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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
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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
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levels of care based on various factors...
- level of disability
- availability of caregivers
- financial circumstances
- personal preferences/ circumstances
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ADL
- activity of daily living
- eating, going to the bathroom
how much assistance is needed depending on where they are
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LTC pt population
- elderly pts
- pts with: chronic diseases, rehabilitation needs, and terminal illnessess
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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
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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)
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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
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Medicaid coverage for LTSS
- federal and state financed program
- primary payer for LTC services
- low income/ asset pts
- SSI supplemental security income recipients
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Medigap
- pays for charges not covered by Medicare
- does not cover custodial or residential care benefits
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LTC insurance
- financial assistance for nursing home placement
- some policies may cover home care
- limits: expense, benefit (scope and duration), and inflation
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assisted living communities
apartment complexes that offer personal care, nursing services, housekeeping and meals depending on the individual's need
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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%
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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
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Community Based Care
- a nonmedical community-based living arrangement for the elderly and people with mental/physical disabilities
- community mental health residential facilities
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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.
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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
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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
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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
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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
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DUE
- Drug Utilization Evaluation
- prospective
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DUR
- drug utilization review
- retrospective
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DRR
- drug regimen review
- analysis of patterns of medication use
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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
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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
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