Chapter 3 Nursing Care Facilities LongTerm Care Managing

Chapter 3. Nursing Care Facilities Long-Term Care: Managing Across the Continuum (Second Edition) 1

Learning Objectives 1. Define and describe nursing facilities 2. Identify sources of financing for nursing facilities 3. Identify and describe regulations affecting nursing facilities 4. Identify and discuss ethical issues affecting nursing facilities 5. Identify trends affecting nursing facilities into the future and the impact of those trends 2

What is a Nursing Facility? Includes: ü Facilities licensed by the states offering room, board, nursing care and some therapies ü Those certified by Medicare as Skilled Nursing Facilities (SNF) and what used to be called Intermediate Care Facilities (ICF) 3

How Nursing Facilities Developed ü Early charity-based forms of care ü Poor public image ü Increased regulation ü Significant improvement ü Still under scrutiny 4

Philosophy of Care ü Medical vs. Social Model § “care vs. cure” ü Multidisciplinary approach ü Family involvement 5

Ownership of Nursing Facilities ü Largely for-profit (2/3+) ü Nonprofit (1/4+) ü Few government ü Growth in multi-facility chains (55%) 6

Services Provided ü Nursing ü Physical Therapy ü Occupational Therapy ü Speech Therapy ü Medical/Dental ü Medications ü Laboratory & X-Ray ü Room & Board 7

Special Care Units By diagnosis or disability: üAlzheimer’s Disease üMental Health & Retardation üBrain Injury üAIDS By age: üPediatric üYoung adult 8

Those Served ü Elderly - over 90% ü Female - three-quarters ü Both physical and mental disabilities - two-fifths have dementia - one-third with depression ü Activities of daily living (ADLs) 9

Activities of Daily Living (ADLs) • Bathing • Dressing • Eating • Toileting • Transferring [Average resident needs help with 4 ADLs] 10

Market Forces ü Need-driven admissions ü Family & physician initiated admissions ü Location relative to family ü Availability of alternatives 11

Regulations Purpose of regulations: 1. Care is safe and of high quality 2. Care is not overly expensive 3. Services are uniformly accessible 4. Rights of workers are protected 12

Types of Regulations ü Affecting residents ü Affecting employees ü Affecting building construction & safety 13

Financing Nursing Facilities Reimbursement sources: üMedicaid - 46% üMedicare - 12% üPrivate pay and other sources – the remainder 14

Medicare Coverage Restrictions: ü Covers only skilled nursing care ü Must follow 3 -day hospital stay ü Limited to 100 days per “benefit period” ü Requires co-payment for days 21 - 100 15

Staffing & Work Force ü Nursing ü Certified Nurse Aides (CNAs) ü Medical coverage ü Other professional staff - Often on contract basis 16

Legal & Ethical Issues Responsibility to: üProtect residents’ rights üAct ethically 17

Types of Legal/Ethical Issues Day-to-day issues: • Autonomy (choice) • Privacy End-of-life issues: • Advance directives (living will, durable power of attorney) • Patient Self-Determination Act • Cognitive ability? 18

Management Qualifications ü Licensed by the states ü Many different state regulations re: § Minimum education § Hands-on experience § Continuing education ü NAB 19

Management Challenges & Opportunities ü Balancing cost and quality ü Integration of differing levels of service ü Coordination with other facilities & organizations 20

Significant Trends üRising acuity levels üManaged care üProspective payment üPrivate insurance üRising liability costs üConsumer choice 21

Summary Nursing care facilities have a long history, but are evolving, as is the overall system. They have gone from being the dominant form of long-term care to one of many provider types. 22