Hello, My name is Kim and I am currently a first year nursing student at the University Of Madison. Coincidentally, I am enrolled in a health care class where we are discussing much of the same topics. I am still extremely confused on many of the health care concepts and feel that it would take years for me to learn and understand everything. With the growing number of older adults, long term care needs to be reformed- in my opinion. Below I will tell you why I believe this to be true.
When I first entered into the nursing program , I had this thought that I would be working with middle-aged persons or younger individuals. Much to my surprise, many of my clinical patients are ages 65+. Out of the past 8 months of clinical work, I can only remember maybe 5 or 6 of my patients being younger; and they were still all over 50. We need to realize that within the next decade or so the number of persons over the age 65 will reach almost 70 million (CDC, 2010). Also, it is alarming that the number of qualified professionals in geriatrics is extremely low. There needs to be more individuals educated in order to care for this growing population. I have seen first-hand the number of elderly patients that are admitted into the hospital on a daily basis.
A few weeks ago, one of my patients was a 76 year old man suffering from dementia and severe arthritis. During the day, I was in charge of administering his medication and helping him with his daily functions. His children were there the entire day and were critiquing my work. It was extremely frustrating as a nurse to have these individuals "watching me like a hawk" as I tried to care for him. This situation made me realize how we need a reform in long term care.
I feel that long term care needs to take on a more "home" based setting. Often, the children or close friends know the individual extremely well and have knowledge on how that patient would want to be cared for. Also, agreements between care givers must be made prior so individuals know how to handle certain situations. Another benefit of a more home-based care, is the attention the patient will receive. In a hospital or nursing home setting, it is impossible for the professional to be present 24/7. In a smaller, intimate, and more personal setting the care-giver can be attentive to the needs of the patient.
Lastly, I believe the health reforms this team proposed are accurace, consistent, and much needed in todays health care setting. There needs to be reform within the long term care setting and with proper action, this team could be the first to propose these important ideas.
Thursday, April 15, 2010
Growing up, my parents had medical insurance. I didn’t know any different. So when I was looking for employment as a young adult, finding an employer with medical insurance was a factor because down the road it would be necessary to have good coverage/long-term health care. When I married and had a family, I was the sole carrier of the medical insurance for my family for many years. I have been employed at a healthcare facility for 25 years and I realize times are changing. I am uncertain what long-term care will be available for me and I ask what lies ahead for my children? My parents have been retired for many years now, and continue to live at home independently. They have good healthcare.
I have had a grandmother spend her final years in a long-term health care facility. She was well taken care of and to be very honest, I have no idea what sort of long-term health care coverage she received. I would guess that it was medicare/medicaid. At 93 y/o, grandma suffered a stroke and they transported her to the hospital. It was her wish to have no life prolonging measures performed. So she was transported back to the care center and kept comfortable until her passing. 20 yrs ago, I believed my grandmother received proper long-term care.
Since that time, I’ve had my father-in-law in the same facility. My father-in-law was in his late 50’s and suffered from MS. My mother-in-law had already passed away and my husband was his power of attorney. We attempted to keep my father-in-law at our home for us to take care of, but with the young family we had and the care my father-in-law needed, it just was not possible. The county social worker visited and evaluated my father-in-law and in that very same afternoon, moved him to the care center facility in our town. My father-in-law was self-employed and therefore carried his own health insurance. After my mother-in-laws battle with cancer, my father-in-law was left with a great deal of debt. So any monies he had for his own long-term care was limited. When his own health care coverage ended, and a great deal of paperwork completed, he received Medicaid. I believe that my father-in-law was well taken care of for the less than ideal situation he was dealt in life.
This blog has brought some very interesting proposals. All of which could work for the right individual/situation. We can argue with the guidelines that the insurance companies are dictating for long-term care. But there will never be 100% approval. I believe that everyone’s situation is different; everyone’s expectations are different.
