The document discusses long-term care, defining it as assistance for those with chronic illnesses or disabilities with activities of daily living rather than medical treatment. It examines the different levels of long-term care including home health, assisted living, nursing homes, skilled nursing facilities and the populations served by each. The challenges facing long-term care are also reviewed such as financing issues and the need for quality staffing.

1. Long-Term Care
Major Paper by: Connor Rawe

2. Long-Term Care Defined
• “Long-term care refers to regular assistance for people
with chronic illnesses or mental or physical disabilities,
both in nursing homes and at home. Unlike other health
care services, long-term care is primarily intended to help
with activities of daily living (ADLs) rather than to treat
medical conditions.”

3. ADL Definition
• ADL- Activities of Daily Living. These activities are
those performed to those residents that cannot perform
these tasks themselves. These activities include:
• 1. Personal hygiene - bathing, grooming and oral care
2. Dressing - the ability to make appropriate clothing
decisions and physically dress oneself
3. Eating - the ability to feed oneself though not
necessarily to prepare food
4. Maintaining continence - both the mental and
physical ability to use a restroom
5. Transferring - moving oneself from seated to standing
and get in and out of bed

4. Who is LTC applicable to?

5. Who is LTC applicable to?
• From the graph on the previous slide,
it is easy to see that majority of the
Long-term care audience are those
people age 65 and older. There are,
however, others who use long-term
care to fulfill their needs. Disabled
persons who require assistance in the
activities of daily living are a large
audience of the long-term care
industry.

6. History of Long-Term Care
• In the 1900’s friends, family and the community care
for the elderly.
• In the early 1900’s religious sponsored affiliates
cared for the elderly. Rest homes also began to come
forth.
• In 1935 the Social Security Act assisted with income
of the elderly.
• In 1954 the Hill-Burton Act ammendments creates
finances to help fund the building of nursing homes.
• In 1972: SNF’s or “Skilled Nursing Facilities are
created/defined.
• In 1987 the Omnibus Budget Reconcilliation Act (OBRA
‘87) includes reformation of the nursing home.
• In 1995 Congress passes legislation repealing OBRA ’87

7. Levels of Long-Term Care
Assisted Living
Nursing Home
Skilled Nursing Facility (SNF)
Rehab Hospital
Home Health Providers

8. Home Health
• “Home health care is a wide range of health care
services that can be given in your home for an
illness or injury. Home health care is usually less
expensive, more convenient, and just as effective as
care you get in a hospital or skilled nursing facility
(SNF).”
• The idea behind home health care is to provide
independence as injury and illness is treated. It also
helps maintain the patient’s self-sufficience.

9. Assisted Living Facilities
• Assisted Living Facilities are an independent alternative
for the elderly who require minimal assistance with daily
living and personal care. The idea and purpose behind
these facilities is to help adults live independently in an
environment where help is readily accessible and where
they may feel safe.
• Those who live in these facilities do not require the
medical and nursing care that is provided in “nursing
homes”

10. Nursing Homes
• A Nursing home is a local or residential facility for
individuals with a disability or chronic illness. Nursing homes
usually are applicable to those who are older and not able to
take care of themselves on their own. There are, however,
exceptions to this. Those individuals with disabilities are able
to live in nursing homes and receive care there.
Other names for nursing homes are “convalescent homes” or
just simply, a “long-term care facility”.

11. Skilled Nursing Facilities
• A Skilled Nursing Facility or (SNF) is a type of nursing
home. This type of nursing home is recognized by CMS
as a a type of facility that meets the medical needs of
individuals who have the potential of functioning
independently after a limited time of care. The staff that
takes care of these residents are predominately RN’s and
more professional caregivers than CNA’s.
• It is important to note that these residents have severe
deficiencies in their ability to perform activities of daily
living. They require constant care.

