Long term care facilities

• Long term care facilities meet the care needs

of people who are, either temporarily or
permanently, unable to care for themselves.
• That care is focused on services that work to
improve or maintain health, well-being and
physical and cognitive function, promote
independence and maximize quality of life.
• There are various types of long term care
facilities in operation today to meet differing
types and levels of care needs.
Indicators of need for long-term care
– Elderly disabled
– Nonelderly disabled (under age 65)
– Developmentally disabled (primarily the mentally
retarded)
– Mentally ill
• Activities of Daily Living (Personal Care Needs)
– Eating
– Toileting
– Mobility
– Bathing
– Dressing
• Instrumental Activities of Daily Living
– Housekeeping
– Shopping and errands
– Food preparation
– Laundry
– Chores
 Estimates of need
• Need for assistance with activities of daily
living (ADL's) increases dramatically with age.
• Only 2.6 percent of persons age 65-74 need
assistance with personal care compared with
31.6 percent of those 85 years of age and
over.
• It is estimated that 8 million persons in the
United States, two-third of whom are elderly,
need assistance with personal care.
 Assisted Living Facilities
• Assisted living facilities are housing options for people who
need some assistance with medical and/or personal care.
• They offer a variety of support services to residents to
facilitate a fairly independent lifestyle.
• Living spaces for residents may be apartments, individual
rooms or shared spaces, and these facilities typically have a
very home-like atmosphere.
• Services vary from one facility to another but often include
meals, social and recreational activities, medication
monitoring, supervision, personal care services, housekeeping,
laundry, and, in many cases, some medical services.
• These facilities benefit individuals for whom completely
independent living is difficult, unsafe, or lonely, but they do
not require the level of care provided in nursing homes or
skilled nursing facilities
 Rehabilitation Facilities
• These facilities offer expert support for recovery and
rehabilitation in people who have suffered debilitating injuries,
surgeries or medical events.
• The focus of care in these facilities is to aid patients in regaining
health and function lost to these health issues, facilitating a return
to independent living as quickly as possible.
• Intensive rehabilitative therapy and care are delivered by a
multidisciplinary team of rehabilitation specialists according to
customized treatment plans designed to meet the individual needs
of each patient.
• Patients benefit from this form of long term care in terms of faster,
more complete recoveries and greater functional gains than are
typically obtained via less intensive recovery/rehabilitation care
options
• Common types of patient conditions treated at
inpatient rehabilitation facilities include:
– Stroke rehabilitation
– Joint replacement (orthopedics) or amputations
– Head trauma (brain injury, disease or condition)
– Spinal cord injury or disease
• Common services provided through
rehabilitation include:
– Physical rehabilitation
– Occupational rehabilitation
– Speech/language pathology
– Prosthetic gait training and limb management
Physical rehabilitation vs Occupational rehabilitation
• The primary distinction between the two disciplines is that
physical therapy’s main focus is gross motor function, while
occupational therapy focuses on how the patient uses fine
motor and cognitive skills to perform tasks that are
meaningful to them.
• PTs are trained intensively in body mechanics and how
different body systems are impacted by motion,
positioning, and exercise. They typically gear interventions
toward improving strength, balance, and range of motion in
order to facilitate body movement. Treatment often targets the
spine and lower extremities.
• Contrast, an OT’s primary goal is to help patients engage in
activities in areas such as self-care, homemaking, leisure,
play, and socialization.
• OTs receive general training across a broad scope of areas.
 Speech therapy
• Speech therapy is the assessment and treatment of
communication problems and speech disorders. It is
performed by speech-language pathologists (SLPs),
which are often referred to as speech therapists.
• Speech therapy techniques are used to improve
communication. These include articulation therapy,
language intervention activities, and others depending on
the type of speech or language disorder.
• Speech therapy may be needed for speech disorders that
develop in childhood or speech impairments in adults
caused by an injury or illness, such as stroke or brain
injury.
 Skilled Nursing Facilities and Nursing
Homes
• While these two terms are often used as if
they are interchangeable, there can be
significant differences between nursing
home care and skilled nursing care – even
though both levels of care may be offered
under one roof in some facilities.
