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

• 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

• level of disability
• availability of caregivers
• financial circumstances
• personal preferences/ circumstances

• activity of daily living
• eating, going to the bathroom

how much assistance is needed depending on where they are

• elderly pts
• pts with: chronic diseases, rehabilitation needs, and terminal illnessess

• short term
• requires training and assistant 
• - ADLs and OT/PT
• based upon: level of care required, ability of the caregiver, insurance and financial resources

• 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)

• 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

• federal and state financed program
• primary payer for LTC services
• low income/ asset pts
• SSI supplemental security income recipients

• pays for charges not covered by Medicare
• does not cover custodial or residential care benefits

• financial assistance for nursing home placement
• some policies may cover home care
• limits: expense, benefit (scope and duration), and inflation

apartment complexes that offer personal care, nursing services, housekeeping and meals depending on the individual's need

• 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%

• 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

• a nonmedical community-based living arrangement for the elderly and people with mental/physical disabilities
• community mental health residential facilities

• 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.

• 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

• 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

• 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

• 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

• Drug Utilization Evaluation
• prospective

• drug utilization review 
• retrospective

• drug regimen review
• analysis of patterns of medication use

• 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

• 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