Aging, Health, and Long-Term Care Chapter 4 PDF

Aging, Health, and Long-Term Care CHAPTER 4 Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.  The population 65 years of age and older will continue to The Impact increase dramatically through the of...

Aging, Health, and Long-Term Care CHAPTER 4 Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.  The population 65 years of age and older will continue to The Impact increase dramatically through the of Future year 2030. More services will be required for Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Demograp the treatment and management hic of chronic and acute health Changes conditions and disabilities. on Medicare beneficiaries with multiple chronic conditions, Healthcare especially the frail elderly with Needs (1 of functional or cognitive 3) impairments in addition to chronic disease, will need care coordination.  Since the first baby boomers turned 65 years old in 2011, the The Impact number of older people has substantially increased. of Future By 2034, those 65 years of age Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Demograp and older are projected to hic outnumber children under the age Changes of 18. By 2060, nearly one in four on Americans will be at least 65 Healthcare years old. Needs (2 of Overall aging of the population is 3) the result of increasing life expectancy and decreasing fertility.  In recent years, the old- The Impact old (85 and older) has of Future been the fastest growing segment of the Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Demograp population. hic The percentage of those Changes 65 years and older is on projected to grow at a Healthcare much slower rate after Needs (3 of 2030. 3) In 2050: 53% nonwhite compared to 21% in 2014.  Chronic diseases are defined as conditions that last 1 year or more Common and require ongoing medical Health attention, limit activities of daily Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com living, or both. Problems Common chronic diseases in the in an elderly Aging Arthritis Population Stroke Diabetes (1 of 2) Chronic lower respiratory diseases Dementia Alzheimer’s disease  Those with chronic Common Health diseases may have pre- Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Problems existing health problems: in an Alcoholism Aging Substance abuse Population Mental illness (2 of 2) Developmental disabilities  Loss of functional ability with aging Basic and Limitations in vision, hearing, mobility, communication, Complex Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com cognition, and self-care Activities Loss of the ability to perform activities that require more of Daily complex thinking and organizational skills, instrumental Living activities of daily living (IADLs) (1 of 4) Managing money, shopping, preparing meals, and taking prescribed medications  Activities of daily living Basic and (ADLs): Basic skills Complex required to Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Activities independently care for of Daily oneself Eating, bathing, Living dressing, maintaining (2 of 4) personal hygiene, and mobility  Chronic disease and a loss of Basic and ability to complete IADLs and ADLs lead to need for long- Complex Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com term care services and Activities support. In a 2016 survey of those of Daily living independently, about Living 69% of those age 85 and older had at least one type of (3 of 4) disability, compared with 9% of the population under the age of 65.  Stroke and dementia are the Basic and most debilitating conditions accompanied by functional Complex Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com impairments among older Activities adults. Alzheimer’s disease is the of Daily most common cause of Living dementia. Dementia is a decline in (3 of 4) cognitive function that affects memory, language, and problem-solving skills.  Medicare for Older Adults Medicare-covered benefits apply mostly to treatment of patients with acute illnesses Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com who require hospitalization and short-term skilled nursing care. Rehabilitation centers Nursing homes Home healthcare Medicare is divided into four parts. Deductibles and copayments  Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Those 65 Years Older or Under Programs for of Age and Medicare Table 4-2 Disabled 65 and Medicaid for Older Adults (1 of 2) Medicaid-covered benefits Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Medicaid covers a broad range of services not covered by Medicare. Acts as supplemental insurance for the elderly and disabled Pays their Medicare premiums Covers prescription drugs Medicaid for Older Adults (2 of 2) The Medicaid program is the primary Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com payer and the only safety-net program for long-term services and supports (LTSS). Under the Medicaid spousal impoverishment provisions, a certain amount of the couple’s combined resources is protected for the spouse living in the community.  