I think Holistic health care is a good thing, but should be covered by long-term health care (chiropractic included). Education on holistic health care would need to improve for individuals to buy into, especially our elderly. Most medical doctors do not believe in Holistic therapy; so many patients won’t buy into it at first. Those that I know who use holistic therapy are those who are looking for a change because current and some times long term medical treatments are no longer working. For instance, I have a friend who has suffered from chronic pain for the last 10 yrs. Her medical doctor has prescribed meds for her pain, and then also offered her anti-depressants because, “Everyone who suffers from chronic pain also has depression.” So after years of masking the pain and treating her for depression never actually diagnosed, she has sought help from a homeopath who is addressing her pain which in turn is alleviating much of her pain and has taken away the antidepressants. Holistic Health care focuses on the entire person’s well-being. Isn’t that one of the most important issues we are looking for in long-term healthcare – everyone’s personal well-being? If this therapy is working, then shouldn’t our healthcare cover those expenses?
My employer does have an affiliation with a long-term healthcare facility in close proximity. Residents of this facility benefit from the closeness to our healthcare institution. Residents have choices regarding their care. They can choose from 1 and 2 bedroom apartment styles for independent living; Home healthcare; assisted-living programs; and on-site skilled nursing care are available when needed. If necessary a medical professional from our institution will make a “house call”. I don’t receive preferential treatment because this facility is associated with my employer (no part of my benefits). Many residents are individuals who have had and continue to live with life-long diagnosis that requires them to be seen frequently at our medical center.
As far as my own long-term healthcare, with the current changes in legislature, it is unclear what I will receive from my employer. I’ve already seen changes in premium payments and coverage. I’ve gone from 100% to 80% and my monthly medical insurance rate has almost doubled. I, like the majority of employees, supplement our retirement with outside plans because we will need more later in life. Many employees who are eligible are retiring this year because they’ve heard the future is not going to be good. At this time there is uncertainty and changes are evident. But will they be for the better or the worse? Who knows, maybe every American will be equal; everyone will receive exactly the same long-term healthcare.
I have had a grandmother spend her final years in a long-term health care facility. She was well taken care of and to be very honest, I have no idea what sort of long-term health care coverage she received. I would guess that it was medicare/medicaid. At 93 y/o, grandma suffered a stroke and they transported her to the hospital. It was her wish to have no life prolonging measures performed. So she was transported back to the care center and kept comfortable until her passing. 20 yrs ago, I believed my grandmother received proper long-term care.
Since that time, I’ve had my father-in-law in the same facility. My father-in-law was in his late 50’s and suffered from MS. My mother-in-law had already passed away and my husband was his power of attorney. We attempted to keep my father-in-law at our home for us to take care of, but with the young family we had and the care my father-in-law needed, it just was not possible. The county social worker visited and evaluated my father-in-law and in that very same afternoon, moved him to the care center facility in our town. My father-in-law was self-employed and therefore carried his own health insurance. After my mother-in-laws battle with cancer, my father-in-law was left with a great deal of debt. So any monies he had for his own long-term care was limited. When his own health care coverage ended, and a great deal of paperwork completed, he received Medicaid. I believe that my father-in-law was well taken care of for the less than ideal situation he was dealt in life.
This blog has brought some very interesting proposals. All of which could work for the right individual/situation. We can argue with the guidelines that the insurance companies are dictating for long-term care. But there will never be 100% approval. I believe that everyone’s situation is different; everyone’s expectations are different.
I think Holistic health care is a good thing, but should be covered by long-term health care (chiropractic included). Education on holistic health care would need to improve for individuals to buy into, especially our elderly. Most medical doctors do not believe in Holistic therapy; so many patients won’t buy into it at first. Those that I know who use holistic therapy are those who are looking for a change because current and some times long term medical treatments are no longer working. For instance, I have a friend who has suffered from chronic pain for the last 10 yrs. Her medical doctor has prescribed meds for her pain, and then also offered her anti-depressants because, “Everyone who suffers from chronic pain also has depression.” So after years of masking the pain and treating her for depression never actually diagnosed, she has sought help from a homeopath who is addressing her pain which in turn is alleviating much of her pain and has taken away the antidepressants. Holistic Health care focuses on the entire person’s well-being. Isn’t that one of the most important issues we are looking for in long-term healthcare – everyone’s personal well-being? If this therapy is working, then shouldn’t our healthcare cover those expenses?