• Skilled nursing facilities offer care to
individuals who have medical problems
that require daily skilled nursing care.
• Patients may be admitted for several weeks or
months to recover and rehabilitate after a serious
medical event or may become long term residents
if ongoing care is required.
• Service includes medical care, personal care, and
physical, occupational and speech therapy, among
others.
• Individuals who can benefit from skilled nursing
facility care include those who have a
documented need for 24-hour medical
supervision and care due to acute or chronic
health problems.
• Nursing homes also offer care to individuals who need 24-hour
supervision and care.
• However, they differ from skilled nursing facilities in that they
primarily provide custodial care – which is assistance with non-
medical care, such as bathing, dressing, grooming and eating.
• People who can benefit from nursing home care include those who
do not need daily skilled medical care, but suffer a physical
disabilities or cognitive impairments that make personal care
assistance and/or supervision necessary for continued health
and well-being.
• If you are weighing long-term care options for yourself or a loved
one and are not sure which of these will best suit your current
needs, a needs assessment can help.
• These assessments evaluate eligibility for institutional or
community-based care.
• Hospital social workers, discharge planners, primary care
physicians or local senior centers can offer help in obtaining these
assessments.
 Living in nursing home Pro’s
• With long term care facilities, you are provided a
fully-serviced living environment that cares for your
every need. Staff will manage your housekeeping,
keeping both your intimate space and shared
space clean.
• Long term care facilities are specifically designed for
the elderly. There are ample hand railing and ramps,
meaning all spaces are walker-friendly and
wheelchair-friendly.
• Even for those with extremely limited mobility, the
design and layout of most long term care facilities
greatly enhances mobility.
 Living in nursing home Pro’s
• Most care facilities offer private residences, and those that
don’t will partner you or your loved-one with a compatible
roommate.
• Long term care facilities usually have extensive grounds
with beautifully landscaped surrounding, perfect for
afternoon strolls.
• There are activities centers, fully-staffed kitchens, and
convenient stores on site.
• The well-maintained living spaces of long term care
facilities are comprehensive and unmatched in the services
that can offer you or your loved-one.
 Living in nursing CONS
• Long term care facilities are known to be incredibly expensive.
• In fact, over the past 5 years the cost of long term care facilities has increased
3.5% annually.
• When you pay to live in a long term care facility, you are essentially paying
rent at a grossly-inflated rate.
• Yes, these costs cover everything from food and cleaning, to medications
and emergency care.
• Still, the average American family cannot afford the rental rates of the
average long term care facility without some form of financial assistance.
• After paying these ever-growing costs, you may not even have the option of
an individual living space.
• If you do have the option for an individual space, it will usually cost more.
• For some seeking senior care, one of the
biggest negatives of long term care facilities is
that they simply are not home.
• You or your loved-one may not want to leave
the comfort of home.
• Some may not be able to even move past the
idea of leaving such an intimate space, after so
many years, and moving into a bustling
facility.
.
 Medical Support at Long Term Care Facilities Pro’s

• Possibly the greatest benefit of long term care facilities is their

constant and comprehensive medical care.
• At a long term care facility you will have constant access to health
care services. Trained, medical professionals will tend to minor
injuries, major injuries, and assist with the administration of
prescriptions.
• Most importantly, long term care facilities offer emergency medical
services–some even have 24-hour monitoring services so you or
your loved-one will never be stranded in need.
• At a long term care facility, risks of injury are dramatically reduced
because of the constant on-site assistance. Should you or a loved-
one slip or fall, medical attention will be received immediately,
minimizing injury.
• On-site medical care is conducted by registered
nurses able to care for most injuries, illnesses,
or conditions.
• The medical services offered by long term care
facilities are particularly positive to those who
are suffering extremely debilitating illnesses, or
those who have lost mental faculties.
• Overall, long term care facilities maximize
health and safety, protecting you or your loved-
one from unnecessary injury and providing
professional medical care as soon as it’s needed.
Medical Support at Long Term Care Facilities
Cons
• Though the comprehensive medical services offered by long term care
facilities are unmatched, some may consider certain aspects of care
impersonal.
• Long term care facilities usually have large staffs, complete with
trained specialists who can provide a wide range of assistance.
