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Long Term Care
The Continuum of Care
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What is Long Term Care?
Health, mental health, social andresidential services provided to
temporarily or chronically disabled personover extended period of time
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Characteristics of LT Care
Physical or mental, temporary or permanent Need based on functional disabilities Promotes or maintains health and independence in
functional abilities and uality of life To enable us to die peacefully and !ith dignity "ultiple services and multiple professions spanning
broad spectrum
"ultifaceted #esigned around uniue needs of the individual $ervice can change over time
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Who needs LT Care
Chronic % permanent or indefinite period of time
&mpaired % a decrease in or loss of ability to
perform #isabled % short or long term' varies by age
group
(unctional ability % person)s ability to performthe basic activities of daily living
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*nderstanding demand for LT Care
Patient represent +mosaic of subsegments- of the population. /ften co
morbid conditions $ervices can be organi0ed across
dimensions of users
$ome users of LT care have significantdifferences from other users
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/rgani0ation of LT Care
&nformal organi0ation % most LT care isprovided by family and friends
1ach community may be differentregarding availability of services
&deal system % client oriented continuum
of care.
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What is Continuum of Care?
"atches resources to patient)s condition "onitors the client)s condition and changes
services as needs change Coordinates care across disciplines &ntegrates care in a range of settings 1nhances efficiency, reduces duplication,
streamlines patient flo! "aintains comprehensive record 2eeping
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Categories of Continuum of Care
1xtended care 3cute inpatient care 3mbulatory care Home care /utreach Wellness
HousingN/T14 Not all LT care clients get this full range of care.This is ideal that may offset or delay chronic illness.
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Providers of LT Care
Hospitals Nursing homes 5average costs 67,899 per
month: Home health agencies Hospices
3dult day service programs Housing organi0ations
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Types of LT Care $ervices5$ource4 http4;;!!!.medicare.gov;LongTermCare;$tatic;Community$ervices.asp
Help with activities
of daily livingHelp with additional
servicesHelp with care
needsRange of costs
Community-BasedServices
<es <es No Lo! to medium
Home Health Care <es <es <es Lo! to high
In-Law Apartments <es <es <es Lo! to high
Housing for Aging
and Disaled
Individuals
<es <es No Lo! to high
Board and CareHomes
<es <es <es Lo! to high
Assisted Living <es <es <es "edium to high
Continuing CareRetirement
Communities
<es <es <es High
!ursing Homes <es <es <es High
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Paying for LT Care
Nursing home care represents approximately => ofpersonal health care expenditures
Home health care about > of expenditures though this
is trending higher $ince LT care is provided mostly by family and friends,
these figures don)t represent full cost "edicare, "edicaid cover much of the cost
/ut of poc2et costs for LT care are significant Little private insurance currently pays for LT care though
incentives have been implemented to cover that area
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How we pay for LT Care
Long Term care insurance % only about @9> ofLT care recipients have this coverage
*sing personal funds % method typically usedfirst until funds run out
"edicare % only provides short term percentageof LT care 5does not include custodial care:"edicare covers @99> cost for first @99 days Provides =9> costs for next =9 days
Provides no reimbursement for subseuent "edicaid % once income eligibility is met, pays
for most of the cost of LT care
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"edicaid $pend #o!n %
1xempt 3ssets "edicaid eligibility based on income Pays for s2illed care and custodial care $ome exemptions apply
*p to 6,999 in cash assets Home, no matter the value Personal belongings /ne car or truc2
Aurial spaces *p to 6@,899 designated as burial fund for applicant and spouse Balue of life insurance if less than 6@,899 5other!ise, must
surrender value in excess of amount up to cost of care:
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"edicaid $pend #o!n Nonexempt
