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Long Term Care

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Huffington Center on Aging-Department of Medicine ... Post-hospital transition care. Linkage to community Alzheimer's services and supports ... – PowerPoint PPT presentation

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Title: Long Term Care


1
Long Term Care
  • Nancy L. Wilson-Baylor College of Medicine
  • Huffington Center on Aging-Department of Medicine
  • Presentation to Citizens Health Care Working
    Group
  • Houston Hearing
  • July 26, 2005

2
  • Mission Statement To improve long-term care and
    supportive services provided to vulnerable older
    adults and family caregivers in Harris County
    through collaborative problem solving and
    strategic planning that involves consumers,
    providers, funding organizations, and other major
    stakeholders of the long-term care system.
  • www.careforelders.org
  • RWJ Community Partnership Program for Older
    Adults

3
Key Issues and Strategies
  • Access to Needed Services
  • Availability of Affordable Services
  • Quality of Care Major Workforce Issues
  • Preparedness for Aging
  • Individual/Personal
  • Organizational
  • Community

4
Todays Presentation
  • Population concerned with long-term care is very
    diverse in terms of age and level of disability
    physical, mental,
  • My Expertise and Experience Focused on Older
    Adults (60-63)
  • Who I think about
  • My brother in-law who has managed with
    functional limitations due to encephalitis
    fiercely independent in his own apartment with an
    electric wheelchair and dependent on daily
    assistance
  • My neighbors Mrs. H, 81 who has congestive heart
    failure and COPD as well as a closed head injury
    sustained from a fall. She would like to remain
    at home with her husband for the duration of her
    illness.
  • My niece who is 22-years-old who has mental
    retardation as a result of
  • complications during birth and has been
    diagnosed with autism. Her family would like her
    to live at home indefinitely , but they need help
    with her care, particularly with a program of
    supervised daily activities.
  • Think about the heroic families who support these
    individuals and the workplaces who make
    accommodations for these families

5
Definition and Examples
  • LTC is difficult to define boundaries among
    primary, acute, and long-term care have blurred.
  • medication management for elders with chronic
    disabilities ?
  • Settings of care are confounded with services
  • Nursing homes provide acute care
  • Home Health Care delivers medical treatment

6
  • Long-term care is primarily concerned with
    maintaining or improving the ability of elderly
    people with disabilities to function as
    independently as possible for as long as
    possible.
  • Long-term care also encompasses social and
    environmental needs and is therefore broader than
    the medical model that dominates acute care.
  • Long-term care is primarily low-tech, although it
    has become more complicated as elderly persons
    with complex medical needs are discharged to, or
    remain in, traditional long-term care settings,
    including their own homes.
  • Services and housing are both essential to the
    development of long-term care policy and systems.
  • R. Stone (2000) Milbank Memorial Fund

7
Key Issue Chronic Disease and Disability
  • 43.5 of Harris County elders report disability
  • 55.5 report two or more disabilities
  • 63,400 need help with basic daily living tasks

8
Key Issue Disability and Long Term Care
  • Not Just Nursing Homes
  • A range of services to address functional
    needs and support independence
  • Everything from a home delivered meal to
    institutionally based care
  • Escalating costs
  • National expenditures in long term care
    expected to triple to 346 billion/year by 2040

9
Long-Term Care Risk
  • The risk of nursing home placement increases with
    age - 31 of those who are severely impaired and
    between the ages of 65 and 70 receive care in a
    nursing home compared to 61 of those age 85 and
    older.
  • Most people with long-term care needs (83
    percent) live in their own home among those
    living at home, the majority (78 percent) does
    not hire any help and only 8 depend only on paid
    help

10
Long-Term Care is Expensive
  • In 2002, the average annual cost for a nursing
    home was 51,000 for a semi-private room and
    61,000 for a private room.
  • Four hours of home care daily costs 26,000 a
    year. (national average)
  • The cost of assisted living can range from less
    than 10,000 a year to well more than 50,000 a
    year (depending on the kind of assisted living
    facility and type of services an older person
    chooses.) (DHHSAdministration on Aging, 2003))

11
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12
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13
The value of the services family caregivers
provide for "free" is estimated to be 257
billion a year.
BILLIONS OF DOLLARS
Source Expenditure data from HCFA, Office of the
Actuary, Levit K. et all, Health Affairs
200221.
14
Economic reality
  • You can save for collegebut most of us cant
    save for long-term care
  • Need to Consider how to approach the individual
    and social risk
  • Physical, emotional, and social burdens that
    providing care impose on the caregiver and its
    economic costs to the caregiver and to society.
  • Caregiving can conflict with caregivers
    employment, creating economic losses for
    caregivers and society.
  • Individuals suffer from inadequate attention to
    basic needs

