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

2. 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)

3. Oregon – Highlights of a leader in the 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.  1990 Oregon’s first ALF is licensed.  1990 – present Expansion of Residential Care and Adult Foster Home Programs.  Mid 1990’s Standardization of dementia care through Best Friends approach.  2003 – 2006 Better Jobs, Better Care Demonstration Project Person-Directed Care Measurement Tool developed.  2004 Making Oregon Vital for Elders coalition formed

4. The History of LTC in Oregon  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.

5. 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.  2/3 receive informal care only.  9% receive only formal 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)

6. Family Caregivers  Nearly 30% of the adult population are unpaid caregivers;  Most caregivers are women, but increasingly caregivers include men.  31% have provided care for 5 years or more (average is 4.6 years), usually to a relative (86%).  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).  About ½ of care recipients live in their own homes, 29% live with the caregiver.  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.  The annual national spending for formal home health care and formal nursing home care, totals about $158 billion.  Family caregiving continues for those receiving formal in-home services and for those living in LTC facilities.

7. Assistance for home dwelling older adult and caregivers  Adult day services  Respite care services “Respite care gives families and other caregivers temporary relief from providing care for frail adults. Companionship, light assistance, recreational activities and security are provided in the resident's home, out of home in a group setting, or overnight in a residential setting. Respite care allows for a healthier and better quality of life for both the caregiver and care receiver.” Oregon Department of Human Services

8. 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.

9. 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

10. In Home Care If a licensed Home Care Agency provides home care services, the person pays privately and the care is subject to Oregon Administrative Rule (see below) Oregon In-Home Care Agency Administrative Rules The person needing help may be eligible for services from the Department of Human Services, Seniors and People with Disabilities. They offer home care worker assistance, and other programs including Independent Choices, Oregon Project Independence, and Spousal Pay. Click on this link to learn more.link

11. 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

12. 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.  Are not required to have licensed registered nurses on staff 24-hours-a-day. The role of the nurse is emerging.

13. ALFs and RCFs  Duties and qualifications of direct caregivers vary among facilities. Staff to resident ratio will typically be lower than what is required for nursing homes.  Caregivers are not required to be certified, although training prior to providing services to residents is mandatory.  Oregon Residential Care and Assisted Living Facilities Administrative Rules Oregon Residential Care and Assisted Living Facilities Administrative Rules

14. In their own words… Hannah and Brad share the experience of a typical day working in an Assisted Living Facility. Please note: Allowing the YouTube clips to fully load in your browser window may result in better video quality.  Hannah Perry, BSN, RN talks about a typical day at work. Hannah Perry, BSN, RN  Brad Finley, RN talks about starting his morning at work and the variety of skills that he uses each day Brad Finley, RN

15. Adult Foster Homes  Adult foster homes offer personal and health care to individuals in private residences.  Care and supervision are provided to maintain a safe and secure setting.  Adult foster homes are licensed, inspected and monitored by the Department of Human Services, Seniors and People with Disabilities and Area Agency on Aging offices.

16. Adult Foster Homes  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

17. 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.

18. Memory Care Community Requirements Structural requirements in an endorsed setting  A secure building that alerts staff if a resident has exited  A secure outdoor area that provides outdoor freedom safely  Interior finishes that are non-glare and well lit  Visual contrasts between floors, walls and doorways Program Requirements  In addition to providing the services required in our other licensed settings, memory care communities must also have programs, which include:  Gross motor activities  Self care activities  Social activities  Crafts  Sensory enhancement activities  Outdoor activities Oregon Department of Human Services

19. 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.  Requires a Doctor/Nurse Practitioner order  Is time limited and usually paid for by insurance  Provides a team approach to care  Oregon Home Health Agency Administrative Rules Oregon Home Health Agency Administrative Rules

20. Professional Support Services  Hospice  Provides palliative and end-of-life support  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)

21. 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

22. 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.

23. In her own words… Polly describes a typical day working in an Nursing Facility Please note: Allowing the YouTube clip to fully load in your browser window may result in better video quality.  Polly Youngren, RN, MN talks about the fact that there is no typical day in her position as Director of Nursing Polly Youngren, RN, MN

24. 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

25. In their own words.. Other nurses describe the administrative and regulation work that they do. Please note: Allowing the YouTube clips to fully load in your browser window may result in better video quality.  Leslie Joy Boyer, RN, an administrator, describes her many roles as Director of Nursing Services. Leslie Joy Boyer, RN  Joan Morris, RN, an Assisted Living regulator, talks about the variety in her work. Joan Morris, RN