Long Term Care Continuum

A.C. is a 79-year-old man living in a long-term care facility. He has had multiple medical diagnoses, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and stroke. He is bedridden and receiving enteral tube feedings. He has chronic diarrhea thought to be related to his tube feedings. He receives digoxin (Lanoxin) and furosemide (Lasix) to manage his CHF.

Hello Dr. Ullom, majority of the long term care facilities are under staffed. There is usually one registered nurse in charge to manage a 240 bed facility, with LPN's  and nursing assistance. I feel that these patients would benefit from having one RN to every six -eight patients with a nursing assistance. Not only would this benefit the patient but the nurse as well. Patient are placed in long term care facility with a certain problem, but ends up with additional condition such as UTI, MRSA, pressure ulcers, and etc. These issues are related to poor care they receive because of unstaffing. I'm not placing blame on the LPN or nursing assistance, but with a RN and low nurse to patient ratio, they will receive better care.

Roles of Administrator and Case Managers in this facility vs. roles of Administrator and Case Manager in other facilities

Hospice is a process to end-of-life care and a kind of support facility for terminally ill patients. It provides comforting care, patient-centered care and related services. Comforting care relieves discomfort without improving the patient’s condition or curing his illness. Hospice is extended in a healthcare facility or at home. Its objective is to provide compassionate, emotional, and spiritual care for the dying patient.

Long-term care is a variety of services that includes medical and non-medical care to people who have a chronic illness or disability. Long-term care helps meet health or personal needs. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, eating, and using the bathroom. Long-term care can be provided at home, in the community, in assisted living or in nursing homes. Long-term care can be given at any age depending on

Throughout Unit 6 we reviewed the continuum of care in long-term care facilities and its many aspects. The continuum of care, also referred to as the delivery system of health care, is best defined as a full range of long-term care services increasing in level of acuity and complexity from one end to the other (PowerPoint). This delivery system is comprised of three substantial components. These components are the informal system, community based care, and the institutional system.

Imagine that you are a patient in an hospital in Ontario - you have undergone acute care and are now ready to enter a Long-term care (LTC) facility for additional care. Now imagine that you have entered a complex maze, like the Waterloo County County Corn Maze, only much trickier. Why?

Long-term care healthcare delivery will be a great/popular option for many of these senior citizens. The long-term care healthcare delivery system falls within the continuum of care. The continuum of care is a series of heath care services that are provided to a great number of older adults who are in need of them throughout the course of their life/older life. The care ranges from: personal care, custodial care, restorative care, skill nursing care, and sub acute care (Shi & Singh, 2012). Different providers work together within the continuum to provide the right care to those in need. The continuum of care, as stated in Long Term Care: Managing Across the Continuum, is “comprehensive, integrated, and client-oriented”(Pratt, 2010). All the services offered should be client-based and cater to the client’s needs and suitable care. The client should be able to obtain services when it is needed from the provider, making it comprehensive. All the different long-term care providers should be interconnected between one another, because their goal is all the same, which is to care for the client’s needs. The continuum of care consists of: nursing facilities, sub acute care, assisted living, residential care, elderly housing, and a variety of community-based services (Pratt, 2010). All these different providers work together to care for the individuals within the health care industry, creating the continuum and making it integrated. As the future progresses and a great amount of

Acute care is short-term care centered around diagnosing and treating illness or injury. Acute curative services respond to life-threatening emergencies, acute episodes of chronic illnesses, and any health problem that requires immediate, time-sensitive response. Acute care can include emergency care, trauma care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization (Yarbrough & Erwin, 2015). Long-term care meets the non-medical care needs of people that need assistance with activities of daily living due to a medical condition. Activities of daily living may include bathing, dressing, eating, housework, or meal prep (Yarbrough & Erwin, 2015).

The transitioning to a long-term care facility can be scary and stressful for residents, and some may find it difficult to adjust. I agree with you that the enabler role can be of great assistance to the resident and their families to help reduce the stress of entering a new facility. The frequent visits and encouragement from the social worker will let both the patient and their family know they will not be alone during this transition. Have you ever had to utilize the services of a social worker? In my current position, I come into contact with patients who require the support of a social worker typically for help with resources that they need to attain. Being a social worker is a demanding position since they are there to assist the patient,

The long-term care system consists of an integrated continuum of many institutional and non-institutional providers who deliver extended care when needed. Long-term care providers distribute a variety of care to individuals with chronic, mobility and/or cognitive impairments/limitations. These providers include: nursing facilities, subacute care, assisted living, residential care, elderly housing options and community based adult services (CBAS) (Pratt, 2010). CBAS is broken down into subdivisions, which include: home health care, hospice care, adult day care and adult day health care (ADHC). ADHC’s falls under the category of non-institutional care, allowing individuals to be independent, stay within their community, live at home, and age in place, while being of high quality and low cost. The ultimate goal of ADHC’s is to keep individuals out of hospitals and nursing homes (institutional care), and allow them to live their life comfortably, independently and in their households with their loved ones (Alteras, 2007).

The continuum of institutional long-term care is for patients whose needs are not adequately met in a more community-based setting. It is for individuals who need more dependency. There are two ends of the continuum of institutional long-term care spectrum. On the one end there are the individuals that may only need basic personal or custodial care (Shi & Singh, 2015, p. 399). An example of personal and custodial care can include help with walking, bladder training, or just helping with bathing. On the other end there are the individuals that may need more round the clock care with nursing or specialized services along with the basic needs (Shi & Singh, 2015, p. 399).

By 2060, ¼ of the United States population will be 65 years and older. To put this in a numbers perspective, the population of Americans 65 and older will double from around 46 million today to 98 million by 2060 (Mather, Jacobsen, & Pollard, 2015). With direct correlation to population trends, the number of individuals using long term care services will also double from 13 million in 2000, to 27 million people in 2050. 35% of the population 65 and plus will eventually enter a nursing home (Friedman, 2015). The average annual rate for a private room in a nursing home is around $90,000 (Effros, Hsu, & Levy- Storms 2017). These high costs place an significantly large burden on the older population who must

Long term health care and end of life care is a reality that is usually inevitable. “Research shows that at least 70 percent of people over 65 will need long term care services at some point in their lifetime” (Centers for Medicare and Medicaid Services, 2012). There are many decisions that people must make in the event. Don and Mary are a married couple who have to make that decision. Don and Mary served together in the military. After the military they both made careers for themselves. Now they are retired and enjoying life traveling and spending time with family. However, now Mary has developed a disease called Alzheimer’s that has left her with a limited memory and sundowner’s syndrome.

Long term or chronic care includes a much broader range of services than acute care, emphasizing social as care well as medical services. While acute care is usually confined to specialty providers, the providers of long term care are more wide ranging. They include traditional medical providers such as physicians and hospitals, formal community caregivers such as home care agencies, facility providers such as nursing homes and assisted living facilities, and informal caregivers such as friends or family members.