Chapter 3. Nursing Care Facilities

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Chapter 3. Nursing Care Facilities

• Long-Term Care Managing Across the Continuum
• (Second Edition)

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Learning Objectives

1. Define and describe nursing facilities
2. Identify sources of financing for nursing
   facilities
3. Identify and describe regulations affecting
   nursing facilities
4. Identify and discuss ethical issues affecting
   nursing facilities
5. Identify trends affecting nursing facilities into
   the future and the impact of those trends

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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)

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How Nursing Facilities Developed

• Early charity-based forms of care
• Poor public image
• Increased regulation
• Significant improvement
• Still under scrutiny

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Philosophy of Care

• Medical vs. Social Model
• care vs. cure
• Multidisciplinary approach
• Family involvement

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Ownership of Nursing Facilities

• Largely for-profit (2/3)
• Nonprofit (1/4)
• Few government
• Growth in multi-facility chains (55)

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Services Provided

• Nursing
• Physical Therapy
• Occupational Therapy
• Speech Therapy
• Medical/Dental
• Medications
• Laboratory X-Ray
• Room Board

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Special Care Units

• By diagnosis or disability
• Alzheimers Disease
• Mental Health Retardation
• Brain Injury
• AIDS
• By age
• Pediatric
• Young adult

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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)

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Activities of Daily Living (ADLs)

• Bathing
• Dressing
• Eating
• Toileting
• Transferring

Average resident needs help with 4 ADLs
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Market Forces

• Need-driven admissions
• Family physician initiated admissions
• Location relative to family
• Availability of alternatives

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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

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Types of Regulations

• Affecting residents
• Affecting employees
• Affecting building construction safety

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Financing Nursing Facilities

• Reimbursement sources
• Medicaid - 46
• Medicare - 12
• Private pay and other sources the remainder

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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

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Staffing Work Force

• Nursing
• Certified Nurse Aides (CNAs)
• Medical coverage
• Other professional staff
• - Often on contract basis

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Legal Ethical Issues

• Responsibility to
• Protect residents rights
• Act ethically

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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?

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Management Qualifications

• Licensed by the states
• Many different state regulations re
• Minimum education
• Hands-on experience
• Continuing education
• NAB

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Management Challenges Opportunities

• Balancing cost and quality
• Integration of differing levels of service
• Coordination with other facilities organizations

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Significant Trends

• Rising acuity levels
• Managed care
• Prospective payment
• Private insurance
• Rising liability costs
• Consumer choice

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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.