Research Paper on "Long-Term Care in a Skilled Nursing Facility"

Research Paper 7 pages (2070 words) Sources: 12

[EXCERPT] . . . .

Long-Term Care in Skilled Nursing Facilities

The elderly population of the United States is increasing rapidly, making the need for long-term care in skilled nursing facilities more important than ever. While tens of thousands of these facilities are already in place, there will be a corresponding need for more skilled nursing facilities in the future than can provide the long-term care the elderly require. Therefore, identifying the long-term care needs of residents in skilled nursing facilities represents a timely and important enterprise which is the focus of this paper. A review of the relevant literature is followed by a summary of two telephonic interviews with registered nurses working in skilled nursing facilities to help identify these needs, followed by a summary of the research and important findings in the conclusion.

Review and Discussion

The elderly segment of the American population is rapidly growing and these trends are projected to continue as the Baby Boomer generation reaches retirement age and beyond. Just 30 years ago or so, more than 80% of all long-term care was provided by family members (Kunkel and Wellin 2006). By sharp contrast, Kunkel and Wellin also note that, "Since that time, there has been a continued increase in the size of the disabled older population, particularly in the proportion of the oldest old, those who are most likely to need long-term assistance" (2006:141). While the percentage of white elderly is projected to nearly double in size by 2030, the percentages of ethnic minorities is expected to increase by as much as 530% by that time (Johnson 1999). According to Williams, Nowak and Scobee, "By the year 2050, an estimated 87 million Americans will be 65 years of age or older, and 21 million will be 85 years old or older Although fewer than 5% of these older adults will reside in long-term care, a significantly higher percentage will require long-term care at some point in their lives" (2006:190). In response to these trends, thousands of skilled nursing facilities have been built across the country. According to Osgood, Brant and Lipman, "There are more than 23,000 long-term care facilities serving over 1.5 million older adults. The average number of nursing home residents is expected to increase over 50% between 1989 and the year 2020" (1999:8). Besides the elderly, other segments of American society also frequently require long-term care in a skilled nursing facility. For instance, Vladeck, Miller and Clauser report that, "People with disabilities and chronic illnesses who require long-term care encompass diverse populations, including persons with acquired immunodeficiency syndrome, children who are technology dependent or otherwise disabled, persons with mental retardation and related conditions, and those experiencing serious mental illness or problems of substance abuse" (1993:5).

While the need for long-term care is rapidly growing, there remain some significant constraints in terms of funding for long-term care. In this regard, Johnson reports that, "With longevity comes the likelihood of chronic illness and the possibility of disability and long-term-care needs that, among other costs, are subsequently translated into economic issues for family and professional caregivers" (1999:2). Indeed, Tepper and Cassidy (2004) emphasize that the cost of long-term care in a skilled nursing facility may amount to more than $100,000 per year, but Medicare and Medicaid do not always cover these costs. In this regard, Hibschweiler, Hopson and Bankosh report that, "Long-term care benefits provided under Medicare are generally of a very limited nature" (1999:69). Likewise, Vladeck and his associates note that, "This review of the current long-term care system reveals that Medicare and Medicaid are not structured to effectively respond to diverse acute and chronic care needs of persons with disabilities" (1993:5) and Cassidy emphasizes that, "Long-term care often can wipe out the life savings of a chronically ill patient in one year or less" (1998:30).

Pursuant to Medicare's hospital insurance program (Part a), benefits can be provided for skilled nursing facility care provided that all of the following five conditions are met:

1. The person has been hospitalized for at least three consecutive days, not counting the day of discharge, prior to transfer to the facility;

2. The patient is transferred to the facility because care is required for a condition that was treated at the hospital;

3. Admission to the facility is within a "short time" (generally 30 days) of discharge from the hospital;

4. A physician certifies that the patient needs and receives skilled nursing or skilled rehabilitation services on a daily basis; and,

5. Confinement at the facility is not disapproved (by a utilization review committee or other intermediary body) (Hibschweiler et al. 70).

In those cases where skilled nursing or rehabilitation services are only required periodically (i.e., once or twice a week), Medicare does not pay for skilled nursing facility benefits (Hibschweiler et al. 1999). According to Rosenblatt, "The key is that a person must have a medical condition that is being treated -- and that providers expect will improve. However, for someone with Alzheimer's disease or cognitive impairment from a stroke, Medicare will not pay for skilled nursing facility care, even for patients who are unable to care for themselves" (2008:2). As Leutz, Capitman, McAdams and Abrahams emphasize, "The strict limits on Medicare coverage mean that services are often inadequate to the needs of frail, medically complex patients. Medicare nursing home coverage requires a prior hospital stay, care in a skilled nursing facility and active participation in a rehabilitation program under a physician's orders" (1992:183). Moreover, with few exceptions, states are not allowed to provide long-term care only in an institution in those cases where an individual's needs can be met in the community (Donlin 2003). In some cases, Medicaid can be used for these purposes. In fact, Medicaid remains the primary funding device for long-term care in the United States, with more than $75 billion being spent in 2001 and another $22 billion being spent for community-based care (Donlin 2003). These are important issues because of the sums involved, as well as who is paying the tab. According to Cassidy, "Financing long-term care is supposed to be the responsibility of the patient. In reality, the burden falls on the taxpayer, because the payments for almost 70% of the long-term care needs of older patients are paid for by Medicare and Medicaid" (1998:30).

Although all elders are unique, of course, there are some commonalities involved in their responses to long-term care in skilled nursing facilities. In this regard, Osgood et al. note that, "Loneliness is a universal phenomenon. More than 80% of the institutionalized elderly are likely to show symptoms of isolation and loneliness. Depression is also prevalent among older residents of long-term care facilities" (1999:133). The impact of these reactions are cumulative and can produce even greater problems for long-term care residents. According to Osgood and her colleagues, "Residents of long-term care institutions often express feelings of loneliness and emptiness, loss of self-esteem and diminished morale, and loss of control during depressive episodes" (133). Long-term care elders in skilled nursing facilities are also at higher risk of committing suicide (Osgood et al. 1999).

Taken together, there are some significant problems associated with providing high quality long-term care in skilled nursing facilities that transcend the strictly physical needs of these individuals, and make the need for a more informed approach more important than ever. To gain some additional insights into the long-term care needs of residents of skilled nursing facilities, two structured telephonic interviews were conducted using a standard set of questions with registered nurses who work in these facilities and the results of these interviews are presented in Tables 1 and 2 below.

Table 1

Interview No. 1: "Jill a.":

Interview Question

Response

What do you see as the most important needs for long-term care residents in skilled nursing facilities?

Besides their immediate physical needs, I think one of the most important needs for long-term care resident is to keep them actively engaged spiritually and emotionally. If elders aren't provided with these opportunities, they run the risk of becoming depressed and that's a downward spiral we want to avoid.

How does your facility address these needs?

Our center has an innovative program in place where kindergarten students from local public schools have their classes on site where residents can watch the children at play. We also encourage interaction between the kids and our residents. We also encourage residents to keep pets if they want and this has been an effective way to keep elders engaged.

Do you have any advice for caregivers contemplating placing family members in skilled nursing facilities?

Be sure to shop around. Visit the centers and see how people are being treated and even what it smells like. Also, check with your primary physician to see what he or she has to say. These healthcare professionals may be in a good position to know which facilities provide the best care.

What can be done to better address the needs of long-term care residents in skilled nursing facilities?

Well, certainly more money would help but this is not the… READ MORE

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