NUR 2755 Multidimensional Care IV MDC 4 Rasmussen Il! Il! Il! Il! Il! Il! Il! Il! Il!
Exam 15 2025/26 Il! Il! Il! Il! Il!
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66% - percent of people 65+ that can't pay for a year of nursing care
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chronic conditions - what will be a huge contributor to the future needs for long term care?
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4 in 10 people - among people turning 65, how many people will need long term care for two or
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more years?
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79 years - the current life projected life expectancy is what? (2010) higher for women
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long term care - involves a variety of individualized, well coordinated services designed to meet
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a persons health or personal care needs during a short or long period of time; it can be temporary
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or permanent; involves both medical and non medical needs; it is "multidimensional"
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purpose of long term care services - assist individuals to live as independently and safely as
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possible when they can no longer perform everyday activities on their own
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essential characteristics of LTC - variety of services Il! Il! Il! Il! Il! Il! Il!
individualized services well-coordinated services
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maintenance of residual function extended periods
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of time holistic approach
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quality of life Il! Il! Il!
use of current technology (DME)
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use of evidence-based practice (back up with science)
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family and friends (unpaid) - who is the biggest provider of long-term care?
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the goal of LTC - to promote maximum possible independence; support, maintain, improve
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LTC users - children, adolescence, young adults, adults < 65, elderly; intellectual & developmental
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disabilities; birth related: autism, brain injury, spina bifida, epilepsy; neurological disorders: MS,
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sports injuries, AIDS/HIV
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37% - percent of people between the ages of 18-64 who need long term care?
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accidents - long term needs for ages 18-64 mainly due to injuries sustained from what?
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14% - percent of nursing home residents that are under 65? young adults are one of the "fastest"
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growing groups using LTC
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community; specifically at home - where do most elderly people prefer to live where it is much Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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less expensive?
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$20/hour - how much an hour for a caregiver?
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$65/day - how much a day for adult day care?
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$40-50/hour - how much an hour for a private duty nurse (not paid by insurance)
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$80,000 - LTC-instititionalized; in 2011, the annual cost of care for a resident paying either out
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of pocket or with private insurance in a "semi private" room in a nursing home averaged nearly
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how much a year? geographically dependent= east & west coast 2X $
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"primary" determinant of LTC - loss of ability to independently perform certain ALDs and Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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IADLs
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activities of daily living - ADL- bathing, bathroom, eating, dressing
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instrumental activities of daily living - IADL- preparing meals, taking meds
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total care - well coordinated services characteristic of LTC; requires that any health care need is
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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recognized, evaluated, and addressed by appropriate clinical professionals
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medicaid - does medicare or medicaid put more money into institutionalized care?
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medicare - does medicare or medicaid put more money into community based care?
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40%
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(medicare-22%) - what percent of medicaid pays for long term services
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community-based - type of long term care offered; providing services in the home in order to Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
keep the person in the home; what can we offer to older community to keep person in their home
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objectives of community-based LTC - All working together.. Il! Il! Il! Il! Il! Il! Il! Il!
1.) to deliver LTC in the most economical and least restrictive setting; (catch infections)
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2.) to supplement informal care giving; (adult day care)
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3.) to provide respite (rest) to family members;
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4.) to delay or prevent institutionalization
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type of community services - senior center; home health care; home delivered meals; equipment,
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devices; homemaker services; senior center; adult day care; adult foster care; case management
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home health care - type of community-based service; requires approval by a physician; medicare
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is the largest single payer; patient must be home bound; planned treatment; sends health care
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professionals to patients home to deliver services approved by a physician
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adult day care - type of community-based service; provide partial respite to family caregivers;
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social; medical/health; specialized; medicaid, private & VA
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adult foster care - type of community-based service; disabilities; medicaid, private; small family
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run home providing room, board, & varying levels of supervision, oversight & personal care to
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non related adults who are unable to care for themselves;
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senior centers - type of community-based service; form of socialization (meals) and recreational;
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offer wellness programs, education & counseling; funded by a variety of services- public service
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home delivered meals (meals on wheels) - type of community-based service; >60 years old;
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improve dietary intake; homemaker services; emergency response system
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case management - type of community-based service; coordination of services: address, identify,
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determine eligibility, make referrals (arrange financing)
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homemaker/handyman services - type of community-based service; designed to assist older Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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people with minor home repairs and errands; medicaid
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emergency response system personal emergency response system (PERS) - type of community- Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
based service; PERS; electronic device enables people to summon help in the event of an
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emergency; computerbased=hooked up with elders phone, putting sensors in home to monitor and
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capture them before they fall
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, institutional - type of long term care offered; bring patient to the services; retirement Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
homes/independent living, assisted living, skilled nursing facilities, sub acute care (LTAC),
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specialized care facilities, nursing home care
