Long Term Care in Older Adults Seki Balogun, MD, FACP.
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Transcript of Long Term Care in Older Adults Seki Balogun, MD, FACP.
Long Term Care in Older Adults
Seki Balogun, MD, FACP
ObjectivesBy the end of this session, students will be able to: Recognize the two main types of long term care
Recognize the differences between the nursing homes and assisted living facilities.
Discuss the different patient characteristics of both institutions.
Relate to older adults who are in long term care.
Long Term Care
Nursing Homes
Assisted living facilities
• Focus of care is to achieve and maintain an optimal level of functioning
• Interdisciplinary care
LTC: Historical background
Twelfth century “Gerocomeia” in ancient GreeceEarly 1900 Europe: special care units for the
chronically ill elderly United States: chronically ill and
disabled Poorhouses
Historical background 1920s
• State licensure programs • Standards and oversight were minimal
Mid – 1900s• Social Security Act • Private nursing homes• Run by nurses• Custodial care
Post- world war II: modeled after hospitals
• Minimum standard of care
Historical background
1980s Nursing Home Reform Act (OBRA
’87) State regulations Quality of care for the cognitively
and functionally impaired
Nursing homes 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 Skilled nursing
care
Long term nursing care
Hospice care
Case 1. 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 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. 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 For those who can no longer
live independently• Require assistance for
self care and IADLs Significant functional,
cognitive or psychosocial deficits
Paid for: 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?
0%
0%
0%
0% 1. They should be admitted to the nursing home: better safe than sorry.
2. Their family should care for them: it is their responsibility
3. They could live in an assisted living facility
4. They should pay for a caregiver
Assisted Living facility Residents require some
supervision or physical assistance due to functional or cognitive deficits
Usually owned by private
organizations
Provision of individual care needs vary with facility
• Provides 3 meals and medication administration
• Costs about $2-4K/month
Paid for: Private pay Long term care
insurance
Assisted living facility Better received by
seniors• More home - like• Less institutionalized
setting
Rare “Auxiliary Grants” for low income people.
A few beds in our area at Mountainside in Crozet.
HealthCare Financing in LTC
Medicare
Medicaid
Long term care insurance
Private pay