1 / 19

Long Term Care in Older Adults

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 Recognize the differences between the nursing homes and assisted living facilities.

zelda
Télécharger la présentation

Long Term Care in Older Adults

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Long Term Care in Older Adults Seki Balogun, MD, FACP

  2. Objectives By 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.

  3. Long Term Care • Nursing Homes • Assisted living facilities • Focus of care is to achieve and maintain an optimal level of functioning • Interdisciplinary care

  4. 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

  5. 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

  6. Historical background • 1980s • Nursing Home Reform Act (OBRA ’87) • State regulations • Quality of care for the cognitively and functionally impaired

  7. 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

  8. Nursing Homes • Skilled nursing care • Long term nursing care • Hospice care

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. So what should happen to seniors who need some help, but do not require 24 hr nursing care? • 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

  15. 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

  16. 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.

  17. HealthCare Financing in LTC • Medicare • Medicaid • Long term care insurance • Private pay

More Related