Transcript Living Arrangements - University of Massachusetts Medical School

Geriatric Interclerkship
Locations of Care: Living
Arrangements
Sarah McGee MD, MPH
Associate Professor of Medicine
Director of Education
Division of Geriatric Medicine
University of Massachusetts
April 30, 2012
Where do you want to live?
Independent Living
Dependent Living
We Imagine it Will Be Like…
We Imagine it Will Be Like…
What we see…
Determinants of location of
care and living arrangements
Patient needs
ADLs
IADLs
Physical
Emotional
Spiritual
Resources
Spouse/Family
Friends
Community
Church
Financial
How to evaluate patients for “best
fit” of various living arrangements
•
•
•
•
Functional Assessment
Quality of life and quality of care
Safety versus autonomy
Getting to know the person, not just the
patient/disease
• What is most important to them?
• Insurance/cost
Independent Living
 Own home or apartment
 Congregate or senior housing
may have:
help with some household upkeep
congregate meals
activities
staff
specific home health services available through
outside agencies
 Naturally Occurring Retirement Communities (NORC)
Assisted Living
• “A type of living arrangement in which
personal care services such as meals,
housekeeping, transportation, and
assistance with ADLs are available as
needed to people who still live on their
own in a residential facility”
– Center for Medicare and Medicaid Services
Assisted Living
2007
975,000 residents
38,000 facilities (25-120 units)
2009
$3022/mo ave cost for pvt unit
($10K-$50K/yr range)
Assisted Living Facilities of America
National Center for Assisted Living
Assisted Living
Means different things in different regions or
states
Lack of consensus on what is the best model,
social vs medical
Types of patients
too frail to stay at home
may have mild to moderate dementia
often required to toilet themselves and do
some of own ADLs
Most do not have 24 hour nursing on site
One hour of personal care/day
Assisted Living
Half the price of a nursing home, but
what services are you getting?
Liability is hurting development of the
industry
Much less regulation than nursing
homes right now
Aging in place is a big issue
Assisted Living
Most Assisted Living Facilities will provide:
•Health care management and monitoring
•Help with activities of daily living such as bathing,
dressing, and eating
•Housekeeping and laundry
•Medication reminders and/or help with medications
•Recreational and social activities
•Security
•Transportation
•Emergency call system in each unit
Aging Together
Long Term Care in Nursing Homes
2010
15,622 facilities (MA 429)
1.66 million beds (MA 48,484)
1.4 million residents
Av LOS 875 days
Av cost $198/day
(Alaska $687, MA $329)
%≥65 yo in NH?
www.longtermcare.gov
www.statehealthfacts.org
Long Term Care in Nursing Homes
How do you qualify for nursing home
care?
How do you end up in a nursing home?
Have we always had
nursing homes?
Percent of NFs Original Construction by Decade
34.7
35.0
30.0
Percent of
existing
facilities
originally
constructed
25.0
19.1
16.2
20.0
15.0
10.0
8.0
8.1
9.2
4.1
0.6
5.0
0.0
Prior
to
1900
1900- 1950- 19601950 1960 1970
1970- 19801980 1990
1990- 2000+
2000
Long Term Care in Nursing Homes
Abuse in 1960s, 1970s
led to
Reforms in 1980s (OBRA ’87)
led to
Government regulation
Can Nursing Homes Be the Best
Alternative?
Long Term Care in Nursing Homes
How is it changing?
Can we make it a more positive
alternative?
Resident-centered care
Geriatrics is a Team Sport
Interprofessional teams enhance the
comprehensive care of complex patients
Teams are not hierarchical
Each person on the team is valued for
his or her unique role and what they
bring to the care of the person
Teams include informal caregivers
(family, friends)
Team Members
 CNA (certified nursing
assistant)
 physical therapist
 dietician
 chaplain
 primary care provider
(MD, NP, PA)
 psychologist
 activity director
 registered nurse
 occupational therapist
 speech therapist
 social worker
Geriatric Care Teams
Regardless of the Setting…
Resources
• Geriatric Interdisciplinary Team Training
– http://www.umassd.edu/gitt/
• Medicare and Medicaid
– www.Medicare.gov
– www.longtermcare.gov
– www.cms.gov
• Assisted Living Facilities of America
– www.alfa.org
• National Center for Assisted Living
– www.ncal.org
• National Council on the Aging (NCOA)
– www.healthyagingprograms.org