Longterm Care and Mental Health

7/25/2019 Longterm Care and Mental Health

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Long Term Care

The Continuum of Care



What is Long Term Care?

Health, mental health, social andresidential services provided to

temporarily or chronically disabled personover extended period of time



Characteristics of LT Care

Physical or mental, temporary or permanent Need based on functional disabilities Promotes or maintains health and independence in

functional abilities and uality of life To enable us to die peacefully and !ith dignity "ultiple services and multiple professions spanning

broad spectrum

"ultifaceted #esigned around uniue needs of the individual $ervice can change over time



Who needs LT Care

Chronic % permanent or indefinite period of time

&mpaired % a decrease in or loss of ability to

perform #isabled % short or long term' varies by age

group

(unctional ability % person)s ability to performthe basic activities of daily living



*nderstanding demand for LT Care

Patient represent +mosaic of subsegments- of the population. /ften co

morbid conditions $ervices can be organi0ed across

dimensions of users

$ome users of LT care have significantdifferences from other users



/rgani0ation of LT Care

&nformal organi0ation % most LT care isprovided by family and friends

1ach community may be differentregarding availability of services

&deal system % client oriented continuum

of care.



What is Continuum of Care?

"atches resources to patient)s condition "onitors the client)s condition and changes

services as needs change Coordinates care across disciplines &ntegrates care in a range of settings 1nhances efficiency, reduces duplication,

streamlines patient flo! "aintains comprehensive record 2eeping



Categories of Continuum of Care

1xtended care 3cute inpatient care 3mbulatory care Home care /utreach Wellness

HousingN/T14 Not all LT care clients get this full range of care.This is ideal that may offset or delay chronic illness.



Providers of LT Care

Hospitals Nursing homes 5average costs 67,899 per

month: Home health agencies Hospices

3dult day service programs Housing organi0ations



Types of LT Care $ervices5$ource4 http4;;!!!.medicare.gov;LongTermCare;$tatic;Community$ervices.asp

Help with activities

of daily livingHelp with additional

servicesHelp with care

needsRange of costs

Community-BasedServices

<es <es No Lo! to medium

Home Health Care <es <es <es Lo! to high

In-Law Apartments <es <es <es Lo! to high

Housing for Aging

and Disaled

Individuals

<es <es No Lo! to high

Board and CareHomes

<es <es <es Lo! to high

Assisted Living <es <es <es "edium to high

Continuing CareRetirement

Communities

<es <es <es High

!ursing Homes <es <es <es High



Paying for LT Care

Nursing home care represents approximately => ofpersonal health care expenditures

Home health care about > of expenditures though this

is trending higher $ince LT care is provided mostly by family and friends,

these figures don)t represent full cost "edicare, "edicaid cover much of the cost

/ut of poc2et costs for LT care are significant Little private insurance currently pays for LT care though

incentives have been implemented to cover that area



How we pay for LT Care

Long Term care insurance % only about @9> ofLT care recipients have this coverage

*sing personal funds % method typically usedfirst until funds run out

"edicare % only provides short term percentageof LT care 5does not include custodial care:"edicare covers @99> cost for first @99 days Provides =9> costs for next =9 days

Provides no reimbursement for subseuent "edicaid % once income eligibility is met, pays

for most of the cost of LT care



"edicaid $pend #o!n %

1xempt 3ssets "edicaid eligibility based on income Pays for s2illed care and custodial care $ome exemptions apply

*p to 6,999 in cash assets Home, no matter the value Personal belongings /ne car or truc2

Aurial spaces *p to 6@,899 designated as burial fund for applicant and spouse Balue of life insurance if less than 6@,899 5other!ise, must

surrender value in excess of amount up to cost of care:



"edicaid $pend #o!n Nonexempt

3ssets 3ll cash assets above 6,999 Certificates of deposit $toc2s, bonds, mutual funds