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retirement home/ independent living - type of institutional facilities; do not deliver medical
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services; goal- independence while providing a supportive environment; emergency call systems;
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private pay
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assisted living facilities - type of institutional facilities; 24-hour supervision; some basic nursing
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assistance-LPNs; medicare/medicaid
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skilled nursing facilities - type of institutional facilities; offers skilled nursing & rehabilitation;
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care provided by RNs and authorized by MDs; paraprofessional approach; admission requires a
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need based on problems with ambulation, nutrition, behavior, etc; only covered when 3 days in
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hospital; medicare/medicaid
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dual certification - facilities that have what can admit medicare and/or medicaid patients to any
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pair of the facility; most nursing homes have opted for this
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continuing care retirement communities (CCRC) - type of institutional facilities; lenoir woods an
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example of this; 450 individuals serves; 200 employees/110 acres; has a nursing home, skilled
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nursing, independent living & assisted living
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nursing home facilities - type of institutional facilities; for the very old and very feeble; for most,
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it will be the last place they ever live; quality varies widely; LPNs; For-Profit; 67% of women;
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67% cognitively impaired; 93% restricted mobility; medicaid
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subacute care facilities - type of institutional facilities; requires intensive medical, nursing & other
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services; follows hospitalization; ventilator support, would care, intravenous therapy, blood
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transfusions; involved multidisciplinary approach; average length of stay is 25 days; medicare and
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medicaid; ex) Landmark hospital
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specialized care facilities - type of institutional facilities; emphasizing nursing & medical care; Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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specialization- rehabilitation, AIDs care, Alzheimer's care; Ex) Rusk Rehab
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long term acute care - LTAC- intermediate kind of care
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respite care - other LTC service; objective is to provide relief of assistance to caregivers for limited
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periods to allow them some free time without neglecting the patient; typically medicare pays for
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this; ex) put in hospital for a weekend
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hospice - other LTC service; end-of-life care; can be in own home or institution; 6 months left to
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live or less; medicare pays for it
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community services - what services rely heavily on donations, grants, federal, state and Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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community support for there funding?
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sources of funding for LTC services - medicare, medicaid
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title III of the older americans act
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total XX social services block grants
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state & local government funds
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private settings Il!
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private donations
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Exam 15 2025/26 Il! Il! Il! Il! Il!
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66% - percent of people 65+ that can't pay for a year of nursing care
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chronic conditions - what will be a huge contributor to the future needs for long term care?
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4 in 10 people - among people turning 65, how many people will need long term care for two or
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more years?
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79 years - the current life projected life expectancy is what? (2010) higher for women
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Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
long term care - involves a variety of individualized, well coordinated services designed to meet
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
a persons health or personal care needs during a short or long period of time; it can be temporary
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
or permanent; involves both medical and non medical needs; it is "multidimensional"
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Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
purpose of long term care services - assist individuals to live as independently and safely as
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possible when they can no longer perform everyday activities on their own
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essential characteristics of LTC - variety of services Il! Il! Il! Il! Il! Il! Il!
individualized services well-coordinated services
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maintenance of residual function extended periods
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of time holistic approach
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quality of life Il! Il! Il!
use of current technology (DME)
Il! Il! Il! Il! Il!
use of evidence-based practice (back up with science)
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Il! Il! Il! Il! Il! Il! Il! Il!
family and friends (unpaid) - who is the biggest provider of long-term care?
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Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
the goal of LTC - to promote maximum possible independence; support, maintain, improve
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
LTC users - children, adolescence, young adults, adults < 65, elderly; intellectual & developmental
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disabilities; birth related: autism, brain injury, spina bifida, epilepsy; neurological disorders: MS,
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sports injuries, AIDS/HIV
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Il!
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37% - percent of people between the ages of 18-64 who need long term care?
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accidents - long term needs for ages 18-64 mainly due to injuries sustained from what?
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Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
14% - percent of nursing home residents that are under 65? young adults are one of the "fastest"
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
growing groups using LTC
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community; specifically at home - where do most elderly people prefer to live where it is much Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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less expensive?
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$20/hour - how much an hour for a caregiver?
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Il! Il! Il! Il! Il! Il! Il! Il! Il!
$65/day - how much a day for adult day care?
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Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
$40-50/hour - how much an hour for a private duty nurse (not paid by insurance)
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
$80,000 - LTC-instititionalized; in 2011, the annual cost of care for a resident paying either out
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
of pocket or with private insurance in a "semi private" room in a nursing home averaged nearly
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
how much a year? geographically dependent= east & west coast 2X $
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
"primary" determinant of LTC - loss of ability to independently perform certain ALDs and Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
IADLs
, Il!
activities of daily living - ADL- bathing, bathroom, eating, dressing
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
instrumental activities of daily living - IADL- preparing meals, taking meds
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
total care - well coordinated services characteristic of LTC; requires that any health care need is
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
recognized, evaluated, and addressed by appropriate clinical professionals
Il!
