Discussion Topic The Continuum Of Care in Nursing Homes

Introduction

 Nursing facilities used to be called “nursing homes”. Discussion Topic The Continuum Of Care in Nursing Homes

 They include those certified by Medicare as Skilled Nursing Facilities (SNF) and what used to be called Intermediate Care Facilities (ICF), the primary difference being the amount of nursing care provided.

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How nursing facilities developed

 Nursing homes grew out of early charity-based forms of care for people without family to care for them or other sources of help.

 They came into their own when the federal government became involved with assisting the needy with passage of the Social Security Act in 1935 and the Medicare and Medicaid amendments in 1965.

 They suffered through a lingering poor public image. Philosophy of care

 Medical vs. Social Model – Nursing facilities find themselves sitting solidly astride the line between acute care and long-term care.

 A Multidisciplinary Approach – They utilize a combination of medical, social, residential, and other allied professionals to provide needed services, blending those disciplinary specialties to develop and implement care plans for individual consumers.

 Family Involvement – Another distinguishing characteristic of long-term care in general, and nursing facilities in particular, is the degree to which family members are involved in the care of the primary consumer.

Ownership of Nursing Facilities

 More for-profit than nonprofit

 More than half owned by national multi-facility chains

Occupancy

 The occupancy rate for nursing facilities has declined from a high of 89.0 percent in 2007 to 86.0 percent to 2013.

 This may be due to competition from community-based services.

Services Provided

 Nursing

 Physical therapy

 Occupational therapy

 Speech therapy

 Medical and dental services

 Medications

 Laboratory and x-ray services as needed.

Special Care Units – many facilities created special care units to meet the needs of a wider variety of residents. They may be:

 Based on a Specific Diagnosis or Disability

 Alzheimer’s Disease

 Mental Health & Mental Retardation

 Brain Injury

 AIDS

 Based on Age

 Pediatric

 Young Adults

Consumers Served

 By age:

 Mostly elderly

 By care Needs:

 Admitted because of functional disabilities, resulting from a number of medical or physical conditions

 May include both physical and mental disabilities

 By gender Mix:

 Three-quarters women

Market Forces Impacting Nursing Facilities

 Need-Driven Vs. Choice-Driven Admissions – most residents do not choose to be admitted, but must be due to their conditions.

 Family/Physician Initiated Admissions – admission is usually not at the request of the resident but by family or a family physician.

 Hospital Readmissions – under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit “excessive” numbers of Medicare patients within 30 days of discharge now face significant penalties.

 Location Relative to the Resident’s Family – facilities are often chosen so the resident can be close to family members.

 Alternative Types of Care (or Lack of) – some are admitted to nursing facilities because of a lack of other alternatives (e.g., community-based care).

Regulations

There are three primary categories of regulations:

 Affecting Residents – Regulations concerning care and quality of care

 Affecting Employees – regulations protecting employees from unfair treatment

 Affecting Building Construction and Safety – regulations assuring proper construction and maintenance of facilities.

Financing Nursing Facilities

 Medicaid is the largest source (two-thirds)

 It covers the medically indigent

 Medicare is the next largest

 It provides limited coverage

 Other sources include insurance and out-of-pocket Staffing/Human Resource Issues

 Nature of the Work Force – nursing facilities utilize a staffing mix that combines both highly trained and relatively untrained staff.

 Must provide both clinical and non-clinical care

 Government regulations, particularly OBRA and Medicare, specify the numbers of staff on duty on each work shift and the mix of personnel categories making up that staff. Discussion Topic The Continuum Of Care in Nursing Homes

 Nursing

 Certified Nurse Aides

 Medical Coverage

 Other Specialists

 Recruitment/Turnover Issues

 Aging of the workforce – the population group available to provide care is getting smaller due to aging

 Relatively low pay – the amount allowed by Medicaid (the primary payment source) is not adequate

 Competition from other sectors – staff can make more working elsewhere, even in fast-food restaurants

 Day-To-Day Quality of Life Issues. Discussion Topic The Continuum Of Care in Nursing Homes