Land contracts or mortgages for real estate sold *.$. $avings bonds "ost &3s Nursing home accounts Prepaid funeral contracts issued in Nevada "ost trusts eal estate other than primary residence "ore than @ car or truc2 Aoats or recreational vehicles



Detting around the $pend #o!n

process &$ allo!s 6@@,999 gift tax per child, but this does not

apply to "edicaid and gifts over 67,899 E years prior tocare !ill result in loss of eligibility until full gift costs are

met. #ivision of assets

3t home spouse is able to 2eep F of all assets up to 6G,999 The other half must be spent do!n for care

$pousal support4 3t home spouse is allo!ed to ma2e upto 6@,8@ per month in income. &f income does not meetthat much, allo!ed to use other LTC spouse income up tothat amount. 5Court orders can increase this amount:



"ental Health Care

The (orgotten Population



&ncidence and Prevalence of "H

#isorders in *.$. E979> experience some psychiatric disorder in

their lifetime

@> of children ages G % @I receive "Hservices in a year an2s nd in terms of burden of disease in

established economies

&n general, @G> of population have mentaldisorder alone, E> have dual diagnosis, and >have addictive disorder



"H #escriptives

"ost people !ith Psych disorders experience onset priorto age E=

"en "ore common among men 5mostly alcohol abuse and antisocialpersonality disorder or +Cochran)s $yndrome-: Phobia and alcohol abuse most common Cognitive impairment most common among those 8 and older

Women $omati0ation disorders 5somati0ation of symptoms mas2ing underlying

psych disorder:, obsessive compulsive, and depressive disorder ates for "H disorders drop after age 78 5except for

cognitive disorders:



1arly Bie!s on "ental &llness

Aased primarily on values. 3berrant behaviorcould be vie!ed as demonic or evil spirits.

Lunatic hospitals began in 1li0abethan 1ngland5primarily to protect society from misfits: "ental illness began as diagnosis during

scientific revolution in Dermany

(reud changed the !ay !e vie!ed mentalillness and related it to unconsciousdevelopment difficulties



"ental &llness 3ttitudes in *.$.

#uring 9th century, there has been increasingacceptance of pluralistic determinants of mentalillness

Dreater reliance on the disease concept Aetter understanding of the role of personality

development from social or cultural influences $till an underlying current of the +1urocentric-

perspective % abnormal or deviant behavior as areflection of values, norms and belief systems ofthe mainstream



ecent *.$. "ental Health Policy

#evelopment of psychopharmacology in the @G89s "ental etardation (acilities and Community "ental

Health Centers Constructions 3ct of @G7 built more

mental health centers "ental Health $ystem 3ct proposed by Pres. Carter

!ould have provided better funding but !as notimplemented by eagan or Aush the (irst.

1xpansion of health insurance to cover treatment5generally significantly less coverage than other healthinsurance:



"H #elivery $ystem

@G88=9, most services provided in state orcounty mental hospitals

Public and private sector health care Public sector primarily paid by "edicare or "edicaid

"aJor decline in state mental health hospitals

/utpatient services account for nearly I8> of"H services



"ental Health and the (uture

Dreater reliance on psychopharmacology #ebate of "H vs. Balues !ill continue

&s "ental &llness an excuse? 3re all of our personality problems attributable to mental illness?

elationship of mental illness and homelessness 5approximately 98> of homeless have mental illness: *p to 89> have cooccurring mental illnesses and substance use

disorders. Their symptoms are often active and untreated, thus difficult to obtain

basic needs for food, shelter and safety and causing distress to those

!ho observe them. They are impoverished, and many are not receiving benefits for !hich

they may be eligible.



"ental &llness and Las Begas

/vercro!ding ofemergency rooms bymentally ill

$hortage of mental healthfacilities andprofessionals

&mplementation of Legal999 to transport and

hold mentally ill Nevada ran2s nd nationally in suicide

Don’t feed

the

homeless! It’s

the law!

Longterm Care and Mental Health

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