Il! Il! Il! Il! Il! Il! Il!
medicaid - does medicare or medicaid put more money into institutionalized care?
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
medicare - does medicare or medicaid put more money into community based care?
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
40%
Il!
(medicare-22%) - what percent of medicaid pays for long term services
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
community-based - type of long term care offered; providing services in the home in order to Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
keep the person in the home; what can we offer to older community to keep person in their home
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
objectives of community-based LTC - All working together.. Il! Il! Il! Il! Il! Il! Il! Il!
1.) to deliver LTC in the most economical and least restrictive setting; (catch infections)
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
2.) to supplement informal care giving; (adult day care)
Il! Il! Il! Il! Il! Il! Il! Il! Il!
3.) to provide respite (rest) to family members;
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4.) to delay or prevent institutionalization
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Il! Il! Il! Il! Il! Il!
type of community services - senior center; home health care; home delivered meals; equipment,
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
devices; homemaker services; senior center; adult day care; adult foster care; case management
Il!
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
home health care - type of community-based service; requires approval by a physician; medicare
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
is the largest single payer; patient must be home bound; planned treatment; sends health care
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
professionals to patients home to deliver services approved by a physician
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
adult day care - type of community-based service; provide partial respite to family caregivers;
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
social; medical/health; specialized; medicaid, private & VA
Il!
Il! Il! Il! Il! Il! Il!
adult foster care - type of community-based service; disabilities; medicaid, private; small family
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
run home providing room, board, & varying levels of supervision, oversight & personal care to
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
non related adults who are unable to care for themselves;
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senior centers - type of community-based service; form of socialization (meals) and recreational;
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
offer wellness programs, education & counseling; funded by a variety of services- public service
Il!
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
home delivered meals (meals on wheels) - type of community-based service; >60 years old;
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
improve dietary intake; homemaker services; emergency response system
Il!
Il! Il! Il! Il! Il! Il! Il!
case management - type of community-based service; coordination of services: address, identify,
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
determine eligibility, make referrals (arrange financing)
Il!
Il! Il! Il! Il! Il!
homemaker/handyman services - type of community-based service; designed to assist older Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
Il!
people with minor home repairs and errands; medicaid
Il!
Il! Il! Il! Il! Il! Il! Il!
emergency response system personal emergency response system (PERS) - type of community- Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
based service; PERS; electronic device enables people to summon help in the event of an
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
emergency; computerbased=hooked up with elders phone, putting sensors in home to monitor and
Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
capture them before they fall
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Il!
Il! Il! Il! Il! Il!
, institutional - type of long term care offered; bring patient to the services; retirement Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
homes/independent living, assisted living, skilled nursing facilities, sub acute care (LTAC),
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specialized care facilities, nursing home care
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retirement home/ independent living - type of institutional facilities; do not deliver medical
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services; goal- independence while providing a supportive environment; emergency call systems;
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private pay
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assisted living facilities - type of institutional facilities; 24-hour supervision; some basic nursing
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assistance-LPNs; medicare/medicaid
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skilled nursing facilities - type of institutional facilities; offers skilled nursing & rehabilitation;
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care provided by RNs and authorized by MDs; paraprofessional approach; admission requires a
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need based on problems with ambulation, nutrition, behavior, etc; only covered when 3 days in
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hospital; medicare/medicaid
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dual certification - facilities that have what can admit medicare and/or medicaid patients to any
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pair of the facility; most nursing homes have opted for this
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continuing care retirement communities (CCRC) - type of institutional facilities; lenoir woods an
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example of this; 450 individuals serves; 200 employees/110 acres; has a nursing home, skilled
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nursing, independent living & assisted living
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nursing home facilities - type of institutional facilities; for the very old and very feeble; for most,
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it will be the last place they ever live; quality varies widely; LPNs; For-Profit; 67% of women;
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67% cognitively impaired; 93% restricted mobility; medicaid
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subacute care facilities - type of institutional facilities; requires intensive medical, nursing & other
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services; follows hospitalization; ventilator support, would care, intravenous therapy, blood
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transfusions; involved multidisciplinary approach; average length of stay is 25 days; medicare and
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medicaid; ex) Landmark hospital
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specialized care facilities - type of institutional facilities; emphasizing nursing & medical care; Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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specialization- rehabilitation, AIDs care, Alzheimer's care; Ex) Rusk Rehab
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long term acute care - LTAC- intermediate kind of care
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respite care - other LTC service; objective is to provide relief of assistance to caregivers for limited
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periods to allow them some free time without neglecting the patient; typically medicare pays for
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this; ex) put in hospital for a weekend
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hospice - other LTC service; end-of-life care; can be in own home or institution; 6 months left to
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live or less; medicare pays for it
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community services - what services rely heavily on donations, grants, federal, state and Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il! Il!
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community support for there funding?
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sources of funding for LTC services - medicare, medicaid
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title III of the older americans act
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total XX social services block grants
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state & local government funds
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private donations
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