Long Term Care Planning: Specialty Community-Based Long Term Care

We were invited to write a series of brief articles for the monthly newsletter of our friends at MDK Insurance Services, describing the continuum of long term care, and how to navigate oneself through it. You can sign up for the newsletter on their website, and each month we provide a copy of the article here as well. Please share the information with someone you know who is thinking ahead about how to plan for (and pay for) their own or a loved one's long term care. 

Volume VII: Specialty community-based long term care

Last month’s issue provided an overview of the basic types of long term care facilities. Here we review a few models of specialty care that are available in the community.

There are several types of specialty Skilled Nursing Facilities (SNFs) in California. A Distinct Part/SNF (DP/SNF) is a hospital-based unit, rather than a freestanding facility. Intermediate Care Facilities (ICFs) provide inpatient care to those who need nursing and supportive services, but who don’t require continuous skilled nursing care.

A Continuing Care Retirement Community (CCRC) is a configuration in which Independent Living, Assisted Living, and Skilled Nursing Facility services are provided on one campus. A resident contracts for care regardless of changing needs, usually for their lifetime. Most CCRCs have a large entrance fee, ranging anywhere from $100,000 to $1 million. CCRCs are regulated by California’s Department of Social Services Continuing Care Contracts Branch.

Some residential care facilities offer specialized services for people with dementia. Dementia Care can be provided within a freestanding facility, or as a separate unit within an Assisted Living facility. Staff are trained to work effectively with people with Alzheimer’s and other types of dementia, and activity programs are tailored to the special needs of the residents. Buildings have secured perimeters to prevent unsafe wandering.

Hospice Care provides comfort and support to patients with terminal illness that is not responding to cure-oriented treatment. Hospice may be provided within the home or in a facility setting, with the goal of maximizing quality of life through effective symptom and pain management. Services provided by an interdisciplinary team address the emotional, spiritual, and social impact of the illness upon the patient and their family.

Restraint Use Declining in Nursing Homes

There was an article in USA Today recently that described a decline in the use of restraints in nursing homes in the United States. This is good news for nursing home residents across the country, and for those of us who advocate for seniors.

Restraints were once commonly used in nursing facilities to control the behaviors of residents with dementia or other psychiatric conditions and to prevent falls. The use of restraints in facilities has declined over time, but education is still needed to help families and health care professionals seek alternatives. In fact, California is one of the U.S. states with the most room for improvement. The most recent data from Medicare in 2007 indicated that 10% of nursing home residents in CA were restrained, while the national average was 5.5%

What is a restraint? The National Consumer Voice for Quality Long-Term Care (NCCNHR) defines a physical restraint as an object or device that an individual cannot remove easily and which restricts freedom of movement or normal access to one's body. Common restraints include: seat belts on wheelchairs, vest restraints, geri-chairs, hand mitts, side rails and lap trays.

Many families and health care providers believe that restraints help nursing home patients to be "safer," though research shows that often times the opposite is true: individuals who are agitated frequently become more agitated when they are restrained. Behavioral approaches such as validation and redirection, as well as activity engagement, can often help agitated people to become less agitated.

As a Geriatric Care Manager monitoring the well-being of clients in nursing homes and in the home setting, it is my responsibility to advocate for no restraint use, or minimal restraint use that is re-evaluated frequently and discontinued as soon as possible.

Finding the Right Nursing Home

This morning's Today Show (NBC) featured an interview with Sarah Baldauf, who wrote a comprehensive, step-by-step guide to finding the right nursing home for U.S. News & World Report. Click here to read the article and watch the video.