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

2 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

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

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

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

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

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

8 Special Care Units By diagnosis or disability: Alzheimer’s Disease Mental Health & Retardation Brain Injury AIDS By age: Pediatric Young adult

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

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

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

12 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

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

14 Financing Nursing Facilities Reimbursement sources: Medicaid - 46% Medicare - 12% Private pay and other sources – the remainder

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

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

17 Legal & Ethical Issues Responsibility to: Protect residents’ rights Act ethically

18 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?

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

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

21 Significant Trends Rising acuity levels Managed care Prospective payment Private insurance Rising liability costs Consumer choice

22 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.