My employer does have an affiliation with a long-term healthcare facility in close proximity. Residents of this facility benefit from the closeness to our healthcare institution. Residents have choices regarding their care. They can choose from 1 and 2 bedroom apartment styles for independent living; Home healthcare; assisted-living programs; and on-site skilled nursing care are available when needed. If necessary a medical professional from our institution will make a “house call”. I don’t receive preferential treatment because this facility is associated with my employer (no part of my benefits). Many residents are individuals who have had and continue to live with life-long diagnosis that requires them to be seen frequently at our medical center.
As far as my own long-term healthcare, with the current changes in legislature, it is unclear what I will receive from my employer. I’ve already seen changes in premium payments and coverage. I’ve gone from 100% to 80% and my monthly medical insurance rate has almost doubled. I, like the majority of employees, supplement our retirement with outside plans because we will need more later in life. Many employees who are eligible are retiring this year because they’ve heard the future is not going to be good. At this time there is uncertainty and changes are evident. But will they be for the better or the worse? Who knows, maybe every American will be equal; everyone will receive exactly the same long-term healthcare.
Monday, April 12, 2010
Patient
I think that long-term health care needs to be made more affordable for everyone involved. Our family of seven grew up on a small farm, so extra money was not plentiful. There was no way to put any money away for a long-term health care situation or afford the insurance one may or may not use. As I recall from my younger years, health insurance was not a priority issue to my family because we did not run to the doctor for a scratch or cough. I don't remember Dad ever saying anything about medical insurance. We got out of the house and worked hard to get exercise and stay in shape to do the farm work. Also, back then medical procedures were a fraction of the cost compared to now.
This was one of several reasons why Mom didn't want to go to a nursing home when she became ill nearly ten years ago. She had visited friends and relatives in nursing homes over the years and had the opportunity to see how they were cared for. After seeing this she had always commented that she would never want to go to a nursing home. In conversations with other people who have patients in long-term care facilities, the patients are put on schedules and have to stick to them whether they like it or not. Everything is dictated as to when and where they have to be.
Fortunately, when Mom was diagnosed with an illness that would eventually take her life, she was able to make decisions about her care up until the last three to four months of her life. She was able to get around most of the time with the aid of a walker but it was still a challenge for her to do some things. Eventually she was down to where she had to use a wheelchair and eventually was confined to a bed set up in her living room. We were able to respect her wishes but it did no come without sacrifices to family and friends.
One thing she did have was a circle of family and friends that were willing to come in and visit with her. They made offers to help her do things around the house, run errands, sit and listen to her, or even entertain her in the privacy of her own home. This allowed her to do things that she wanted to and did not have to be on a schedule to do anything if she did not want to. With the help of her friends, the family was able to get time away to spend time with their own families. I am not saying Mom was a burden to the family, but many personal sacrifices were made to schedules to make things work and that everybody took their turn to help with her care.
Near the end of her life she has spent some time in the hospital which was harder on her because she did not want to be there. There was talk of sending her to a nursing home but Mom said no to this. She wanted to go home. We as a family, had to decide and work out a plan with our family/friends on how to grant her final wishes. When hospice came in to help we were able to get a home health nurse to come in several days a week to help her get breakfast and shower in the morning, and help her freshen up for the day. This service relieved some of the stress on the family and gave them opportunity to get a way for a little while. We simply knew that hospice was a call away if we had questions. I think that they were the most helpful during the long-term care process because they covered everything in detail to make things run smoothly.
Another thing that Mom did during her illness was to visit a chiropractor several times a month, but Medicare and Medicaid only allowed for so many visits to be covered. Her number of treatments exceeded this amount so she worked with the chiropractor to continue her care and not use all her finances to pay for care. This treatment helped relieve some of the symptoms of her medical illness. She was fortunate to live in a small town, where the chiropractor knew her and her circumstances and would help her with her billing to help prevent large bills from being accumulated. Sometimes I feel that living in a small community has some advantages when it comes to health care. One can be a person, not just a number. There are still people that care about the patient and not just the almighty dollar and how much they can collect from insurance companies or even the patient themselves.
