- 66 percent for profit
- 27 percent not-for-profit
- 7 percent government.
Generally, Nursing health care settings governed by private body, provides superior health care services than provided by government controlled Medicaid. According to National Senior Citizens Law this health care setting differentiate against Medicaid patients in opposition to private setting. The dissimilarity may be a particular division of a home, deportation of Medicaid patients and substandard food and services. This issue ascertained by an expert who calculated that every nine out of ten attorneys give awful recommendation on qualifying for Medicaid. Something like 63 percent of this health care patient of cognitively impaired.
What the common organizational structures (i.e. free standing, governmental, hospital affiliated)?
- State Dept of Health and Human Services (DHSS)
- JCAHO – Joint Commission on Accreditation of Health Care Organizations.
- NCQA – National Committee for Quality Assurance
The general structure of a typical nursing home is comprises of nursing chief, trained nursing workforce and specialized nurse aides. The staff constitutes a trained health care center includes; Owner, administrator, medical director, attending physician, charge nurses, registered nurses, certified practical nurses, licensed nursing assistants, physical/speech therapists and social worker.
What is the primary source of financing (i.e. Medicaid/Medicare, private insurance, other government)?
Medicare
Medicare provides funds for inpatient care (for all). Medicare also provides support for outpatient care (patient pays a premium and deductible). Major changes to Medicare benefits literally require an act of Congress.
Medicaid
Medicaid is a health insurance program for certain lower income people or those with very high medical bills.
- Each state administers their own program.
- About 33 million Americans are covered.
- No co-payment or deductibles.
- Generally only covers basic medical services.
Insurance
Insurance is another source of funding for long term care provided by skilled nursing health care setting.
Military Health Care
- This is a kind of insurance that government provides to and for the health care needs for families of active service army men, retired personnel and veterans.
Self Pay
- Those without any medical insurance pay for all medical expenses out of their own pockets.
- People can also purchase their own medical insurance.
- It is generally more expensive to privately purchase health insurance than to be part of a group of people purchasing the insurance.
Employer Paid Insurance
- Employers with a large number of employees will often offer health insurance to their full-time employees.
- Purchasing insurance for a large group of people is more cost effective (volume discount).
Who are the primary care givers and how is the care team structured?
As said before, skilled nursing facilities have registered nurses. Registered nurses can also be named as licensed practical nurses. These nurses help provide 24/7 assistance to the patients who are unable to help themselves due to reasons mentioned in earlier paragraphs. A certified physician superintends every resident’s care, and other health care specialists are present at the location regularly. Certified nurse aides work under the superintendence of the head duty nurse. They're the principal health care providers in a nursing home. A certified nurse aides helps patients with routine activities. Basic functions executed by certified nurse aides include answering patients call signals, turning and repositioning bedridden patients, to forbid pressure ulcer, regular observation of patient's condition and feeding patients who cannot feed themselves. Almost 98 percent of nurse aides are female, 74 percent constitutes minorities, and only 8 percent of them have more than a high school education (Castle, Engberg, Anderson).
The primary users of nursing homes are the elderly people with age 65 years and above. Health care needs for every elderly patient are different from one another. Some of them may need long-term assistance, perhaps due to more severe disease, severe weakness, or a heart attack. Other persons may only require a less assistance for injuries received due to small accident, which requires a short-lived stay at hospital followed by healing. They are normally allowed to go home after their brief stay at hospital. The patients may still be getting some medical assistance at home till fully recovered.
How does this setting interface with other settings in the health care delivery system?
Generally health care delivery systems are categorized based on the intensity of health care that is offered within each health care system.
Acute care
Acute care is a health care environment in which health care services are provided to patients with severe symptoms. Patient is usually seen within a hospital/ inpatient care setting. They requires round the clock care by a team of skilled health care workers. Acute care health delivery setting involves following centers:
- Hospitals
- Emergency Rooms
- Critical Care
- Surgery Centers
- Birthing Centers
- Acute Drug Healing Centers
- Hospice
Extended care
Provided at a lower level than acute care; however, the patient is not critically ill or in need of a critical level of health care intervention. Patient does not require round the clock assistance. A resident are recuperating or is chronically ill and in need of additional health care services. This setting includes:
- Skilled Nursing Facilities (SNF)
- Nursing Homes
- Convalescent Care Facilities
- Residential Care
- Healing Centers
- Inpatient Hospice
Home care
Patient is stable enough to be cared for in the home; however, is not well enough to be transported back and forth to the clinic or doctor’s office. Health care providers come to the home on a periodic basis to administer medications and/or treatments. They generally do not stay with the patient. Family or caregivers take care of patient’s daily needs. Home visits may be conducted by registered nurses, physical therapist, nurse assistant and social worker.
