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HA150 Exam 2
| Term | Definition |
|---|---|
| LTC | Not all old people need LTC because they don't need assistance LTC is defined by a need for custodial (ADLs/IADLs) and/or skilled care (therapy, RN, etc.) |
| ADL in NH residents | Bathing - 96% Dressing - 91% Toileting - 87% Transferring - 80% Eating - 56% |
| ADL in Assisted Living residents | Bathing - 68% Dressing - 47% Toileting - 34% Transferring - 25% Eating - 19% |
| Strengths of LTC system | Responds to changing needs of population Dedication of caregivers (not paid well) Develop innovative types of care Increase focus on customer |
| Weakness of LTC system | Reimbursement driven system Inequitable distribution of services Fragmented system Poor public image Overshadowed by acute care systems |
| PAC | Immediate care of a person post-surgery Mostly take place in nursing and rehab facilities (80% SNFs and 20% IRFs) The major payer is MC (thru DRG bundling w/ hospital) |
| ALF | Senior LTC alternative for more assistance than retirement communities but no medical or nursing care 60% come from home Typically 86 year old mobile woman needing help w/ 2 ADLs 34% discharged to NF, 30% die, 36% move back home or to diff ALF |
| Hospice | Care for ppl near end of life w/ focus on fulfilling phy/spiritual needs Mostly happens at home tho most die in hospital Handles terminal illnesses for patients that confirmed by a physician to have <6 months Patients agree to not seek treatments |
| Hospice | Underutilized bc ppl r afraid of dealing with death-related issues, including end-of-life care Also not a money maker from a business perspective |
| Nursing home | Offers PAC & LTC Residents that cannot perform ADLs & need skilled care 85y/o caucasian female w/ avg LOS of 892 days PAC after hospital covered by MC for 100 days (90 via DRG bundling) After residents pay OOP -> low income & MA pays (SPEND DOWN) |
| DRG (diagnosis related group) | Reimbursement received by hospital (and NH when considering DRG bundling) Based on diagnosis of the patient, Hospital/nursing home allocate resources efficiently so they can keep profits |
| PDPM (patient driven payment model) | MC changed SNF reimbursement from RUG-IV to PDPM Based on ICD-10 codes, no payment based on therapy mins Accurate payment amount based on individual needs rather than categories, prov additional resources for high need residents & fewer MDS assessments |
| PDGM (patient driven grouping model) | PDPM but for HHC Old 60-day episode model replaced by PDGM so HHC couldn’t get more money based on volume of care (more HHC visits doesn't equate to more $) Payment adjustments based on patient complexity |
| DRG-building | Related to quality of SNF care bc hospital get to choose which SNF they partner w/ In order to capilize on profit, hospitals choose the best SNFs |
| Inspection deficiency in NH | Top inspection deficiency is accident envir In 2019, 92.3% of facilities had at least 1 deficient w/ avg being 7 Only 18% of NH had deficiency that caused harm or jeopardized patient safety More deficiencies doesn't necessarily mean lower quality |
| Home health care | Homebound patients w/ skilled care Paid by MC Diff than HC since HC is custodial care paid OOP Needs more funding so ppl don’t end up in hospitals and have to use MC or MA C decr and A & Q incr |
| MDS (Minimum data set) & OASIS (Outcome Assessment and Information Set) | MDS determines pay for NH and OASIS determines pay for HHC Assessment tools (questionaires) that help determine quality and reimbursement lvls Medicare.gov and Care compare websites |
| OBRA (Omnibus Budget Reconciliation Act) | Omnibus Budget Reconciliation Act Nursing reform act enacted minimum data sets Registered Nurse Assessment Coordinators (RNACs) fill out the MDS, which controls the pay for the nursing home & measures quality |
| Adult day services | Cognitively impaired adults Home -> ADS -> Home 2 models: Social day services - care services; Adult medical day services which offer custodial and skilled care. Growing demand bc of aging population |
| Social day services | ADS model that offers only care services |
| Adult medical day services | ADS that offers custodial and skilled care |
| PACE/LIFE | System of managed care serving frail elderly (eligible for NH) Not every state has this program bc they aren’t profitable; everyone is using resources/treatments in the risk pool; no where to spread risk |
| Direct care workers | Hands-on care done by paraprofessional (non-licensed) Typically a 25-44 y/o women of color Work part time, receiving no benefits, $14.51 nationally & $15 in PA Need 75 hrs of training and 12 hrs in service for nursing homes No training for ALF or HC |
| Direct care workers | Called differently depending on location Nursing Home - Certified Nursing Assistant Home Care - Certified Home Health Aide, Home Care Aide or Homemaker Assisted Living - Personal Care Attendant Adult Day Service - Activities Assistant |
| Crisis in LTC workforce | Older demographic needing LTC is incr, while women 25-44 is same @ orgz lvl; respect, empowerment & supervision needs change Creates turnover -> incr $, decr Q & more clients for DCW to pickup ACA calls for addressing issue but nothing has happened |
| Spend down | Person goes to a hospital (surgery) -> SNF (PAC) covered under MC (DRG-bundling Once MC stops paying after 100 days, person goes to LTC paying OOP until low-income and MA covers DRG bundling is 90 days, MC covers PAC for 100 days |
| Acute care | Crisis oriented Sudden onset Responds to treatment High tech care |
| Long term care | LT/chronic illness Gradual onsent Medical management Low tech, high touch care |
| CCRC (Continuing Care Retirement Committee) | Consists of independent, assisted, and nursing care. Housing market is crucial as people sell houses to move into CCRC Higher housing market, higher cost of CCRC is |
| CCRC (Continuing Care Retirement Committee) | Regulated by Department of Health, Department of Human Services, and Department of Insurance (as you pay monthly premium like insurance) Diff than SNF regulated by Dept of Health and ALF by Depart of Human Services |
| Similarity and diff b/w CCRC Life Care contract, managed care plan, and PACE | Similarity - capitation / forms of PPS Diff -> risk pools (PACE, managed, and CCRC highest to lowest risk) |
| LNHA (Licensed nursing home administrators) | Job w/ following req Bachelor’s degree (usually), completed AIT (administrator in training, 1000 hours) program, State Licensing Board exam, and Continuing education |
| JCAHO | Joint commission on Accreditation of Healthcare Organizations Ensure high quality patient care and safety |
| BBA | Balanced Budget Act - made PACE/LIFE programs a medicare benefit in 1997 |
| LIFE | Living independently for elders, PACE program in PA |
| PACE | Program of All-Inclusive Care for the Elderly |
| ADL | Activities of daily living (toileting, transferring, dressing, eating, bathing) |
| IADL | Instrumental activities of daily living (money management, housekeeping, grocery shopping) |
| IRF | Inpatient rehab facility, 20% of nursing homes |
| RNAC | Registered Nurse Assessment Coordinators Fills out the MDS, which controls pay for the nursing home & measures quality (like OASIS for HHC) |
| OASIS | Outcome Assessment and Information Set - determines pay for HHC & measures quality |
| MDS | Minimum data set - under the OBRA 1987 (nursing home reform act), determines pay for nursing homes Registered Nurse Assessment Coordinators fills out MDS, which controls pay for the nursing home & measures quality (like OASIS for HHC) |
Created by:
phillipchristopherr