It just does not seem fair that the government or insurance companies should be able to tell doctors or nurses how to take care of patients. Each case is unique in it's own way. I feel that it should be left up to the people who know the patient to get the proper treatments. I feel that the government should have less control over how much of the service can be provided to the individual in need, and the doctor should be able to work alongside the insurance company to help the patient to the best of their ability
We can not tell the government how to do their job. Sure we can protest but will they listen to the public? It takes a long time to have a specific government official voted out if we want to see some sort of change. I feel that the health care bill that was just passed may mess more things up than it will help but then who knows. I understand that everyone should have access to affordable health care, whether it is long-term or short-term but why does everything have to be so complicated just to get the coverage that we need? It is bad when the law that is passed is confusing even to the lawyers of the insurance companies! I heard that my employer's insurance company has lawyers working to interpret the current health care reform. I think that the government officials need to make the bill understandable to everyone! There is no reason why they continue to speak at a higher reading level that the average citizen of the United States.
Who is getting screwed? Us as a patient because I can't see the government screwing up, can you?
I feel that the health care reform that was recently passed may be a step in the right direction, but it is not going to solve all of our health care issues. I agree that we need to make health care more affordable, especially when it is coming to the end stages of one's life. I also feel that the patient should not be limited to a certain amount of care. Mom could have been more comfortable in the end of her battle with her illness if her insurance company covered more chiropractor appointments. Take into consideration what the patient really needs, not what you think is best for the patient. EACH PATIENT IS DIFFERENT!
Sunday, April 11, 2010
Guest Author
I'd like to share with you my personal experience with long term health care. I am 49 yrs old. My Mom was in a nursing home for 15 months before her death 2 years ago. She was a healthy 88 yr old when she could no longer live on her own. By healthy, I mean that she didn't have cancer or any other major health issues just those that come with being 88. Prior to going imto nursing home care my Mom lived in a beautiful apartment complex for seniors. She never wanted to go to the nusring home but there just were not enough services available for her to manage on her own. It's very hard to put someone you love in a place that they have asked not to go but the reality was that I worked full-time as did my other sister and Mom needed more help than we could provide on our own. Because of her age it was difficult for her to get around and she had a tendancy to fall. This made even daily tasks long and arduous for her. Showering, cooking, getting groceries, attending social functions and church were difficult and getting ready to attend tired her. I looked for services to assist with her daily living but such services are hard to come by and costly for someone on a limited income. I truly feel that she could have remained in her apartment if we could have found a provider to help her on a regular basis. We did find a grocery store to deliver her groceries but she lost the opportunity to squeeze the fruit, pick out the size and brand and even just get ideas for cooking that comes with shopping yourself. It would have been such a blessing to have somene take her to the store and help her, at her pace, choose her groceries. Personal care was also an area that she needed assistance. Once she fell while in the shower and laid there for six hours before being discovered. This is a traumatic experience for an elderly person. If we could have found someone to come in to help her bathe and clean herself and her things it would have aided in her ability to live independently. The place she lived did provide a noon meal, but the food was institutional and bland and frankly, she hated it. All of this forced our hand at placing her in nursing home care, against her wishes.
When we interviewed the nursing home where she moved we asked a lot of questions. They presented the facilities in a different light than what we actually experienced. First, they put her in a wheel chair right away. She went there walking on her own and within a week she was hardly walking at all. I understand that this has to do with safety concerns; they were concerned about her falling but I also think that it simplifies things like getting the tenents to and from meals and around the facility. It also seemed to keep her in her room more. Next, they prescribed medication for her, one of which was an anti-depressant. My Mom had never really taken meds and these prescriptions threw her into turmoil. It wasn't easy getting them to stop giving the medication but they finally agreed. Another thing they boasted in our pre-placement interview were the social activities that were offered daily. What they didn't tell us was that if they asked her to come and she said "No" they would just go on to the next patient. My Mom was so new there and afraid. I wished they would have talked with her and encouraged her more to participate. Instead she sat in her room more and more. In the end my Mom was in her room alone, day after day, after day. She stopped eating in the lunch room, stopped going for strolls in the halls and just basically stopped living. Shortly after she went there five friends and I took six pre-made Bloody Mary's to her room to have a short social time with her. We had discuss alcohol before he was admitted and told them that she enjoyed an ocassional Bloody Mary. When we got there my Mom was so excited to see us and eager to have her cocktail. As we started to enjoy ourselves a Nurse came in and very rudely and loudly kicked us out. My Mom was so confused about why this was happening. I remember the look on her face as I took the drink out of her hand and told her that we had to leave. My heart was broken that this place that we had move her wasn't like her home at all, but rather, it was an institution. I think that long term care needs to be a place that is more like home. I don't understand why all the rules change and that what the elderly want is not available. I wish that there were senior apartments that provided a safe, homey place and still offered services like grocery shopping, self-care, cleaning, social activities and a place that the residents could be proud of and feel like they were able to function on their own. I don't know if I would do anything different with my Mom, because I know that during that time I was doing the best I could for her. But I do know that more services need to be available to allow people to stay in their homes and I pray that I never have to go to a nursing home myself.
