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Chapter 3. Nursing Care Facilities

Long-Term Care: Managing Across the Continuum

(Second Edition)

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Learning Objectives

1. Define and describe nursing facilities2. Identify sources of financing for nursing

facilities 3. Identify and describe regulations affecting

nursing facilities 4. Identify and discuss ethical issues affecting

nursing facilities 5. Identify trends affecting nursing facilities

into the future and the impact of those trends

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What is a Nursing Facility?

Includes:Facilities licensed by the states offering

room, board, nursing care and some therapies

Those certified by Medicare as Skilled Nursing Facilities (SNF) and what used to be called Intermediate Care Facilities (ICF)

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How Nursing Facilities Developed

Early charity-based forms of care Poor public imageIncreased regulationSignificant improvementStill under scrutiny

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Philosophy of Care

Medical vs. Social Model “care vs. cure”

Multidisciplinary approach

Family involvement

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Ownership of Nursing Facilities

Largely for-profit (2/3+)Nonprofit (1/4+)Few governmentGrowth in multi-facility chains (55%)

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Services ProvidedNursingPhysical TherapyOccupational TherapySpeech TherapyMedical/DentalMedicationsLaboratory & X-RayRoom & Board

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Special Care UnitsBy diagnosis or disability:

Alzheimer’s DiseaseMental Health & RetardationBrain InjuryAIDS

By age:PediatricYoung adult

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Those ServedElderly - over 90%Female - three-quartersBoth physical and mental disabilities

- two-fifths have dementia

- one-third with depressionActivities of daily living (ADLs)

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Activities of Daily Living (ADLs)

• Bathing

• Dressing

• Eating

• Toileting

• Transferring

[Average resident needs help with 4 ADLs]

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Market Forces

Need-driven admissionsFamily & physician initiated

admissionsLocation relative to familyAvailability of alternatives

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Regulations

Purpose of regulations:

1. Care is safe and of high quality

2. Care is not overly expensive

3. Services are uniformly accessible

4. Rights of workers are protected

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Types of Regulations

Affecting residentsAffecting employeesAffecting building

construction & safety

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Financing Nursing Facilities

Reimbursement sources:Medicaid - 46%Medicare - 12%Private pay and other

sources – the remainder

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Medicare Coverage

Restrictions:Covers only skilled nursing careMust follow 3-day hospital stayLimited to 100 days per “benefit period”Requires co-payment for days 21 - 100

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Staffing & Work Force

NursingCertified Nurse Aides (CNAs)Medical coverageOther professional staff

- Often on contract basis

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Legal & Ethical Issues

Responsibility to:Protect residents’ rightsAct ethically

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Types of Legal/Ethical Issues

Day-to-day issues:• Autonomy (choice)• Privacy

End-of-life issues:• Advance directives

(living will, durable power of attorney)

• Patient Self-Determination Act• Cognitive ability?

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Management Qualifications

Licensed by the statesMany different state regulations re:

Minimum education Hands-on experience Continuing education

NAB

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Management Challenges& Opportunities

Balancing cost and qualityIntegration of differing levels of

serviceCoordination with other

facilities & organizations

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Significant Trends

Rising acuity levelsManaged careProspective paymentPrivate insuranceRising liability costsConsumer choice

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Summary

Nursing care facilities have a long history, but are evolving, as is the overall system. They have gone from being the dominant form of long-term care to one

of many provider types.