Though, staffing often circulates, with certain facilities having a higher
turnover rate than others. Depending on how shifts are managed, your
loved-one may not have the same caregiver assisting with more
private matter.
• For instance, your loved-one will have immediate assistance with any
of their Activities of Daily living–however, the same caregiver may not
always help with more delicate matters like bathing and continence
• If you or your loved-one are uncomfortable with the idea of not being
tended to by the same familiar caregiver (and your needs are not
severe), in-home care may be a better option than the larger, more
 Infections in nursing homes:
• Over 1.5 million people live in 16,000 nursing homes in
the USA and experience an average of 2 million
infections a year.
• Infections have been associated with high rates of
morbidity and mortality, rehospitalization, extended
hospital stay and substantial healthcare expenses.
• Emerging infections and antibiotic-resistant organisms in
an institutional environment where there is substantial
antimicrobial overuse and the population is older, frailer
and sicker, create unique challenges for infection control. 
• Infections in NH residents have been associated with
adverse clinical outcomes, including high rates of
morbidity and mortality, rehospitalization, prolonged
hospital stay and substantial healthcare expenses
 COVID-19 And long term facilities
• The COVID-19 pandemic has affected older people
disproportionately, especially those living in long-term care
facilities.
• In many countries, evidence shows that more than 40% of
COVID-19 related deaths have been linked to long-term
care facilities, with figures being as high as 80% in some
high-income countries.
• Concerted action is needed to mitigate the impact across all
aspects of long-term care, including home- and community-
based care, given that most users and providers of care are
those who are vulnerable to severe COVID-19.
 Condition of nepal
• Demographic Changes : Life expectancy in
Nepal has increased from approximately 27
years in 1951 to 64 years in 2008 (CBS, 2008).
There has been a sharp rise in the relative and
absolute size of the elderly population in the
past four decades.
 Socio- economic Conditions
The majority of elderly in Nepal are living in
rural areas (85 %+).
They are usually active and productive in their
advancing years doing things such as taking
responsibilities for child care, cattle herding,
handicrafts and many more.
Among 65+ years aged persons, 47.12% are
found economically active with sex differential
of 59.7% for males and 34.3% for females.
 Health
• The Nepalese Council of Ministers on 2061-05-03 BS
adopted a guidelines entitled Jeshtha Nagarik
Swashthopachar Sewa Karyakram Karyanyowan
Nirdeshika 2061BS (Senior Citizens Health Facilities
Program Implementation Guideline, 2061BS) which
attempts to provide medical facilities to the old age people.
• The government has provision to establish Jeshtha Nagarik
Swashthopachar Kosh (Senior Citizens Health Facilities
Fund) in each district.
• The government allocates some fund each year for each
district for the purpose.
• Following the “Senior Citizens Health Facilities
Program Implementation Guideline, 2061 BS”, the
poverty affected elderly people are provided free
medicine and treatment up to NRs.2000 at a time in all
75 districts from the fund.
• The Government has proclaimed through the budget
speech of fiscal year 2066/67 that the government will
provide free health service for heart and kidney patient
of 75 years and above age.
• The current fiscal year (2066/67) budget also has
provision to establish one health center for the elderly
“Aarogya Aashram” in each of the five development
regions of the country.
• Nepal has developed various policies and
programs to expand the health care services to
its population.
• It is stated in the Constitution to provide
essential health care services free of cost to
ultra poor, vulnerable, poor, senior citizens,
people living with physical and psychological
disabilities, and women.
 Recommendation
• Socio-economic, health and nutritional survey of
conflict affected elderly population should be
carried out with high priority.
• Promote health research activities in
collaboration with universities, colleges and old
age homes both in private and public sectors.
• Develop research programs on various Geriatric
Health Problems and strengthen National Health
Research Center for the purpose.
• Carry out a monitoring and evaluation study to
improve upon the existing system of subsidy for
hospital beds to older people.
• Conduct a review study on social, economic and
environmental determinants of healthy ageing.
• Carry out a feasibility study on providing health
and medical services for healthy older persons
and frail older people living in their own homes.
• Prepare feasibility study for establishment of
modern and well equipped Geriatric Centers and
Old Age Homes in different parts of the country.