AGING IN OREGON Understanding Long Term Care Services for the Older Adult Module 2 – The Oregon System

What is long term care?  “Long term care refers to provision of a range of services to individuals who require assistance with daily activities because of chronic illnesses and functional impairments.” Noelker & Harel, 2001, p. 3  Long term care options in Oregon include:  In-Home Care (IHC)  Assisted Living Communities (ALF)  Residential Care Communities (RCF)  Memory Care Communities (MCC)  Adult Foster Homes (AFH)  Nursing Facilities (NF)

Oregon – A state leading the way in community- based care of the older adult  1981 Oregon Legislature calls for shift from nursing home care to home and community-based care. First Medicaid home and community-based care waiver in the country granted.  1987 RNs permitted to delegate nursing care tasks to unlicensed persons (nurse delegation). Assisted Living Facility (ALF) concept introduced.  Read about how, when, and why Oregon’s long term care system developed the way it did in this clip from the “Campaign for Oregon’s Seniors and People with Disabilities” website. “Campaign for Oregon’s Seniors and People with Disabilities” website.

The Older Adult Living at Home  The vast majority of older adults live independently in their own homes.  Over 90% of older adults with chronic disabilities receive informal (unpaid from family & friends) and/or formal (e.g., paid) services.  Cost of full time care at home varies (e.g., private caregiver charges an average of $15 per hour, through an in-home care agency the cost is $20 – 24 per hour)

Family Caregivers  Nearly 30% of the adult population are unpaid caregivers;  Most caregivers are women, but increasingly caregivers include men.  More than ½ of care recipients need help with at least one ADL; almost all need help with an IADL (e.g., grocery shopping, transportation, paying bills).  The economic value of the unpaid, informal care friends and family provide nationwide is $306 billion per year.  Most caregivers are employed; the costs of the health impact of caregiving on employees are estimated at more than $13 billion annually.

Assistance for home dwelling older adult and caregivers  Adult day services Older adult travels to a setting for services that include recreation, socialization, physical activity, mental stimulation, snacks/meal; may include some therapies.  Respite care services Designed to provide ‘respite’ for caregiver. May be for a few hours every week or for several days in a row once a year. Happens in the home or in a group setting. Companionship, light assistance, recreational activities and security are provided.  Both services are usually paid for ‘out of pocket.’  Oregon Department of Human Services

In Home Care  Seniors and people with physical disabilities can receive services while living in their own homes.  In Home Care may be provided by different providers depending on who is paying for the service.  Care may be delivered on an hourly basis or as a 24-hour “live-in” shift.

In Home Care Services may include help with:  Bathing, dressing and personal hygiene  Mobility and transfers  Housekeeping and laundry  Meal preparation or delivery (Meals on Wheels)Meals on Wheels  Shopping and transportation  Medical equipment  Medication Assistance

Assisted Living /Residential Care Communities Assisted living facilities (ALF) provide housing and supportive services for six or more residents. These facilities are fully wheelchair accessible. Residents of assisted living facilities have private apartments, ranging from a studio to one or two bedrooms. Each apartment unit has a kitchenette and private bathroom with a wheelchair accessible shower. Residential Care facilities (RCF) are like ALFs but are not required to have private apartments, a kitchenette, or private bathrooms with a shower. Oregon Department of Human Services

ALFs and RCFs  Are best suited for individuals who want to remain as independent as possible and who are able to direct their own care. However, acuity in both ALFs or RCFs has increased considerably so that most residents are dependent in at least one ADL and many have significant cognitive impairment.  Are licensed and regulated by the Department of Human Services, Seniors and People with Disabilities.  Require RN presence for some activities. Are not required to have licensed registered nurses on staff 24- hours-a-day.RN presence

ALFs and RCFs  Duties and qualifications of direct caregivers vary among facilities. Staff to resident ratio is typically lower than what is required for nursing homes (may be 3 assistive staff on PM shift for 70 residents).  Caregivers are not required to be certified, although training prior to providing services to residents is mandatory.  Basic monthly charge often covers only room/board. Assistance with toileting, bathing, dressing, etc. are extra charges.  Nurse delegation happens in these settings.delegation

Adult Foster Homes  Adult foster homes offer personal and health care to individuals in private residences.  Adult foster homes are licensed, inspected and monitored by Seniors and People with Disabilities.  People often choose adult foster care because it is more affordable than other care facilities and care is provided in a homelike setting.  These homes provide care for no more than five individuals.  Oregon Adult Foster Home Administrative Rules Oregon Adult Foster Home Administrative Rules Oregon Department of Human Services

Memory Care Communities  Some facilities/communities specialize in providing care only to persons with dementia.  A community that specializes in the care for people with memory impairment must receive an endorsement and is governed by additional regulations that are specifically intended to support individuals with dementia.  Oregon Memory Care Communities Administrative Rules. Oregon Memory Care Communities Administrative Rules.

Professional Support Services  Home Health  Provides short-term, skilled care for home-bound individuals. Services may include nursing, physical therapy, occupational therapy, speech therapy, social work, and/or home health aide care.  Is time limited and usually paid for by insurance  May provide services in assisted living, residential care, and foster home settings.  Oregon Home Health Agency Administrative Rules Oregon Home Health Agency Administrative Rules

Professional Support Services  Hospice  Provides palliative and end-of-life support  Services are available in the client’s ‘home’ that includes nursing homes, assisted living, residential care, memory care and foster care.  Team members include nurses, physical therapists, occupational therapists, social workers, chaplains, hospice aides, and volunteers.  Oregon Hospice Agency Administrative Rules (from the Oregon Hospice Association) Oregon Hospice Agency Administrative Rules (from the Oregon Hospice Association)

Nursing Facilities  Nursing facilities are licensed by the Department of Human Services, Seniors and People with Disabilities and are required to meet both federal and state regulations.  Services offered in nursing facilities  Nursing care on a 24-hour basis  On-site physical rehabilitation (Skilled Care)  Recuperation after hospitalization for serious illness or surgery (Skilled Care)  Restorative services  End-of-life care

Nursing Facilities  Nursing facilities are most appropriate for people who need 24-hour medical oversight and a protective/structured setting. Residents may have medical and behavioral needs that cannot be met in other care settings.  Most residents must share their room. Space is limited, but residents are allowed to bring personal items to encourage a more home-like atmosphere.

Future trends in Long Term Care  Cost efficiency and Innovative Ideas (read this September 2010 report on Long Term Care in Oregon)September 2010 report  The Role of Nurses in Long Term Care (Module 4)  Culture Change (Module 4)  The PACE model (including a program in Oregon) in this article from seniorjournal.comseniorjournal.com  Respite Care and Adult Day Services:  Great idea that isn’t currently working  Great need, but no reimbursement currently  Transportation is one of the problem issues