When we interviewed the nursing home where she moved we asked a lot of questions. They presented the facilities in a different light than what we actually experienced. First, they put her in a wheel chair right away. She went there walking on her own and within a week she was hardly walking at all. I understand that this has to do with safety concerns; they were concerned about her falling but I also think that it simplifies things like getting the tenents to and from meals and around the facility. It also seemed to keep her in her room more. Next, they prescribed medication for her, one of which was an anti-depressant. My Mom had never really taken meds and these prescriptions threw her into turmoil. It wasn't easy getting them to stop giving the medication but they finally agreed. Another thing they boasted in our pre-placement interview were the social activities that were offered daily. What they didn't tell us was that if they asked her to come and she said "No" they would just go on to the next patient. My Mom was so new there and afraid. I wished they would have talked with her and encouraged her more to participate. Instead she sat in her room more and more. In the end my Mom was in her room alone, day after day, after day. She stopped eating in the lunch room, stopped going for strolls in the halls and just basically stopped living. Shortly after she went there five friends and I took six pre-made Bloody Mary's to her room to have a short social time with her. We had discuss alcohol before he was admitted and told them that she enjoyed an ocassional Bloody Mary. When we got there my Mom was so excited to see us and eager to have her cocktail. As we started to enjoy ourselves a Nurse came in and very rudely and loudly kicked us out. My Mom was so confused about why this was happening. I remember the look on her face as I took the drink out of her hand and told her that we had to leave. My heart was broken that this place that we had move her wasn't like her home at all, but rather, it was an institution. I think that long term care needs to be a place that is more like home. I don't understand why all the rules change and that what the elderly want is not available. I wish that there were senior apartments that provided a safe, homey place and still offered services like grocery shopping, self-care, cleaning, social activities and a place that the residents could be proud of and feel like they were able to function on their own. I don't know if I would do anything different with my Mom, because I know that during that time I was doing the best I could for her. But I do know that more services need to be available to allow people to stay in their homes and I pray that I never have to go to a nursing home myself.
Sunday, March 28, 2010
Reform Proposal, A shift towards Cash and Counseling
I am proposing a reform to shift long term care towards more of an individual choice, such as Cash and Counseling.
Cash and Counseling is a program that gives elderly and disabled Medicaid consumers who receive personal assistance services the option of directing their own care. Some examples of the services included would be cooking, bathing, dressing, and housekeeping. Usually, the Medicaid programs are in contract with the home care agencies to provide these services. However, the patient has very little say in who, when, where, or how these very personal needs will be met. The vision of Cash and Counseling includes, “A nation where every state will allow and even promote a participant-directed individualized budget option for Medicaid-funded personal assistant services.” (cashandcounseling.org) Also, Academy Health researchers found a large, statistically significant amount of elderly that proclaimed unmet needs, dissatisfaction with care, and poor quality of health with their current LTC services. Clearly, a change is needed!
