Read Me First



Read Me First LTC/315

Week One

INTRODUCTION

As you explore various living environment options for the aging and older population, you may recognize which environments provide the maximum amount of independence, such as active adult communities, which are becoming a popular choice for individuals that are 55 years of age or older. As obesity and chronic illness are on the rise, individuals are eager to become proactive in their health decisions. Individuals residing in active adult communities, senior apartments, cohousing, or congregate housing are generally healthy and independent, seeking the security of a community with commonalities.

As you progress from most independent to least independent, you may note the benefits of home care or home health services rendered in the independent setting. Home health care services and home care offer an intermediate step between independent living and assisted living. Home health services often provide a successful transition from the hospital setting as an individual returns to his or her independent setting. Services include rehabilitation therapy, nursing services, and private assistance with activities of daily living (ADLs), including bathing, grooming, and dressing. In the event that an individual’s dependence of care exceeds a few hours a day or more than 3 days per week, home health care services may no longer be cost effective for the individual.

Assisted living provides personal care assistance with ADLs, medication management, and supervision in a relatively social environment. Skilled nursing services are provided in a medical model for individuals needing extensive assistance with ADLs, individuals with moderate to severe cognitive impairment, and individuals who require 24-hour nursing supervision. Hospice is the last phase in long-term care as it provides palliative care at the end of life. Palliative care ensures that an individual’s wishes for end-of-life care are carried out and the individual is comfortable, by way of pain control, until death.

Continuing care retirement communities (CCRCs) are an excellent option for individuals that have the resources to afford this living option. CCRCs provide care across the continuum, including independent apartments and cottages, assisted living, skilled nursing services, and hospice all on one campus. Life care communities are a form of a CCRC in which a contract, generally a lifetime contract, is signed and care is provided to the individual for one monthly rate as the individual progresses across the continuum and becomes more dependent on services.

A person’s financial situation generally plays a large role in determining the appropriate setting for an individual. Home health services are provided in the home and are becoming increasingly popular as most people want to stay in their own home until the end of life. Home health services are covered by insurance and included rehabilitative services and some nursing services. Other private services such as assistance with bathing or meals can be provided for a fee, generally around $20 per hour. Home health services do not always hire CNA’s or caregivers, though. The agencies hire companions that are trained to assist older adults, but generally do not have medical or nursing education or experience. Assisted living homes and centers provide services in a social setting for approximately $2,000 to $5,000 per month. These homes and centers do accept some long-term care insurance policies, the Department of Veteran’s Affairs, and personal funds as main sources of payment. Skilled nursing facilities provide the greatest amount of nursing services and supervision for a rate of $6,000 to $8,000 per month. Sources of payment for skilled nursing facilities include Medicare, Medicaid, some long-term care insurance policies, the Department of Veteran’s Affairs, and personal funds. Hospice operates in the same manner as home health services, but on the opposite end of the spectrum. Hospice is paid for by insurance and offers benefits to the individual until the end of life. Additional hospice services may be rendered for a fee. CCRCs are ideal for individuals that have assets and monthly income to supplement their selected living environment. Many individuals sell their home and use their home as the endowment fee for the community. The monthly service fee comes from Social Security income and any personal pension or retirement funds. Once an individual qualifies for the CCRC, the individual will receive care for a lifetime. If the individual outlives their resources, the community will care for the individual until death.

Cultural beliefs, traditions, and religion also play a role in the decision for the various living environments. For example, a community that does not provide a kosher diet for a potential Jewish resident would not be a good fit. Although federal regulations require communities to meet resident preferences, this situation continues to be a challenge. Another example of this is within the Asian culture, which highly respects their older adults and cares for individuals in their homes until the end of life. If an individual is residing in a community that does not understand a particular culture, language, tradition, or meal selections, the environment will ultimately be detrimental for the resident. At times, the challenge occurs in differences among separate states. This could be seen in a situation such as an African American that lived in Arkansas for his or her entire life, and then moves to Arizona to be closer to his or her family. The individual happens to be the only African American residing in the community, which is particularly intimidating for the individual. The individual is used to different food selections, environment, and activities. Ultimately, the individual may become very depressed, even with the community and family intervention. Often this is the result if the community is not a near perfect fit. One must consider menu options, activity programming, religious programs, and culture of the community.

THIS WEEK IN RELATIONSHIP TO THE COURSE AND THE PROGRAM

This week you identify the various living environments for the aging population. You only take a summary look at these, though, as you take a closer look at the specific living environments as well as their advantages and disadvantages in future weeks.

You learn how insurance and financial resources affect an individual’s decision for various living environments. The costs for living environments increase as the amount of required care increases. Individuals often sacrifice space or square footage for the care they receive as they progress from most independent to least independent.

You analyze how cultural beliefs, traditions, and religion affect an individual’s decision for a particular living environment. Meals and activities are the two most important components in selecting a living environment.

HINTS FOR A READING STRATEGY OF THE ASSIGNED MATERIALS

As you read this week’s materials, remember the various independent settings and how they differ. What are the benefits of an active adult community in relation to cohousing or congregate living? Even though all are independent living settings, think about how resources affect an individual’s decision for a particular independent environment.

Examine the effect of Medicare, Medicaid, private insurance, the Department of Veterans Affairs benefits, long-term care insurance, and life care communities on an individual’s decision for short-term and long-term care. Notice that many services accept a variety of payers to assist the individual in finding an affordable and comfortable setting.

When determining the effect of values, traditions, culture and religion consider language barriers, dining services programming, activities, and religious accommodations. It is important to understand the role of the family as they advocate for patient rights in the various settings.

SOME QUESTIONS TO ASK AS YOU HONE YOUR CRITICAL THINKING

If individuals have the resources, why would they not select a CCRC that provides all services under one roof from independent living to end-of-life hospice care services?

Would an individual need a long-term care policy if they plan to reside in a life care community? Can an individual be over insured?

As the role of the family or caregiver increases what are the advantages and disadvantages of keeping a loved one at home? What community-based services make it possible for an individual to reside in their independent setting for a long period of time or until death?

SUMMARY

A variety of living environments exist for the aging population and it is important that individuals educate themselves of the advantages and disadvantages of each setting. Financial resources, culture, values, beliefs, traditions, and religion help an individual make a decision for an appropriate living setting. Generally, families are assisting the aging individual in making a decision based on the above factors in addition to the amenities, programs, and services offered. The amount of care required by the aging individual may be a determining factor for the appropriate living environment.

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