Long Term Care Overview

  • Long term care (LTC): a range of health, personal care, social & housing services provided to people whom can no longer care for themselves as a result of chronic illness, mental disability or physical disability
    • 90% of LTC patients are elderly (primary payer = medicare)
    • Originally funded by spiritual & charity organizations
    • Minimal custodial care is given
      • Basic food, shelter, clothing
      • Chemical restraints
      • Physical restraints
  • Functional Capacity determines the need for long term care.
  • Functional capacity is made up of:
    • ADL’s (activities of daily living)- depending on others for assistance in personal care functions
      • Bathing, dressing, eating, going to the bathroom
    • IADL’s (instrumental activities of daily living)- measure of a person’s ability to perform household & social tasks
      • Shopping, transportation, making food, managing money
  • 1/3 of LTC patients are in an institutional setting
  • 2/3 of LTC patients are in a community setting
  • Skilled Nursing Facilities (SNF)
    • Only LTC paid by Medicare (1st 20 days out of hospital, after that days 21-100 involve significant cost sharing)
    • Most medically intensive form of all nursing facilities

  • Nursing facilities (NF) used to be known as intermediate care facilities (ICF)
    • Generally aren’t used for acute care
    • More for maintenance purposes
    • Medicare didn’t pay for ICFs
    • Private insurances, medicaid, & people paid out of pocket for it
  • Other types of LTC facilities
    • Adult day care- patient lives @ home & travels there during the day.  No federal regulation.
    • Assisted living centers–patient lives at facility but can utilize services as needed
    • Hospice–may be in patient’s home or NF.  2/3 are Medicaid certified
    • Aging in place–patient supplied with only the care required to live in their own home (ex. PACE–all-inclusive takes place in patient’s household & CCRC–all ambulatory care is in a “neighborhood”, which are both covered by MEDICARE), cheap
  • Financing LTC
    • Skilled Nursing Facilities
      • Medicare ays 1st 20 days after hospitalization
      • Days 21-100 include cost sharing
    • All 50 states have Medicaid programs that pay for some LTC
    • There are specific types of LTC insurance plans
    • Out of pocket– patients must meet spend-down in order to be Medicaid eligible
    • LTC growth driven by :
      • Increasing # of older people
      • Changing of the family structure
      • Prevalence of chronic illness
      • Cost containment in health care
  • Long-term care specifies longer than 100 days which is covered by MEDICAID
  • Short term care (<100 days) is covered by MEDICARE or private insurance

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