3ssets 3ll cash assets above 6,999 Certificates of deposit $toc2s, bonds, mutual funds
Land contracts or mortgages for real estate sold *.$. $avings bonds "ost &3s Nursing home accounts Prepaid funeral contracts issued in Nevada "ost trusts eal estate other than primary residence "ore than @ car or truc2 Aoats or recreational vehicles
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Detting around the $pend #o!n
process &$ allo!s 6@@,999 gift tax per child, but this does not
apply to "edicaid and gifts over 67,899 E years prior tocare !ill result in loss of eligibility until full gift costs are
met. #ivision of assets
3t home spouse is able to 2eep F of all assets up to 6G,999 The other half must be spent do!n for care
$pousal support4 3t home spouse is allo!ed to ma2e upto 6@,8@ per month in income. &f income does not meetthat much, allo!ed to use other LTC spouse income up tothat amount. 5Court orders can increase this amount:
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"ental Health Care
The (orgotten Population
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&ncidence and Prevalence of "H
#isorders in *.$. E979> experience some psychiatric disorder in
their lifetime
@> of children ages G % @I receive "Hservices in a year an2s nd in terms of burden of disease in
established economies
&n general, @G> of population have mentaldisorder alone, E> have dual diagnosis, and >have addictive disorder
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"H #escriptives
"ost people !ith Psych disorders experience onset priorto age E=
"en "ore common among men 5mostly alcohol abuse and antisocialpersonality disorder or +Cochran)s $yndrome-: Phobia and alcohol abuse most common Cognitive impairment most common among those 8 and older
Women $omati0ation disorders 5somati0ation of symptoms mas2ing underlying
psych disorder:, obsessive compulsive, and depressive disorder ates for "H disorders drop after age 78 5except for
cognitive disorders:
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1arly Bie!s on "ental &llness
Aased primarily on values. 3berrant behaviorcould be vie!ed as demonic or evil spirits.
Lunatic hospitals began in 1li0abethan 1ngland5primarily to protect society from misfits: "ental illness began as diagnosis during
scientific revolution in Dermany
(reud changed the !ay !e vie!ed mentalillness and related it to unconsciousdevelopment difficulties
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"ental &llness 3ttitudes in *.$.
#uring 9th century, there has been increasingacceptance of pluralistic determinants of mentalillness
Dreater reliance on the disease concept Aetter understanding of the role of personality
development from social or cultural influences $till an underlying current of the +1urocentric-
perspective % abnormal or deviant behavior as areflection of values, norms and belief systems ofthe mainstream
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ecent *.$. "ental Health Policy
#evelopment of psychopharmacology in the @G89s "ental etardation (acilities and Community "ental
Health Centers Constructions 3ct of @G7 built more
mental health centers "ental Health $ystem 3ct proposed by Pres. Carter
!ould have provided better funding but !as notimplemented by eagan or Aush the (irst.
1xpansion of health insurance to cover treatment5generally significantly less coverage than other healthinsurance:
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"H #elivery $ystem
@G88=9, most services provided in state orcounty mental hospitals
Public and private sector health care Public sector primarily paid by "edicare or "edicaid
"aJor decline in state mental health hospitals
/utpatient services account for nearly I8> of"H services
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"ental Health and the (uture
Dreater reliance on psychopharmacology #ebate of "H vs. Balues !ill continue
&s "ental &llness an excuse? 3re all of our personality problems attributable to mental illness?
elationship of mental illness and homelessness 5approximately 98> of homeless have mental illness: *p to 89> have cooccurring mental illnesses and substance use
disorders. Their symptoms are often active and untreated, thus difficult to obtain
basic needs for food, shelter and safety and causing distress to those
!ho observe them. They are impoverished, and many are not receiving benefits for !hich
they may be eligible.
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"ental &llness and Las Begas
/vercro!ding ofemergency rooms bymentally ill
$hortage of mental healthfacilities andprofessionals
&mplementation of Legal999 to transport and
hold mentally ill Nevada ran2s nd nationally in suicide
Don’t feed
the
homeless! It’s
the law!