REIMBURSEMENT ISSUES - PowerPoint PPT Presentation

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REIMBURSEMENT ISSUES

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Chapter 38 Long-Term Care – PowerPoint PPT presentation

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Title: REIMBURSEMENT ISSUES


1

Chapter 38 Long-Term Care
2
Long-Term Care
  • Long-term care is defined by the American Nurses
    Association (ANA) as the provision of physical,
    psychologic, spiritual, social, and economic
    services to help people attain, maintain, and
    regain their optimum level of functioning.
  • Long-term care is provided in a variety of
    settings and offers a broad spectrum of services.

3
Setting for Long-Term Care
  • The Home
  • Most older adults live in a home setting, with
    only a small percentage of those aged 65 or older
    residing in an institutional setting.
  • Care of the older adult at home may involve a
    great deal of participation from loved ones.
  • It costs approximately half as much to care for
    an older adult at home as it would cost in a
    long-term care facility.
  • Home patients may require only minimal
    assistance, or they might receive complex medical
    therapies.

4
Figure 38-1
Family is important in helping to maintain
quality of life for the older adult.
5
Setting for Long-Term Care
  • Hospice
  • Provides services to patients and families as the
    end of life approaches.
  • The philosophy of maintaining comfort as death
    approaches is central to hospice care.
  • Provide nursing interventions to meet basic
    needs ADLs pain and symptom management and
    spiritual and psychosocial support for the
    patient, family, and significant others.
  • Care providers include CNAs, HHAs, LPN/LVNs, and
    RNs.

6
Setting for Long-Term Care
  • Adult Daycare
  • Community-based programs are designed to meet the
    needs of functionally or cognitively impaired
    adults through an individualized plan of care.
  • These structured, comprehensive programs provide
    a variety of services, including physical care,
    mental stimulation, socialization, assistance
    with health maintenance, and health referrals,
    during any part of the day but providing less
    than 24 hours care.
  • They are designed to serve adults who require
    supervision, social opportunities, or assistance
    due to a physical or cognitive impairment.

7
Figure 38-2
Available settings that provide long-term care
services.
8
Setting for Long-Term Care
  • Residential Care Settings
  • Primarily an older adult population, offering a
    wide variety of services
  • Assisted living
  • A type of residential care setting whereby the
    adult patient rents a small one-bedroom or
    studio-type apartment and can receive several
    personal care services
  • Continuing care retirement communities
  • Offer a complete range of housing and health care
    accommodations, from independent living to
    24-hour skilled nursing care

9
Setting for Long-Term Care
  • Institutional Settings
  • Subacute Unit
  • This type of institutional setting provides a
    less-expensive alternative to acute care when
    patients have high-acuity medical and nursing
    intervention needs.
  • Most are located in freestanding skilled nursing
    facilities others are former hospital units that
    have been reclassified to provide subacute care.
  • They provide a stronger rehabilitative focus and
    shorter length of stay than a long-term care
    facility.

10
Setting for Long-Term Care
  • Institutional Settings
  • Long-Term Care Facility
  • Most dominant setting for long-term care services
  • Commonly known as a nursing home or extended care
    facility
  • Provides services to primarily older adults
  • Provides 24-hour care to individuals who do not
    require inpatient hospital services but who do
    not have options for care at home or by other
    community agencies/services

11
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Because the long-term care facility becomes a
    home for the older adult, the adults are referred
    to as residents rather than as patients.
  • Most residents have more than one health disorder
    when they are admitted, and more than half have
    three or more medical diagnoses.

12
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • The most common disorders on admission are as
    follows
  • Cardiovascular disease, including hypertension
    and cerebrovascular accident
  • Mental and cognitive disorders, including
    depression, anxiety, and dementia
  • Endocrine disorders, including type 2 diabetes
    mellitus and hypothyroidism

13
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Two categories of residents
  • Short-term transferred from an acute care
    facility to which he or she had been admitted for
    an acute illness or worsening of a chronic
    illness admitted primarily for rehabilitation
    and expected to be discharged within 6 months
  • Long-term usually stays in the facility until he
    or she dies or is transferred to an acute care
    facility. Most residents are long term.

14
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Interdisciplinary setting
  • Health care professionals work together as an
    interdisciplinary team to meet the needs of the
    older adult.
  • Facility is managed by an administrator and has a
    director of nursing (DON).
  • These facilities are highly regulated by state
    and federal agencies to ensure quality services
    to a potentially vulnerable population.

15
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Restorative nursing care
  • Basic concepts of physical therapy for
    maintenance of functional mobility and physical
    activity care is provided by CNAs who have
    completed an educational program for restorative
    care
  • Omnibus Budget Reconciliation Act (OBRA)
  • Defines requirements for the quality of care
    given to residents of long-term care facilities

16
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Medicare
  • A federally funded national health insurance
    program in the United States for people over age
    65
  • Provide funding to long-term care facilities by
    adhering to the HCFA guidelines for reimbursement

17
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Medicaid
  • A federally funded, state-operated program of
    medical assistance to people with low incomes
  • A large source of revenue for the long-term care
    facility

18
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Several different types of nursing can be seen in
    this setting
  • Team nursing
  • Functional nursing
  • Total resident care
  • Combination of the above

19
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • The interdisciplinary functional assessment of
    the resident is the cornerstone of clinical
    practice.
  • Resident Assessment Instrument (RAI)
  • OBRA-prescribed method of resident assessment and
    care plan development
  • Consists of three parts
  • Minimum Data Set (MDS)
  • Resident Assessment Protocols (RAP)
  • Utilization Guidelines

20
Setting for Long-Term Care
  • Institutional Settings (continued)
  • Long-Term Care Facility
  • Documentation of the residents condition
    including vital signs and weights, is only
    required on a monthly basis.
  • The exception to this charting is a condition
    change, acute illness, or incident reporting,
    which must be documented at or soon after the
    time of occurrence.

21
Nursing Process
  • Nursing Diagnoses
  • Aspiration, risk for
  • Airway clearance, ineffective
  • Gas exchange, impaired
  • Cardiac output, decreased
  • Nutrition less than body requirements
  • Fluid volume, risk for deficient
  • Incontinence
  • Thought process, disturbed
  • Confusion, chronic

22
Nursing Process
  • Nursing Diagnoses (continued)
  • Self-care deficit
  • Injury, risk for
  • Mobility, impaired physical
  • Skin integrity, risk for impairment
  • Self-esteem, chronic low
  • Grieving
  • Anxiety
  • Social isolation
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