Transcript Long Term Care Services Business Design and Creation

Long Term Care Services
Business Design and Creation
A Vision to Create Innovative Relevant and
Sustainable Industry
at Oakwood University
Staggering
Demographic
Status of Current Industry
Statistics
• On January 1, 2011, baby boomers
began to celebrate their 65th
birthdays and 10,000 people will turn
65 every day for the next 20 years.
• Nationwide numbers total
10,480,000 in the last 2 years 10
months and 13 days.
Alliance for Aging Research. "Alliance for Aging Research Home Page".
Growth of Senior Population
Growth Continued
Status of Senior Health
• The 2002 State of Aging & Health in America, as well as
other sources, indicates older adults use more health
care services than any other age group.
• Today, those aged 65 and older represent 13% of the
population (14.2% in Huntsville, Alabama)
• Seniors account for half of physicians' visits and half of
all hospital stays.
• The average 75-year-old has been diagnosed with
three chronic conditions and uses five prescription
drugs.
Compounding Crisis
There is a crisis of health status in
the senior population. This
problem is serious but it may be
exceeded by the crisis of capacity
for senior services providers.
Lack of Specialized Care
• There is a gap between aging patients and health care
providers.
• Of the 650,000 practicing physicians in the U.S., less
than 9,000 are geriatricians or 2.5 geriatricians per
10,000 elderly patients.
• Sadly, that number is expected to fall to about 6,000
in the near future.
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Opportunity
• The compounding crisis presents unique opportunity
to develop businesses within the LTCS
• The focus of these businesses should be
• Improving health status of seniors
• Maintaining independence of seniors
• Improving the quality of life for seniors
• Delaying institutionalization of seniors
• Accomplishing these goals and outcomes creates
sustainability and market dominance
Overview of the LTCS
Sector
Home and Community Based Service
(HBCS)
• Community Based Services
• Intended to delay or avoid Long Term Care
institutionalization
• Adult Day Services/Senior Health Maintenance Programs
• Community Based Residential Alternatives
• Home Based Services
• Intended to maintain the person in their home through
provision of supportive non-medical services.
• Collective known as Home and Community Based
Services (HCBS)
Adult Day
Services
• Adult Day Services (ADS) are non-
•
residential services at a community
based facility providing activities
for elderly and/or disabled individuals.
• Most centers operate 10-12
hours per day and provide meals,
social/recreational outings, and
general supervision.
• Adult daycare centers operate
under a social model and/or a
medical model.
Social model curriculum is designed
to provide social stimulation and
recreation which may improve or
maintain physical and cognitive
function as well as assist in avoiding
depression.
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Medical model provides same
services as social model but with
clinical oversight and services.
Adult day care centers provide
respite care, enabling caregivers
to work or to have a break from
their care giving responsibilities.
Attendance often prevents rehospitalizations and may delay
admission to residential long
term care.
Daily fees for services are usually
less than a home health visit and
less than half the cost of a typical
nursing facility.
Personal Support Services
• Services provided to assist with activities of daily
living, and related essential household tasks, and
other activities that enable a person to remain in the
home, as an alternative to Nursing Facility care,
including the following:
• Assistance with activities of daily living (e.g., bathing,
grooming, personal hygiene, toileting, feeding, dressing,
ambulation, and med reminders), including errands,
grocery shopping, and health care appointments;
• Assistance with cleaning that is an integral part of
personal care and is essential to the health and welfare of
the enrollee, and
• Assistance with maintenance of a clean and safe
environment.
Interaction between LTC , Home Health and
Private Duty Nursing Services
• LTC are non-medical supportive services and can be
stand-alone or used in conjunction with HH and PDN
• Supportive Services are distinguished from medical
services in that supportive services assist with ADLs while
HH and PDN provide skilled/licensable service (e.g. wound
care, catheter care, vent services)
• HH Aide services are most like LTC supportive services
but at a higher cost.
• HH agency may provide a skilled service for 1 hour in the
day and then continue to provide HH Aide services which
look substantially similar to LTC supportive services but at
a much higher cost.
• When the skilled service is no longer medically necessary
the HH Aide may be discontinued.
Financing LTC Services
• Long Term Care Insurance
• Reimbursement model up to policy threshold
• Member purchases services and is reimbursed after the service has been
provided.
• Veteran’s Administration
• Full range of benefits accessed the VA clinical assessment and referral
• Medicare
• Limited Benefits
• Medicaid (TennCare)
• Claims based reimbursement model
• Non traditional Medicaid eligibility standards
• Services established based on Medical Need with H&P or other clinical
documentation serving as indicator of ADL deficiency
• Private or Self Pay
Integrating Business Into
Academics
• foreFront envisions the
newly developed LTCS
Business Model as fully
integrated into several
academic areas within
the institution
• Students would gain
practical useful real
world experience in one
of the fastest growing
and sustainable business
sectors in the nation.
Examples of Integration
• Social Work
• Performance of Needs
Assessment
• Communications
• Marketing
• Psychology
• Mental Health
Assessment
• Counseling
• Business/Finance/Accounting
• Financial Operations of the
Business
• Nursing
• Provision of Direct Care
• Clinical
• Non Clinical
• Allied Health
• Physical Occupational,
and Speech Therapies
•
Computer Science
• Software
Development
Relationship Model