All Medicaid consumers should have the right to know their individual choices. A lot of consumers may be unaware that Cash and Counseling even exists. As previously stated, the Medicaid individual would have the personal right to decide who, what, where, and how their personal services would be met. This can include what meals they will be served, who would prepare these meals, or if they would rather purchase cooking equipment to help with the meals they eat. There have been many success stories and individuals have seen a big change. Some of these changes include, patients are more satisfied with the quality of their services, increased access to paid care, had fewer unmet service needs, and experienced an improved quality of life. (cashandcounseling.org) Also, patients who choose to use a family member or friend as their main means of service have benefited from an increase in communication and positive relationship with this person (Kaiser Network).
According to the New York State Health Policy Research Fund, an estimated $207 billion of all health care costs were for long-term care, including nursing homes, services with persons with disabilities, home based services, and hospice care. Also, the high cost of long-term care is important for state governments because they administer and partially fund Medicaid (Courtney Burke). Expenses for the elderly are nearly six times those for children and adults enrolled in Medicaid. It has been proven that Cash and Counseling does not increase states’ Medicaid costs. In terms of cost, I believe it would go down if this service were used more often. Instead of patients paying for services they do not actually need, they could use this for appropriate services. The patients and family can sit down together and discuss what services the patient truly desires. This would benefit cost as well as quality. If the patient themselves is directly requesting the type of care, the quality would greatly increase. According to the Health and Human services committee, almost 75% of the elderly using this program rated their over all quality as, “very satisfied.” The care can be narrowed down to specific services, as opposed to the millions of little services the person was providing before.
In conclusion, Cash and Counseling would greatly benefit the patients and care-givers in both cost and quality. Useless services would no longer be paid for and used. The patient would have a direct say in what services and type of care they would like to receive. This would in turn provide a more efficient service for the elderly.
http://www.cashandcounseling.org/
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1486
www.state.nj.us/humanservices/dds/.../NGAWinterMtg08NJ_DDS.ppt
http://www.academyhealth.org/files/publications/cashandcounseling.pdf
Thursday, March 25, 2010
I am proposing a reform to shift long term care towards a new method called “Green Houses”.
The Green House Project is a model which creates a smaller community for elders, they focus on life and many relationships are formed. Green Houses are different from traditional nursing homes and assisted living facilities. They alter the size of the facility, interior designs, staff members, and the methods for delivering services. The primary purpose is for it to be a place where elders can receive the assistance they need that support the activities of daily living and clinical care. Dr. William Thomas states, “The Green House model is intended to deinstitutionalize long-term care by eliminations large nursing facilities and creating social settings.” The green house vision demonstrates a change in life, work, and relationships.
Green Houses apply to elders qualified to live in skilled nursing homes. Green Houses are licensed as a skilled nursing home and are regulated by each state. It is a home for six to ten elders, which incorporates outdoor and indoor space. Providers need the option of moving Green House nursing homes off of long-term care campuses and across America. Green Houses need to be licensed as a nursing home; service providers may include home health agencies, local health care providers, or an existing nursing home. Departing from traditional nursing homes and moving locations, Green Houses are places where elders can receive the support they need through daily living and clinical care. Green Houses are designed to feel like private homes/apartments in the community. Changes have developed from Green Houses such as introducing plants and animals to structural changes. Changes that occur within Green Houses are deinstitutionalizing elders, moving to a small house setting, changing the structure, and a homelike environment.
For residents, Medicaid, private pay and limited Medicare may cover the elder’s care. But the cost per day depends on the cost structure; Green Houses are licensed as traditional nursing homes are eligible for Medicaid and Medicare reimbursements. There are now more than 100 Green Houses nationally. If Green Houses continued to rise across America the access would definitely increase due to similarities in cost of traditional nursing homes and allow the elders to have a more homelike setting. It’s about quality not quantity in Green Houses. High satisfaction levels have been reported by residents, family, and staff. Also, within Green Houses there has been an increase in daily living activities such as bed mobility, transfer, eating and toileting. There has been a decrease in depression while more meaningful activity increases with relationships and food enjoyment.
