Long Term Care

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  1. long term care
    • set of health, personal care, and social services delivered over a sustained period of time to a persons who have lost or never acquired some degree of functional capacity
    • Health, social, and residential services provided to chronically disabled persons with functional or cognitive impairments
  2. LTSS
    • long term services support
    • supportive services needed by people who have limitations in their capacity for self-care bc of physical, cognitive, or mental disability
    • defines all services and infrastructure to improve pt independence 
    • use in the Affordable Care Act of 2010
  3. levels of care based on various factors...
    • level of disability
    • availability of caregivers
    • financial circumstances
    • personal preferences/ circumstances
  4. ADL
    • activity of daily living
    • eating, going to the bathroom

    how much assistance is needed depending on where they are
  5. LTC pt population
    • elderly pts
    • pts with: chronic diseases, rehabilitation needs, and terminal illnessess
  6. Rehabilitation
    • short term
    • requires training and assistant 
    • - ADLs and OT/PT
    • based upon: level of care required, ability of the caregiver, insurance and financial resources
  7. terminal illness
    • close to death/ poor prognosis
    • hospice care: physical, social, spiritual needs 
    • may receive care in an institutional setting or at home (palliative care: comfort care)
  8. Medicare coverage for LTSS
    • limited benefits
    • short term post hospitalization care: only is the pt is aged and or disabled and requires short term (skilled care or therapy services: OT/PT
    • hospice: end of life care
    • medically necessary home health services
    • part-time or intermittent skilled nursing care
    • only covered for about 100D and only fully covered up to 30D
  9. Medicaid coverage for LTSS
    • federal and state financed program
    • primary payer for LTC services
    • low income/ asset pts
    • SSI supplemental security income recipients
  10. Medigap
    • pays for charges not covered by Medicare
    • does not cover custodial or residential care benefits
  11. LTC insurance
    • financial assistance for nursing home placement
    • some policies may cover home care
    • limits: expense, benefit (scope and duration), and inflation
  12. assisted living communities
    apartment complexes that offer personal care, nursing services, housekeeping and meals depending on the individual's need
  13. continuing- care retirement community (CCRC)
    • a continuum of independent living, assisted living, and skilled nursing care at a single complex
    • as a senior's health and needs change, they relocate to a different part of the same campus
    • between '03 and '04 the number of CCRCs increased by 32.2%
  14. Adult Day Services
    • community-based group programs designed to meet the needs of functionally and/or cognitively impaired adults through an individual plan of care
    • pt reside on their own or with family, and travel to a central location for services
    • care is focused on maintenance and rehabilitation 
    • 3 models of care: 
    • 1. social: fun
    • 2. medical/health: social and more extensive therapeutic services
    • 3. specialized: serves a particular pt pop
    • available in 46 states
  15. Community Based Care
    • a nonmedical community-based living arrangement for the elderly and people with mental/physical disabilities
    • community mental health residential facilities
  16. Money Follows the Person Rebalancing program
    • MFP 
    • 2005
    • provides grants to states for people needing LTSS to live in their own homes or residential settings of their choice instead of institutions 
    • for: medicaid beneficiaries, intellectual/mental disabilities, residing in a facility > 6 mos.
  17. PACE
    • Program for All inclusive Care for the Elderly
    • authorized by the Balanced budget Act of 1997
    • Comprehensive Service Delivery: sole source of medical, social, and rehabilitative services and allows the pt to stay at home
    • Medicare and Medicaid financing
  18. Key Features of Pace
    • interdisciplinary team assesses, plans, and delivers integrated services
    • responsible for provided all needed services
    • day care center that provides medical and social services
    • flexible financing
  19. PACE goals
    • better care management and pt monitoring: has planning documents in place, better monitoring of symptoms and safety, and fewer unmet needs
    • more appropriate use of services: better use of prevention services, and fewer hospitalizations
    • better health outcomes and satisfaction: improved health and mental health status, improved functioning, higher satisfaction with life, and higher satisfaction with care
  20. Pharmaceutical Services in LTC
    • distribution services: dispensing, medication reconciliation, policies and procedures, audits, and forms
    • consultant services: DRR (drug-regimen review) analysis to optimize therapy, Drug Utilization analysis to optimize therapy DUE and DUR, MTM, formulary management, and dosing
  21. DUE
    • Drug Utilization Evaluation
    • prospective
  22. DUR
    • drug utilization review 
    • retrospective
  23. DRR
    • drug regimen review
    • analysis of patterns of medication use
  24. ASCP
    • American Society of Consultant Pharmacists
    • organizations that empowers pharmacist to enhance the quality of care for all older persons through the appropriate use of medication and promotion  of healthy again 
    • members manage and improve drug therapy and improve the quality of life of  geriatric pts and other individuals residing in a variety of environments (NF, sub-acute care and assisted living facilities, psychiatric hospitals, hospice programs, and home and community-based care
  25. Fleetwood Project
    • ASCP foundation 
    • 3 phases:
    • 1. assessment of the baseline cost of meds-related problems in NH setting and the impact of pharmacist DRR on pt outcomes and costs
    • 2. Assessment of prospective interventions utilizing a pharmaceutical care model ("fleetwood model") for pts at high risk for medication-related problems
    • 3. assessment of the fleetwood model in assisted-living facilities and NH
    • RESULT: estimated the consultant pharmacists would reduce med-related morbidity and mortality costs in US nursing homes by $3.6 billion annually
Card Set
Long Term Care
health care
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