Chapter 3. Nursing Care Facilities

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

2. Learning Objectives • Define and describe nursing facilities • Identify sources of financing for nursing facilities • Identify and describe regulations affecting nursing facilities • Identify and discuss ethical issues affecting nursing facilities • 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: • Care is safe and of high quality • Care is not overly expensive • Services are uniformly accessible • 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 21 - 100

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.