Long-Term Services and Supports (LTSS) (1 of 2) Long-term health care Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com The help needed by people of any age who are unable to complete basic activities of daily living (ADLs) because of physical and/or mental impairment Preadmission Screening and Resident Review (PASRR) Intermediate care facilities for people with intellectual disability (ICF/ID)  Long-Term Services and Supports (LTSS) (2 of 2) Inpatient psychiatric services for Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com individuals under age 21 Services for individuals age 65 or older in an institution for mental diseases Nursing facilities (NF) and skilled nursing facilities (SNF)  Community Long- Term Care Services Privately funded, long-term Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com care providers that are regulated by federal and/or state governments in addition to nursing homes include Adult day care Residential care communities Home health agencies Hospice National Study of Long-Term Care Providers Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Study conducted by 2016 data on long- 65,000 long-term care the National Center term care services service providers for Health Statistics in the United States serving more than 8.3 (NCHS) million people annually Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com States, 2016 Providers in the United Long-Term Table 4.3 Care  Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Figure 4.1 Comparison Diagnoses by Type of Services, 2015–2016 of Most Common Long-Term Care Figure 4.2 Percentage of Those Using Long- Term Care Services Needing Assistance Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com with ADLs, 2015–2016  Nonmedical Care Facilities Residential Care Communities/Assisted-Living Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Facilities Provide a room or apartment, meals, housekeeping, medication management, assistance with ADLs as needed, and recreational activities Might provide transportation for shopping or doctor visits May be part of a retirement community, nursing home, senior housing complex, or a stand-alone facility Sometimes part of a continuing care community  Home Health Agencies Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Provide part-time nursing and medical care in patients’ homes May also provide other services Physical therapy Speech therapy Occupational therapy Social services Medical supplies and equipment Wheelchairs, walkers, etc.  Hospice Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Hospice care helps manage pain and other symptoms associated with dying when conventional treatment is no longer of value. Emotional, psychological, and spiritual support for the patient and family Bereavement counseling for surviving family and friends Medical care may include necessary medications, medical supplies, and equipment. Adult Day Adult day care is used to supplement home care services or as less costly Care alternative to a residential care Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com facility or a nursing care facility. Services Supervision because of dementia or assistance with ADLs Therapeutic treatment to maintain physical or cognitive functioning Social and recreational activities and meals and snacks Some medical services Most include transportation services  Programs encourage states to Program provide the full array of Medicaid of All- and Medicare benefits through a single delivery system in order to Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Inclusive provide quality care for dual eligible enrollees, improve care Care for coordination, and reduce administrative burdens. the PACE provides comprehensive Elderly preventive, primary, acute, and long-term care services so older (PACE) individuals with chronic care needs can continue living in the community.  A system of federal, state, and local entities committed to supporting older Americans in living Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com independently in their homes and communities Network consists of the U.S. The Aging Administration on Aging (AOA), 56 Network state aging units, 622 Area Agencies on Aging (AAAs), and more than 250 Title VI Native American aging programs. Senior centers are the focal point where 60% of services are delivered.  Many measures of disease and disability differ significantly by race and ethnicity. Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Demograp Shifts in the U.S. population are expected, hic Trends with a decrease in the percentage of Caucasians and an increase in all other and racial groups. Projections Shifts in the racial and ethnic makeup of the United States require health professionals and organizations to achieve cultural competence and to ensure that they utilize appropriate and tailored approaches in working with specific population groups.  Limited health literacy affects people of all ages, races, incomes, and education levels. Disproportionately impacts lower Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Health socioeconomic and minority groups, those with low English proficiency, and Literacy older adults Health literacy includes (1 of 2) Ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctors’ directions, and consent forms Ability to negotiate complex healthcare systems  Limited health literacy is Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Health also associated with worse health outcomes Literacy and higher costs. (2 of 2)  Healthcare practitioners will routinely serve older people in the future as part of their regular Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com duties. Personnel This care will make up Needs (1 of approximately one-third to two- 2) thirds of the workload of healthcare personnel. Requirements for personnel specifically prepared to serve older people will greatly exceed the current supply.  Future education for health professions Interprofessional education (IPE) Shifts in training health personnel Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Need for broader understanding Personnel and competence in geriatrics Needs (2 of Knowledgeable about health 2) problems of different ethnic, racial, and socioeconomic groups, including recent immigrants Health literacy factors  Summary The future of health services will Copyright © 2023 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com be concentrated among older and very old people. This fact has important implications for the education and training of all healthcare personnel. The impact of these changes will have an increasing role in the delivery of health care and on the economy of the United States.