12. Challenges of LTC
#1 Finance
• A significant problem that is facing Long-term care facilities is its
ongoing reliance on Medicaid funding. The cyclical nature of the
state government revenues makes it difficult for these facilities to
have a high profit margin. The reimbursement that Medicaid offers is
very minimal. It is estimated that nursing homes lose, per medicaid
patient, approximately $13 per day.
• Another problem facing LTC facilities is the difficulty in filling all
the available beds. In recent years, there has been a vast increase in
the elderly living in assisted living facilities. Because of this growth,
other facilities are suffering in occupancy.

13. Challenges of LTC
#2 Quality Staff
• Another major problem of LTC facilities is
finding and maintaining quality staff. The
caregivers, or CNA’s are the face of the
facility. How the CNA’s perform reflects
the overall morale and reputation of the
facility. If the goal is to have a “full house”,
it is absolutely crucial to find competent,
kind, and hardworking caregivers. What a
blessing for the “The Homestead” that I am
the face of their company.

14. Funding Sources
• In the next slide, the graph portrays where the money is
coming from that is paying for the residents of a long-
term care facility. Notice that Medicaid/Medicare pays a
significant amount of the cost, followed by out-of-pocket
and then private insurance.

15. Funding Sources #2

16. Older Americans Act O.A.A
of 1965
• “Congress passed the Older Americans Act (OAA) in 1965 in
response to concern by policymakers about a lack of community
social services for older persons. The original legislation established
authority for grants to States for community planning and social
services, research and development projects, and personnel training
in the field of aging. The law also established the Administration on
Aging (AoA) to administer the newly created grant programs and to
serve as the Federal focal point on matters concerning older persons.”
• Some of the services that the OAA provides is in-home assistance,
transportation, job training, home delivered meals, caregiver support,
and protection from abuse. The purpose of the Act is to help older
americans stay as independent as possible. In the year 2014, OAA
funding from the government was 1.88 billion.

17. The 1965 Medicare
Amendment to the SS ACT
• July 30, 1965 marked the day that President Johnson
officially signed the Amendments to the social security
act which established Medicare and Medicaid, with a
promise that they would "improve a wide range of health
and medical services for Americans of all ages."
• These new services were to be of assistance to the elderly
Americans who would not be able to afford quality
healthcare and/or insurance. They were successful not
only to the elderly, but to a vast audience of qualified
participants.

18. Advocacy Group for LTC
• Family Caregiver Alliance is the closest thing the Long-term care has for
an advocacy organization. It’s purpose is to support all those involved in
long-term care and provide the best possible assistance when it comes to
educating others, researching, and advocating. Below is their “about us”
found on their website and is similar to their mission statement.
• “FCA is first and foremost a public voice for caregivers. Founded in the
late 1970s, we were the first community-based nonprofit organization in
the country to address the needs of families and friends providing long-
term care for loved ones at home. We illuminate the caregivers' daily
challenges to better the lives of caregivers nationally, provide them the
assistance they need and deserve, and champion their cause through
education, services, research and advocacy.”

19. My desire to work in Long-
Term Care
• For about the past year or so, I have had a great desire to
work in the healthcare industry, specifically Long-Term
Care. I have been working at an assisted living facility for
the past 8 months and have just loved working “where the
tire hits the pavement”. It has been a great blessing to
serve the elderly with their ADL needs and to get to know
them personally. I have the leadership qualities and
financial intelligence to run a Skilled-Nursing facility on
my own hopefully someday soon.

20. Sources Cited
• “Long-Term Care Intro PPTX.” Dennis Tolman
• http://www.medicare.gov/what-medicare-covers/home-health-
care/home-health-care-what-is-it-what-to-expect.html ( quote
on home health)
• http://www.aoa.gov/AOA_programs/OAA/index.aspx O.A.A
slide
• http://www.lbjlibrary.org/press/the-1965-medicare-
amendment-to-the-social-security-act Medicare Slide
• https://caregiver.org/about-fca Advocacy Organization