1. There Is No Place Like Home
THE FOUNTAINVIEW CENTER
FOR ALZHEIMER’S DISEASE
There Is No Place Like Home
Speaker’s Notes: None
Tedd Watts, RN, LNHA, CDP
Executive Director

2. Educational Objectives:
Become familiar with Nursing Homes
Understand who are candidates for Nursing Homes
Define the services provided.
Identify some important issues at Nursing Homes
Speaker’s notes: none

3. Provide a “home like” Environment
As we go through my presentation today and in keeping with the theme of today’s seminar – “There is no place like home” - I want you to keep this image and thought in your mind “Provide a ‘home like’ environment”.

4. The Stats!
Approximately 1.4 million Americans (~4.1%)>65 have spent time in a skilled nursing facility – 2012 National Nursing Home Survey
Harris-Kojetin, L., et al. (2013). Vital Health Stat, 3(37).
Expected to be 3 million in 2030 if continues at this rate.
~42% of those 95 and older live in nursing homes.
51% of nursing home residents require assistance with all ADLs
Speaker’s notes:
With the aging population, Nursing homes become increasingly important

5. Skilled Nursing Facilities (Nursing Homes)
Skilled Nursing Facility: part of a Nursing Home or Hospital that provides skilled nursing care.
Registered Nurses who provide skilled nursing care to people, along with interdisciplinary staff/team
Licensed practical and vocational nurses
Physical Therapy, Occupation Therapy
Speech Therapy
Social Worker/Case Manager
Skilled care usually a short period
Custodial Care may be required for longer period
Speaker’s notes:
What is a skilled nursing facility?
Who is the interdisciplinary team at the SNF?
We’ll talk more about the requirements for skilled stays in a nursing home in a couple of slides.

6. Skilled Nursing Facilities (Nursing Homes)
A licensed physician supervises each patient’s care and a nurse or other medical professional are always on the premises.
>80% of nursing homes use community physicians to provide care
Average family physician supervises 9.6 nursing home residents and conducts 2.3 nursing home visits per week
2008 AAFP survey
Speaker’s notes: None

7. Skilled Medical Care Skilled Services:
RN doing wound care or administering and monitoring IV antibiotics
A physical therapist working to improve strength and balance in a patient with difficulty walking
A speech therapist helping a patient speak and swallow after a stroke.
An occupational therapist helping a patient relearn dressing, grooming and eating.
Skilled care may also involve managing injections, ostomy management and tracheotomy care amongst other needs.
Speaker’s notes:
What are the skilled services that are provided?

8. Custodial Care Need assistance with ADLS
Bathing
Dressing
Eating
Grooming
Getting in and out of bed, or walking around
Toileting (incontinence care)
Often provided at a Nursing Home
May also be temporary
Speaker’s notes:
1. These are examples of Basic activities of daily living (ADLs)

9. Who May Need a Nursing Home?
Skilled Nursing facility is for Patients who:
Require a short stay for skilled services prior to returning to previous residence
Can no longer care for their own personal needs, such as feeding, bathing, toileting (custodial care) because of medical, physical, behavioral problems
Need more care than can be provided at home
Has extensive medical needs requiring daily attention, or monitoring
Speaker’s notes:
Examples of patients that may need a short stay in a Skilled Nursing Facility include patients following surgery or a prolonged hospital stay.
Also suitable for those who can no longer care for themselves.

10. Who May Need a Nursing Home?
Special Needs in Skilled Nursing Facility –
Dialysis, Dementia care, Respiratory Care, Parkinson’s Care
Hospice care, Chronic Psychiatric Care
Speaker’s notes:
Some additional services that may be seen in skilled nursing facilities

11. Nursing Home Costs Medicare coverage for skilled care:
Medicare Part A (Hospital Insurance)
Qualifying 3 day hospital stay 30 days prior to Nursing home admission
100 day benefit period (renewable if not hospitalized, or in SNF for 60 consecutive days)
1st 20 days, Medicare covers full cost
Between Day 21 and 100 there is a copay (Currently $164.50/day)
After Day 100, Medicare covers nothing.
Speaker’s notes:
How is nursing home care paid for.
In order to qualify a patient must also demonstrate a daily need for skilled care, and progress with skilled therapies.

12. Nursing Home Costs Medigap may cover deductibles/other charges
Medicaid for Custodial care, Long Term Care Insurance
Speaker’s notes:
Long term patients may have their costs of care covered by Medicaid, or long term care insurance policies. If not the patient will have to bear the costs.