Ambulatory care
Comes from the word “ambulate” which means to walk. Ambulatory care refers to an outpatient health care setting (that you walk to and walk from). Ambulatory care includes following health care centers:
- Clinics
- Physician Offices
- School Nurse
- Mobile Clinics
- Public Health
- Rehabilitative Clinics – PT/OT
- Mental Health Clinics
- Dentist Offices
Health Care Delivery System Interface
Patients move between different levels of health care. Let’s take an example to describe the interface between nursing homes (extended care) and other health care delivery systems.
Example: An elderly patient who has fallen and broken his hip.
- Acute care setting: The patient is admitted to hospital and undergoes a surgery. Extensive physical care including physical therapy is provided to the patient. After certain period of time, he is now able to get out of bed, walk using walker and is eating well.
- Patient is transferred to Extended Care (to some nursing home) as he is not critically ill but does require round the clock assistance.
- When the patient can move safely around and no longer needs 24 hour care, he can be transferred home. A Home Health Care nurse verifies patient safety and transition into this environment. Plan for home patient treatment is established and care continues at home until patient is independent and caring for himself.
- Ambulatory Care: Patient will have scheduled appointments with doctor(s) and physical therapist to follow up and continue care.
Overall health care services normally differ from nursing home facility. Many health care settings offer health care for lesser period of time. normally, a patient’s hospital stay is for around 4 days. Where as in nursing homes, average resident stay is 20-25 days.
Challenges and Opportunities
Some of the key challenges faced by the organizations which provide long-term health care services are personnel shortages and unstable financing. Almost 91 percent of skilled health care centers are deficient in an sufficient number of staff for fundamental health care. In 2010, various researchers estimate that there will be a 30 percent shortage of aides in long-term care. Yearly revenue rates of specialized nurse aides approach 100 percent in this setting (Raphael). Job dissatisfaction is also a widespread problem. Registered and licensed practical nurses in nursing homes comprise extremely difficult and challenging job. They required handling care for residents with numerous conditions, keeping up with express advances in the field of medicine and expertise and learning how to steer family dynamics. Despite these challenges, para-professional work continues to be a low-wage business with less or literally no benefits. On the average, nurse aides earn between $10,000 and $14,000 annually (Raphael). High injury rates, minimal job security, little support, and limited opening for advancement also add to job unhappiness.
Public funds govern financing in long-term health care. The biggest foundation of community finances comes from Medicaid, which accounts for 45 percent of all long-term care expenditure, though state Medicaid expenses, eligibility, and treatment vary (Melnyk). Medicaid expenses make up an average of 15 percent of state budgets. As budget shortfall hit statehouses as a result of the weak financial system, however, two-thirds of states have begun cutting Medicaid benefits, growing co-payments, restricting eligibility, or removing people from the rolls.
As the cost of care is increasing, total expenses on nursing home care is predictable to more than triple over the next 25 years and to enhance more than five-fold in the next 45 years (Melnyk). These increases will place a heavy load on Medicaid and finally on taxpayers, most of whom are working-age grownups. at the moment, there are about 5 working-age adults per senior, but by 2030, there will only be 2.9, which is a 40 percent decline (Melnyk). This decline will occur while both the need for and cost of long-term care increase.
The 76 million Americans born between 1946 and 1964 correspond to the "baby boom" generation. In 1999, baby boomers represented almost 30 percent of the U.S. population. Over the next 12 to 30 years, the boomers will join the ranks of the residents 65 years and older. While one in eight Americans was 65 or older in 1999, this will rise to about one in five in 2030 (“Aging Statistics”). The long-term care industry will be forced to confront the challenge of who is going to care for these “baby boomers” and how it will be financed.
In conclusion, administration could broaden more power in several stages of involvement. A first stage could involve the Federal Government unifying the Medicaid compensation process by enforcing the same rules all over the country. Some states do a poor job of handling Medicaid compensation, other states do a fair job and others do a good job. Federal equalization might make it fairer for everyone.
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