15
Best Practice Approaches with Potential to Reduce
LTC Costs
  • Integration of care for long-term care
    recipients
  • PACE Program of All-Inclusive Care for the
    Elderly (55 Medicare/Medicaid population)
  • EverCare nursing home managed care (Use of NPs
    and PAs to deliver medical care)
  • Consumer-Directed Services Cash and Counseling
    Demonstration
  • Public Policy Support of Private Insurance Plans
    and Consumer Education

16
Other Approaches
  • Incorporating Geriatric and Prevention Approaches
    to Chronic Illness

17
A Geriatric PerspectiveFinding the Appropriate
Balance and the Right Plan
A
B
C
D
ProlongingLife
Optimizing Qualityof Life
Increasing age and frailty
18
Examples of promising complements to primary care
of senior populations
  • Brief GEM/disability prevention with attention to
    primary care adherence in community (HEP, Stuck)
    or clinic
  • Chronic Disease Self-management and other proven
    self-management support programs
  • Post-hospital transition care
  • Linkage to community Alzheimers services and
    supports
  • Problem-solving therapy for depression
  • Post-prescription drug monitoring
  • Senior oriented physical activity
  • (Ed Wagner, Seattle 2005)

19
Threats to Health and Quality of Life
  • Physical inactivity
  • Poor diet and nutrition, obesity
  • Falls
  • Alcohol and substance abuse
  • Depression
  • Smoking
  • Infection (flu and pneumonia)
  • Inability to self-manage chronic conditions
  • Inattention to clinical preventive services
  • Social isolation

20
Underlying Risk Factors The Actual Causes of
Death
  • Behavior of deaths, 2000
  • Smoking 18
  • Poor diet nutrition/ 17
  • Physical inactivity
  • Alcohol 4
  • Infections, pneumonia 3
  • Racial, ethnic, economic ?
  • disparities
  • Mokdad et al., Actual causes of death in the
    United States, 2000, JAMA, March 10, 2004.

21
Threats to Health and Well-being Among Seniors
  • 37 women 33 men aged 65 74 report no
    physical activity
  • 24 - obese
  • 33 - fall each year
  • 34 - no flu shot
  • 45 - no pneumococcal shot
  • 47 - no mammogram
  • 88 - at least one chronic condition
  • 37 experience some activity limitation

22
Evidence Based Health Promotion Programs
  • Administration on Aging and National Council on
    the Aging (www.healthyagingprograms.org)
  • Evidence Based Disease Self-Management National
    Demonstration Program
  • 3 of 13 projects in Texas

23
  • Houston
  • Care for Elders/Sheltering Arms
  • Depression intervention
  • Neighborhood Centers, Inc. St. Josephs
  • Physical activity intervention
  • San Antonio and Other Projects Nationally
  • Chronic disease self management
  • Diabetes
  • Heart disease
  • Nutrition and diet
  • Falls prevention
  • Medication management

24
Contact Information
  • Nancy L. Wilson
  • Huffington Center on Aging
  • Baylor College of Medicine
  • One Baylor Plaza M-320
  • Houston, TX. 77030-3498
  • 713.798-3850
  • nwilson_at_bcm.edu

25
Key Issue Long Term Care and Funding
26
Access to Needed Services
27
Access to Needed Services Advocacy Message
  • Support efforts that promote coordination
  • Between state and local levels
  • Between public and private sectors

28
Availability of Affordable Services
  • Inadequate supply to meet the demand
  • Transportation
  • Home and personal care assistance
  • Affordable housing and home repair
  • Respite
  • Mental health services

29
Availability of Affordable Services Advocacy
Messages
  • Redirect Medicaid funding away from
  • institutionally based care and toward home
  • and community-based long-term care
  • Support efforts that expand services
    through integration of existing services

30
Quality of Care
31
Quality of Care Advocacy Messages
  • Require higher standards for orientation and
    training of direct care workforce
  • Increase wages for direct care workers

32
Preparedness for Aging
  • Individual knowledge and action to prepare for a
    healthy old age
  • Family readiness to assume elder care
    responsibilities
  • Provider preparedness for the growing number and
    diversity of older adults
  • Community elder-friendliness
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