Longterm Care HCMG 4401
Popular in Intro Primary/Long Term Care
Popular in Nursing and Health Sciences
This 5 page Bundle was uploaded by Bahja Benford on Monday February 1, 2016. The Bundle belongs to HCMG 4401 at Clayton State University taught by Latrina Walden in Summer 2015. Since its upload, it has received 44 views. For similar materials see Intro Primary/Long Term Care in Nursing and Health Sciences at Clayton State University.
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Date Created: 02/01/16
Primary/Long-term Care (Chapters 1-3) Current State of LTC Policy 1. Financing - Multiple sources of financing within LTC services - Access and utilization become uneven - People face obstacles to pay for services *Private pay * Social Security * Medicare/Medicaid - Financing has shifted from nursing homes to community-based care ACA: Money follows the Person (2016) Community First Choice Medicaid: approx. $175 a day Medicare and Commercial/Private Pay: approx. $400-500 per day - Rising Expenditures - Pay for performance does not result in consistent improvements in quality. - CLASS (Community Living Assisted Services and Support) - OBRA-87: Hospital care recommendations 1. Community-based 2. Quasi-intuitional (kind of) Who is paying for what? Community-based Providers 1. Home Health Providers - Least restrictive environment - Duggan v Bowen: expansion of home health under Medicaid: 1. Removed 3-day stay 2. Abolished 100 visits Medicare Pays! 2. Homemaker and Personal Care Service Providers - In-home assistance and chores - Pay: SS check, home-based stay - Medicare does not pay for services; Medicaid may pay; coordinated through an area: Agency on Aging Adult- Day care providers Dementia Patients Respect for family Some provide transportation back and forth Over 4,800 ADC centers Medicaid pays via waivers $55-75 cost 37% are under age 65; 32% have Alzheimer’s or Dementia 4. Hospice: 72 days; 6 months or less to live - programs have grown - Medicare is the largest source of payment - support during and after death Quasi-Institutional - Government-assisted housing - Private pay - Co-housing *Public Housing (Section 8 Section 202) 62 years and older Private Pay: all other extras free Custodial care: - Medicare does not pay! - Funding: Medicaid, insurance, private funds - These are people that don’t have family - Money Follows the Person Institutional Assisted living - $3,500 in 2012 ($4k a month rent) - Fastest growing LTC - No block grants in Georgia - All states licensure - Misplaces patients Nursing Homes Licensed: open and operating Certified: Medicare/caid, meet government requirements to take money 1. Skilled nursing facilities - Variety of disabilities often coexist here. - Patients have cognitive impairment and law social function - Physician must be present - For profit (private) - Medicaid largest payer 2. Subacute care: cannot leave in hospital - May be recovering after hospitalization (need a lot care) - Active monitoring, treatments, and technically complexed care are often requirements *Long-term care hospitals (LTCHS) -certified as hospitals *subacute units in skilled nursing facilities 3. Intermediate Care Facilities (ICFS) -mental retardation or disabled 4. Continuing care retirements communities - aging in place Insurance Sector HMO keep costs LOW! - Gatekeeper: PCP (primary care physician) Medicare C: Med. Advantage- is an option D: prescription drugs LTC Professionals 1. Administrative professionals (Executive Directors, etc.) - Oversees compliance - Finance reimbursement - Legal and ethical behaviors - Meet the budget 2. Home Health Agency Admin. - Registered nurse - Training 3. Assisted-Living Administrators - License requirements in states (GA!) - Required qualifications established - National exam administered - State nursing home regulations - Quality of life! - Adapt to new trends - Legal and regulatory compliance - 4. Clinicians: Physicians - - Medical director (5k a month) - - Attending physicians - - authorized administration to facility and/or home health - send patients - - prescribe medical, nursing, rehab, and dietary interventions - - MD or DO - - 5. Clinical Nurses - - RNs - -LPNs - - 6. Non-physician Practioners - - NPs- cannot admit to hospital - PAs - - 7. Rehab Professionals - - Dietitians - - care plans - - Dietary managers: handles behind the scenes with food; making sure it’s clean, warm, etc.
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