Private pay
Long term care insurance
Assisted living facility
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Better received by
seniors
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More home - like
Less institutionalized
setting
Rare “Auxiliary Grants”
for low income people.
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A few beds in our area at
Mountainside in Crozet.
HealthCare Financing in LTC
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Medicare
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Medicaid
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Long term care insurance
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Private pay