About Long Term and Post Acute Care
The traditional segmentation of the healthcare profession is made up of two major sectors: Acute Care and Ambulatory Care. With the movement to person centric longitudinal healthcare and eliminating provider silos, adding a third segment of healthcare better defines the full spectrum of care. The emerging care models also encourages the care of an individual in the best care setting, at the right time, at the right acuity, and cost. Over the next four years as more accountable care organization and medical home models are adopted there is a possibility of only one healthcare segment, the individual. Today, adding the long term & post acute care (LTPAC) sector provides professionals with a full view of the total spectrum of care.
The following graphic illustrates the LTPAC healthcare segment. Even though hospitals are considered members of the Acute Care healthcare segment they are listed as a reference point.
There are 16,000 Centers for Medicare and Medicaid (CMS) licensed skilled nursing facilities in the USA. Skilled means that there is skilled nursing (Registered Nurses) available 24x7. The approximate number of beds is 1.6 million. The national average length of Medicare stay (LOS) is 28 days but up to an estimated 43 days when chronic care with co-morbidity patients are sent to a SNF for rehabilitation after an episodic visit to a hospital. There are also long term care residents under Medicaid that reside in SNFs. SNFs are reimbursed on a per-deum basis determined by severity of illness. Nursing Facilities (NF) are basically nursing homes that do not have skilled nursing staff.
Home care, including hospice, is a significant component of the health care delivery system. Home care encompasses a wide range of health and social services that are delivered to recovering, disabled, chronically or terminally ill persons to enhance their ability to live in their home and remain fully integrated in the community. Hospice care involves a core interdisciplinary team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for the terminally. Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends. Home care services may include medical, nursing, social, or therapeutic treatment and/or assistance with the essential activities of daily living (e.g. bathing, dressing, meal preparation).
In most cases, the delivery of quality home care services is very dependent upon the collaboration and sharing of health information among various health care providers across the care continuum. These providers include physician practices, hospitals, skilled nursing facilities, rehabilitation facilities, case managers and other related healthcare professional.
Currently 12 million people receive community-based care from home care and hospice providers to help with post-acute and chronic conditions, disabilities, or terminal illnesses. As more and more older people prefer to age in place and elect to live independent, non-institutionalized lives, they are choosing to receive home care services as their physical capabilities diminish. Younger adults who are disabled or recuperating from acute illness are choosing home care whenever possible. Chronically ill infants and children are receiving sophisticated medical treatment in their loving and secure home environments. Adults and children diagnosed with terminal illness also are being cared for at home, receiving compassionate care and maintaining dignity at the end of life.
- 33,000 home health care providers treat 12 million patients annually.
- Medicare certified home health providers treat nearly 3.5 million patients annually.
- Medicare home health services cost approximately $41 per day over a 60 day episode of care, compared to skilled nursing facilities which cost $358 a day and hospitals which cost $1,805 a day.
- Just over 65 percent of all home health agencies now have electronic medical record (EMR) systems.
- Twenty three percent of home health agencies reported using telehealth systems in 2009, up from 17.1% in 2006.
- The Veterans Administration realized a 25 percent reduction in the number of bed days of care, a 19 percent reduction in hospital admissions, and an 86 percent satisfaction rate of veterans being seen in their home using remote monitoring technology.
There are 428 CMS licensed long term acute care hospitals in the USA. Long Term Acute Care (LTAC) hospitals serve a valuable role in the spectrum of American healthcare by caring for patients who need longer than usual hospital stays, on average 25 days or more. (By comparison, the average length-of-stay in short-term hospitals is only 5-6 days.). Access to these hospitals is crucial to a small but critically-ill population of patients. LTAC hospital patients are severely-ill, medically-complex patients with multiple co-morbidities.
The inpatient rehabilitation facility (IRF) benefit is designed to provide intensive rehabilitation therapy in a resource intensive inpatient hospital environment for patients who, due to the complexity of their nursing, medical management, and rehabilitation needs, require and can reasonably be expected to benefit from an inpatient stay and an interdisciplinary team approach to the delivery of rehabilitation care.
Assisted living is often viewed as the best of both worlds. Residents have as much independence as they want with the knowledge that personal care and support services are available if they need them. Assisted living communities are designed to provide residents with assistance with basic ADLs (activities of daily living) such as bathing, grooming, dressing, and more. Some states also allow assisted living to offer medication assistance and/or reminders. Assisted living communities differ from nursing homes in that they don’t offer complex medical services.
Medication Management is a distinct service or group of services that optimize therapeutic outcomes for individual patients. Medication Management services are independent of, but can occur in conjunction with, the provision of a medication product. Medication Management encompasses a broad range of professional activities and responsibilities within the licensed pharmacist's, or other qualified health care provider's, scope of practice. These activities focus on reducing drug related side effects and polypharmacy (over prescribing medications). Today, this patient consulting function is part of the responsibilities of multiple pharmacists, which reside in SNFs, hospitals, and retail pharmacies. In a person centric elderly care environment a single certified senior care geriatric pharmacist will be reviewing a person’s medications across their spectrum of care.
PACE is a capitated benefit authorized by the Balanced Budget Act of 1997 (BBA) that features a comprehensive service delivery system and integrated Medicare and Medicaid financing. The PACE model was developed to address the needs of long-term care clients, providers, and payers. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than be institutionalized. Capitated financing allows providers to deliver all services participants need rather than be limited to those reimbursable under the Medicare and Medicaid fee-for-service systems.
Participants must be at least 55 years old, live in the PACE service area, and be certified as eligible for nursing home care by the appropriate State agency. The PACE program becomes the sole source of services for Medicare and Medicaid eligible enrollees.
An interdisciplinary team, consisting of professional and paraprofessional staff, assesses participants' needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PACE programs provide social and medical services primarily in an adult day health center, supplemented by in-home and referral services in accordance with the participant's needs. The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the care of the PACE participant.
PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible enrollee. PACE providers assume full financial risk for participants' care without limits on amount, duration, or scope of services.
Independent Care is when an individual contracts with a healthcare professional to provide their care.