Transcript Chapter 1. Long-Term Care Today: Turbulent Times

Chapter 3. Nursing Care
Facilities
Long-Term Care: Managing
Across the Continuum
(Second Edition)
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Learning Objectives
1. Define and describe nursing facilities
2. Identify sources of financing for nursing
facilities
3. Identify and describe regulations affecting
nursing facilities
4. Identify and discuss ethical issues affecting
nursing facilities
5. Identify trends affecting nursing facilities
into the future and the impact of those
trends
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What is a Nursing Facility?
Includes:
Facilities licensed by the states offering
room, board, nursing care and some
therapies
Those certified by Medicare as Skilled
Nursing Facilities (SNF) and what used to
be called Intermediate Care Facilities (ICF)
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How Nursing Facilities
Developed
Early charity-based forms of care
Poor public image
Increased regulation
Significant improvement
Still under scrutiny
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Philosophy of Care
Medical vs. Social Model
 “care vs. cure”
Multidisciplinary approach
Family involvement
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Ownership of Nursing
Facilities
Largely for-profit (2/3+)
Nonprofit (1/4+)
Few government
Growth in multi-facility chains (55%)
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Services Provided
Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
Medical/Dental
Medications
Laboratory & X-Ray
Room & Board
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Special Care Units
By diagnosis or disability:
Alzheimer’s Disease
Mental Health & Retardation
Brain Injury
AIDS
By age:
Pediatric
Young adult
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Those Served
Elderly - over 90%
Female - three-quarters
Both physical and mental disabilities
- two-fifths have dementia
- one-third with depression
Activities of daily living (ADLs)
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Activities of Daily Living
(ADLs)
• Bathing
• Dressing
• Eating
• Toileting
• Transferring
[Average resident needs help with 4 ADLs]
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Market Forces
Need-driven admissions
Family & physician initiated
admissions
Location relative to family
Availability of alternatives
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Regulations
Purpose of regulations:
1. Care is safe and of high quality
2. Care is not overly expensive
3. Services are uniformly accessible
4. Rights of workers are protected
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Types of Regulations
Affecting residents
Affecting employees
Affecting building
construction & safety
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Financing Nursing Facilities
Reimbursement sources:
Medicaid - 46%
Medicare - 12%
Private pay and other
sources – the remainder
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Medicare Coverage
Restrictions:
Covers only skilled nursing care
Must follow 3-day hospital stay
Limited to 100 days per “benefit period”
Requires co-payment for days 21 - 100
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Staffing & Work Force
Nursing
Certified Nurse Aides (CNAs)
Medical coverage
Other professional staff
- Often on contract basis
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Legal & Ethical Issues
Responsibility to:
Protect residents’ rights
Act ethically
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Types of Legal/Ethical Issues
Day-to-day issues:
• Autonomy (choice)
• Privacy
End-of-life issues:
• Advance directives
(living will, durable power of
attorney)
• Patient Self-Determination Act
• Cognitive ability?
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Management Qualifications
Licensed by the states
Many different state regulations re:
 Minimum education
 Hands-on experience
 Continuing education
NAB
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Management Challenges
& Opportunities
Balancing cost and quality
Integration of differing levels of
service
Coordination with other
facilities & organizations
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Significant Trends
Rising acuity levels
Managed care
Prospective payment
Private insurance
Rising liability costs
Consumer choice
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Summary
Nursing care facilities have a long
history, but are evolving, as is the overall
system. They have gone from being the
dominant form of long-term care to one
of many provider types.
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