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There are a few different types of long-term facilities. There is an “aging in place” and this is made to meet each patient’s needs. This is where the needs will change and the center accepts that. “The idea is that long-term care recipients should live in a stable, homelike setting that is familiar and comfortable, in which services can be provided.” (Pratt, 2016 p.25). There are multilevel facilities. These are similar to “aging in place”, but each level has a different amount a service. If someone can’t do dishes she may live on level one. If someone cannot do their own laundry they may live on level two. If someone needs help with everything, they may live on a third level. There is a neat thing called Adult Day Care. This is used for family members to be able to drop of their loved ones and they would be watched by a skilled employee! This lets the primary caregiver to have a break for a small amount of time.
There are several reasons as to why there is a rapid growth with long-term care. The first one is there has been a huge amount of births in the population particularly from the “baby boomers”, and the “baby boomers” are now in the higher end of age. Health costs, current machinery, and technicians, plus cost of running these machines all play a role as to why costs in long-term care is rising. There are more health care professionals, and many people rely on medications to survive. My grandmother is on over thirty different prescriptions for things like diabetes, high blood pressure, and heart problems. Many of the elderly have one of these problems. The rising cost of insurance also plays a role in the cost and there were more malpractice suits. Many people are also living longer, and by living longer, they incur more health expenses. Long-term care can range from a nursing home to help with in home and day to day activities.
There are many strengths in long term care. The first is that long term care always changes to meet the need of its patients. “For example, not only are there skilled nursing facilities, but within them, there are specialized units to meet the needs of its residents such as those with Alzheimer’s, Parkinson’s, and other forms of dementia.” (Bboaz, 2010 p.2). When someone needs more care there are other facilities to work with. When my grandmother has a diabetic shock and lost her memory, she needed to regain that, and how to check her blood sugars. She had a nurse who came to her and retaught her how to check her blood sugars, and what her insulins would look like. When she was finally cleared, she was then on her own. This would have been long-term if she wanted to keep it, but she disagreed with it. Currently, there are more centers that change with the residents.
There are also a few weaknesses. Long term care used a reimbursement-driven system. This means that some patients have to pay for services and wait to be reimbursed from their insurance or another source. “Instead of focusing primarily on the needs of individual consumers, the system focuses on payment availability, resulting in gaps in services for many consumers.” (Pratt, 2016 p.27). This means that some people have to stay at home and receive services, while some may have to move into a facility to get help with long term care services. Secondly, long-term care services are not available to everyone. This particularly has to do with the first weakness. There may be issues with staffing, or a lack of funds available. This makes it a challenge for the whole system, because there may be services available but they may not be easily accessed.
We have a broken, and inept system because nothing is set in stone, and there are some things that should be specified but are not. There are various payers, provides, and very few regulations for this system. Every provider, and payer have their own set of rules that must be followed. Many people who are studying medical tend to go work for an acute system. This creates a shortage of those available to work with long-term care residents. There is also a poor public image of long-term care. There are a few situations that get promoted and give all facilities a bad name. There are many reports of poor care being provided. I had heard at the nursing home my sister worked at, that an employee became agitated and punched a resident. While this was completely uncalled for, the resident was moved to a new facility. The employee denied all allegations, despite the bruised face, his family moved him somewhere they viewed safer.
For a different class, I got to meet with a resident at a nursing home to discuss concerns with healthcare. While I was there I was given a small scale tour. In this particular home, the residents can leave whenever they want, but lived in this nursing home in their own apartments. There were many activities, like music, and animals! When I was there the residents got to watch chick eggs hatch, and then watch a caterpillar change to a butterfly! Another great strength is that many residents are allowed to play bingo, or sing! This helps with not only residents’ health skills, but also ensures they remember their social skills, and have fun. Many family members provide the long-term care by having the patient live with them. For example, a child may move their parent into the same household to better provide for their needs.
There are a few provisions that affect long-term care. One of the goals of the Affordable Care Ace was that it wanted to increase clarity in nursing homes. The purpose of this is to improve the quality of life, and to prevent abuse and neglect for residents. Pay-for-performance is an arrangement that gives an incentive to those who reach great outcomes for patients. This is popular with Medicare, and Medicaid. “Studies have shown that financial incentive plans such as P4P can improve quality in management of chronic diseases, such as diabetes and heart disease.” (Pratt, 2016 p.43).
The Medicaid Expansion, that consists of both federal and state funding granted health coverage to many people. States were allowed to set the income requirements. It covered people up to 133 percent of the poverty level. Asset Recovery is when a state allows Medicaid to recover costs by claiming assets. The Medicare advantage plan is a plan that gave part A and part B. It lowered premiums, increased enrollees and this was exactly what was wanted.
“Accessibility to services depends on several components, including availability of those services, financial coverage, physical logistics (location, style, etc.), and the degree of complexity of the consumer’s needs.” (Pratt, 2016 p.61). You want the program to be easily accessible, and user friendly. Single facility caring is encouraged, and should not be very restrictive. A center should balance family, residents, and professional staff. Most importantly, it should meet the patients’ needs, even if those needs should change.
A resident does have rights. They are encouraged to have a plan in place for plan of care, and family should be included in making these decisions. “As members of the care team, they should accept their share of accountability for the success of the team’s efforts. In doing so, they would find incentives to do their utmost to cooperate with—and support—the care plan, thus greatly improving the likelihood of success of that plan.” (Pratt, 2016 p.59). The resident should not be harmed. Actions that could harm or cause a resident to be unable to function are not allowed. A resident may have to stop smoking, drinking or follow a recommended diet. There should be a contribution to ensure that one can afford the long-term care that is needed. “Accepting some degree of financial responsibility, no matter how small, also gives consumers an incentive to use the system wisely and appropriately.” (Pratt, 2016 p.60). It is recommended that there be a sliding fee scale for those who need it. Otherwise some sort of program that will not just deny someone, but that can meet what the resident can pay. This can eliminate financial issues.
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