From Anvita Health Wiki
Introduction
- Definition: A set of health, personal care & social services delivered over a sustained period of time to persons who have lost or never acquired some degree of functional capacity.
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- Out of pocket expenditures
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- different goals for care
- prevalence of specific conditions
- different approaches to care
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- limited data
- complicated decision making
- administrative policies & procedures
- logistical & resource constraints
- legal liability
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- funding
- regulation
- legal liability
- sociodemographic
- growth of subacute care
- growth of assited living
- prospective payment for postacute ('subacute') care
- in nursing home system, based on MDS/ RUGS
- capitated care programs
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- resident autonomy
- highest practical level of function
- quality of care standards
- medical necessity/unavoidability
- physical & chemical restraints
- resident assessment
- MDS -> triggers -> RAPS -> care plan
- increasing number of lawsuits against facilities & physicians
- bad outcome vs substandard or negligent care
- number of frail, very old people
- availability of family caregiver
- expectations of older people & their families
- sicker patient population
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- adequate reimbursement
- skilled nurses
- availability of high-quality medical care & ancillary services (laboratory, pharmacy etc)
- change in mindset
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- 11,459 facilities, average size 53 beds
- 611,300 total beds
- 521,500 residents
- unregulated care of very frail older people
- lack of health professional oversight
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- standards for staffing
- make the survey process outcomes based & NOT as adversarial & punitive
- avoid further unfunded mandates
- selected cases
- involvement of experts
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- risk adjustment (e.g. RUGS)
- adequate payments, assuming efficient care
- outcome monitoring based on quality indicators
- appropriate incentives
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- community-based programs
- institutional care
- acute hospital
- provider network
- education
- salary
- professional opportunities
- practice standards
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- liason between medical & nursing staff
- communication with families
- implement preventive strategies
- assessment & management of acute & subacute illnesses
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- basic
- translational
- clinical intervention
- health services
- fear
- costs to facilities
- subject recruitment/consent
- subject attrition
- need for multi-site studies
- human subject concerns
- Translating research into practice
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- staff training & buy in
- targeting
- CQI programs
- resident/family satisfaction
- survey process
- reimbursement for effective interventions
More General Terms
References
Ouslander, JG: In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
long-term health care