Each Green House project is run independently. Green Houses may be developed by individuals and organizations (nonprofit and for-profit) that can provide a high level of services. This proposal plays a large role with the aging population. Dr. Thomas noticed many unexpected deaths in traditional nursing homes and residents did not like what they saw. Dr. Thomas fixed nursing homes by developing Eden Alternative which includes plants, animals, and children into nursing homes. Some people believe that giving grants to Green Houses are not beneficial to elders. But any elder who has had an experience in a Green House would say that the difference is not even comparable. Dr. Thomas interviewed Joe Shapiro in 2005, he said, "I believe that in the nursing home every year, thousands of people die of a broken heart. They die not because their organs fail, but because their grip on life has failed." Along with old age come psychological disorders, evidence shows that Green Houses reduce depression. If depression was decreased there would be an increase in the aging population. Why not help out elders to the best of our ability, while maintaining reasonable cost!
Bailey, Sue. Future Without Nursing Homes? (2004): 6. Web. 25 Mar 2010..
Breindel, DeSantis. Place to Call Home (2008): n. pag. Web. 25 Mar 2010.
Halloran, Liz. "Green House Projects Let Elders Age In Homes." (2010): 2. Web. 25 Mar 2010..
McAilly, Steve. "Green Houses at Traceway Retirement Community: Tupelo, Mississippi - Design Center." (2003): 4. Web. 25 Mar 2010..
The Green House Project is a model which creates a smaller community for elders, they focus on life and many relationships are formed. Green Houses are different from traditional nursing homes and assisted living facilities. They alter the size of the facility, interior designs, staff members, and the methods for delivering services. The primary purpose is for it to be a place where elders can receive the assistance they need that support the activities of daily living and clinical care. Dr. William Thomas states, “The Green House model is intended to deinstitutionalize long-term care by eliminations large nursing facilities and creating social settings.” The green house vision demonstrates a change in life, work, and relationships.
Green Houses apply to elders qualified to live in skilled nursing homes. Green Houses are licensed as a skilled nursing home and are regulated by each state. It is a home for six to ten elders, which incorporates outdoor and indoor space. Providers need the option of moving Green House nursing homes off of long-term care campuses and across America. Green Houses need to be licensed as a nursing home; service providers may include home health agencies, local health care providers, or an existing nursing home. Departing from traditional nursing homes and moving locations, Green Houses are places where elders can receive the support they need through daily living and clinical care. Green Houses are designed to feel like private homes/apartments in the community. Changes have developed from Green Houses such as introducing plants and animals to structural changes. Changes that occur within Green Houses are deinstitutionalizing elders, moving to a small house setting, changing the structure, and a homelike environment.
For residents, Medicaid, private pay and limited Medicare may cover the elder’s care. But the cost per day depends on the cost structure; Green Houses are licensed as traditional nursing homes are eligible for Medicaid and Medicare reimbursements. There are now more than 100 Green Houses nationally. If Green Houses continued to rise across America the access would definitely increase due to similarities in cost of traditional nursing homes and allow the elders to have a more homelike setting. It’s about quality not quantity in Green Houses. High satisfaction levels have been reported by residents, family, and staff. Also, within Green Houses there has been an increase in daily living activities such as bed mobility, transfer, eating and toileting. There has been a decrease in depression while more meaningful activity increases with relationships and food enjoyment.
Each Green House project is run independently. Green Houses may be developed by individuals and organizations (nonprofit and for-profit) that can provide a high level of services. This proposal plays a large role with the aging population. Dr. Thomas noticed many unexpected deaths in traditional nursing homes and residents did not like what they saw. Dr. Thomas fixed nursing homes by developing Eden Alternative which includes plants, animals, and children into nursing homes. Some people believe that giving grants to Green Houses are not beneficial to elders. But any elder who has had an experience in a Green House would say that the difference is not even comparable. Dr. Thomas interviewed Joe Shapiro in 2005, he said, "I believe that in the nursing home every year, thousands of people die of a broken heart. They die not because their organs fail, but because their grip on life has failed." Along with old age come psychological disorders, evidence shows that Green Houses reduce depression. If depression was decreased there would be an increase in the aging population. Why not help out elders to the best of our ability, while maintaining reasonable cost!
Bailey, Sue. Future Without Nursing Homes? (2004): 6. Web. 25 Mar 2010.
Breindel, DeSantis. Place to Call Home (2008): n. pag. Web. 25 Mar 2010.
