geriatric interclerkship locations of care: living arrangements
DESCRIPTION
Geriatric Interclerkship Locations of Care: Living Arrangements. Sarah McGee MD, MPH Associate Professor of Medicine Director of Education Division of Geriatric Medicine University of Massachusetts April 30, 2012. Where do you want to live?. Independent Living. Dependent Living. - PowerPoint PPT PresentationTRANSCRIPT
Geriatric InterclerkshipLocations of Care: Living
Arrangements
Sarah McGee MD, MPHAssociate Professor of Medicine
Director of Education Division of Geriatric MedicineUniversity of Massachusetts
April 30, 2012
Where do you want to live?
Independent Living
Dependent Living
We Imagine it Will Be Like…
We Imagine it Will Be Like…
What we see…
Patient needs Resources
ADLs Spouse/FamilyIADLs FriendsPhysicalCommunityEmotional ChurchSpiritual Financial
Determinants of location of care and living arrangements
How to evaluate patients for “best fit” of various living
arrangements
• Functional Assessment• Quality of life and quality of care• Safety versus autonomy• Getting to know the person, not
just the patient/disease• What is most important to them?• Insurance/cost
Independent Living
Own home or apartment Congregate or senior housing
may have: help with some household upkeep congregate meals activities staff
specific home health services available through outside agencies
Naturally Occurring Retirement Communities (NORC)
Assisted Living
• “A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with ADLs are available as needed to people who still live on their own in a residential facility”
– Center for Medicare and Medicaid Services
2007 975,000 residents 38,000 facilities (25-120 units)
2009 $3022/mo ave cost for pvt unit ($10K-$50K/yr range)
Assisted Living Facilities of America National Center for Assisted Living
Assisted Living
Assisted Living
Means different things in different regions or states
Lack of consensus on what is the best model, social vs medical
Types of patientstoo frail to stay at homemay have mild to moderate dementiaoften required to toilet themselves and do some of own ADLs
Most do not have 24 hour nursing on site One hour of personal care/day
Assisted Living
Half the price of a nursing home, but what services are you getting?
Liability is hurting development of the industry
Much less regulation than nursing homes right now
Aging in place is a big issue
Most Assisted Living Facilities will provide:
•Health care management and monitoring •Help with activities of daily living such as bathing, dressing, and eating •Housekeeping and laundry •Medication reminders and/or help with medications •Recreational and social activities •Security •Transportation•Emergency call system in each unit
Assisted Living
Aging Together
201015,622 facilities (MA 429)1.66 million beds (MA 48,484)1.4 million residentsAv LOS 875 daysAv cost $198/day
(Alaska $687, MA $329)
%≥65 yo in NH? www.longtermcare.gov www.statehealthfacts.org
Long Term Care in Nursing Homes
Long Term Care in Nursing Homes
How do you qualify for nursing home care?
How do you end up in a nursing home?
Have we always hadnursing homes?
4.18.0
8.1
34.7
16.2
9.2
19.1
0.6
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Percent of existing facilities originally
constructed
Priorto1900
1900-1950
1950-1960
1960-1970
1970-1980
1980-1990
1990-2000
2000+
Percent of NFs Original Construction by Decade
Long Term Care in Nursing Homes
Abuse in 1960s, 1970s led to
Reforms in 1980s (OBRA ’87) led to
Government regulation
Can Nursing Homes Be the Best Alternative?
Long Term Care in Nursing Homes
How is it changing?Can we make it a more positive
alternative?Resident-centered care
Geriatrics is a Team Sport
Interprofessional teams enhance the comprehensive care of complex patients
Teams are not hierarchicalEach person on the team is valued for
his or her unique role and what they bring to the care of the person
Teams include informal caregivers (family, friends)
Team Members
CNA (certified nursing assistant)
physical therapist dietician chaplain primary care
provider (MD, NP, PA)
psychologist activity director registered nurse occupational
therapist speech therapist social worker
Geriatric Care TeamsRegardless of the Setting…
Resources
• Geriatric Interdisciplinary Team Training– http://www.umassd.edu/gitt/
• Medicare and Medicaid– www.Medicare.gov – www.longtermcare.gov– www.cms.gov
• Assisted Living Facilities of America– www.alfa.org
• National Center for Assisted Living – www.ncal.org
• National Council on the Aging (NCOA)– www.healthyagingprograms.org