13. Nursing Home Costs
2016: Genworth Market Survey of Nursing Home and Home Care costs, $257/day, or $92,378 a year – Private room
Shared room $228/day, or $82,125 a year.
Costs can vary with location –
Alaska, highest rates for private room $297,840/yr, or $816/day
Louisiana, lowest rates for private room $61,663/yr, or $169/day
Speaker’s notes:
1. Nursing homes can be very expensive.

14. What’s the Alternative?
Assisted Living facility
Subsidized senior housing
Board and care homes (personal care homes)
Continuing care retirement communities
Program of All-Inclusive Care for the Elderly and the Social Managed Care Plan
Speaker’s notes:
Other places patients who need extra care may be able to find it.
This also includes living at home with hired in home assistance.

15. Important Issues in Skilled Nursing Facilities
Transitions of Care
To and From Acute Care settings
To Home and or other Long Term Care options
End of Life Care
11.7% of nursing home residents die within one year of admission
Estimated by 2020, 30% of all deaths will occur in nursing homes.
Tanuseputro, P., et al. (2004). J Am Med Dir Assoc. 5(3):
End of life care similar to that in the community setting, and hospice and palliative care can be provided in the skilled nursing facility
Speaker’s notes:
Communication barriers can be a problem in transitions of care. Important to be able to communicate the nursing home course of care to the hospital or outpatient MD, and vice versa.

16. Important Issues in Skilled Nursing Facilities
Dementia
~67-78% of nursing home residents
Behaviors can be a serious problem
Nonpharmacologic treatment (identify triggers, activities, environment modification, staff and family education).
Pharmacologic treatment: higher risk of morbidity/mortality?
Speaker’s notes:
Behavior problems can be the trigger for placement into a skilled nursing facility.
Use medicines cautiously.

17. Oversight & Regulations
State Licensing Laws
State licensing laws govern the licensing of nursing homes required for their local operation.
Historically, licensing of healthcare facilities, including nursing homes, has been a state prerogative and matter of state law.

18. Oversight & Regulations
Medicare/Medicaid Certification laws
Federal Medicare/Medicaid certification laws govern the certification of nursing homes required for participation in the Medicare program, Medicaid program, or both.
In 2015, Medicaid, which pays for long-term care in Medicaid-certified facilities, accounted for about 44% of national nursing home expenditures.
In 2015, Medicare, which pays for skilled nursing care for a limited time, accounted for about 20% of such expenditures.
An estimated 95% of all nursing homes participate in Medicare, Medicaid, or both.

19. Oversight & Regulations
1987 Congress enacted legislation requiring all nursing home participating in Medicare and/or Medicaid programs to comply with certain quality of care rules.
This was in response to widespread reports of neglect and abuse in nursing homes prior to 1987
There are 372 specific regulations listed in the Requirements of Participation (RoP)
Nursing Homes are the 2nd highest regulated industry; 2nd only to nuclear power plants
Some of these regulations include:
Sufficient staffing levels
Completion of comprehensive assessments
Development of care plans
Resident Rights
Quality of life requirements
Abuse & Neglect prevention

20. Oversight & Regulations
Nursing Homes inspections are:
Unannounced
As a standard last between 4-5 consecutive days
10% of all inspections must start outside of normal business hours , or on a holiday.
Happen between 9 – 15 months from the last incpection
Exception, complaint surveys

21. Today’s Nursing Homes were Yesterday’s Step Down Units
Provide a home like environment with
Increased level of care expectations
Increased regulations
Decreased reimbursement
Increased consumer demands
When I think of home I think of comfort, family and love. Sometimes in our industry we can not provide the material things that might remind of one of “home”. While there is truly is no place like home, we strive daily to ensure that our residents live in an environment that is as comfortable as possible. That those who live with us, and those that rely on us to provide care to their loved ones, become like family to us. Regardless of all of the things that we have talked about today, the one thing we do daily to make our settings as “home-like” as possible is to love on those that are entrusted to our care.

22. Pros & Cons Pros Cons Full-time Care Structured schedules
Active social life
Specialized medical care
Respite for caregivers
Cons
Cost
Nursing Home horror stories
Subjectivity of care standards
Increased burden of care without increased resources

23. Thank you!
Questions?
Speaker’s notes: None