Halloran, Liz. "Green House Projects Let Elders Age In Homes." (2010): 2. Web. 25 Mar 2010.
McAilly, Steve. "Green Houses at Traceway Retirement Community: Tupelo, Mississippi - Design Center." (2003): 4. Web. 25 Mar 2010.
Monday, March 22, 2010
I am proposing a reform to include holistic health therapies in all long-term facilities.
Holistic health is a philosophy of medical care that views physical and mental aspects of life as closely interconnected and as equally important approaches to treatment. (holisticnetwork.org) It is not allopathic medicine that is used in hospitals and facilities. It consists of focusing on lifestyle, mental well-being and spiritual awareness through health and fitness. Instead of using medicine and regular hospital therapies to help the physical pain or disease of the person, the goal is for a wellness that involves the entire person.
How does holistic health help the patient? It is understood that when symptoms of sickness develop, it is mostly long after the cause of these symptoms actually occurred. The holistic approach focuses on the cause of the symptoms or sickness rather than treating the symptoms and/or syndromes. Some examples of holistic health therapies are chiropractic techniques, massage therapy, reflexology, energy balancing, acupressure, and acupuncture. These are just a few of many different techniques and therapies used in holistic health.
One technique that would be great for elderly or disable in long-term care would be message therapy. Because of the direct contact, massage therapy provides those with Alzheimer's disease a way to relax. In doing so, it reduces the anxiety linked with the disease. Massage also provides stimulation, which helps the residents communicate physically. Pain is very common in many senior’s lives not matter what condition they have, which is why massage therapy is very important. About 80 to 85% of people past the age of 65 will experience pain caused by a health problem. Of these elders, 25 to 50% will admit to having significant pain, and of those living in nursing homes, this percentage increases to 45 to 80%. (massagebysuzanne.com) Massage therapy can help reduce the pain of chronic disease and minor injuries, decrease muscle spasms and stiffness, and increases mobility. However, the only reason massage therapy is important is not only because of the pain. Decreased social contact at this point in their lives makes massage therapy an effective treatment approach for seniors. Basically, massage therapy can be used to help loneliness that the elderly encompass. Just the simple touch of another human being helps the feeling of being lonely decrease.
Another technique that would be useful would be meditation practices. Meditation is used as for pain control as well. It is a way of healing the body, and is used for relaxation and stress relief. It is a simple practice, a skill that can be tremendously beneficial to the body as well as the mind. A guide to meditation is a must when you want to conduct yourself towards enlightenment and inner peace. This is something that may be very important to elderly. Therefore, not only does meditation help their body physically, but it helps their spiritual and mental health as well.
Using these different therapies and techniques would develop a great improvement in residents of long-term facilities. It is a different approach then what is regularly used, and could also be a good way for residents to have fun and socialize. Even if facilities would have a therapy session once a week for the residents it could improve their mental, spiritual, and physical health.
http://www.holisticnetwork.org/about_the_discipline.cfm
http://www.healthynewage.com/
http://www2.kenyon.edu/khistory/holistic/definitions.htm
http://www.massagetherapy.com
http://www.massagebysusanne.com/massage-for-the-elderly.htm
http://www.project-meditation.org
Holistic health is a philosophy of medical care that views physical and mental aspects of life as closely interconnected and as equally important approaches to treatment. (holisticnetwork.org) It is not allopathic medicine that is used in hospitals and facilities. It consists of focusing on lifestyle, mental well-being and spiritual awareness through health and fitness. Instead of using medicine and regular hospital therapies to help the physical pain or disease of the person, the goal is for a wellness that involves the entire person.
How does holistic health help the patient? It is understood that when symptoms of sickness develop, it is mostly long after the cause of these symptoms actually occurred. The holistic approach focuses on the cause of the symptoms or sickness rather than treating the symptoms and/or syndromes. Some examples of holistic health therapies are chiropractic techniques, massage therapy, reflexology, energy balancing, acupressure, and acupuncture. These are just a few of many different techniques and therapies used in holistic health.
One technique that would be great for elderly or disable in long-term care would be message therapy. Because of the direct contact, massage therapy provides those with Alzheimer's disease a way to relax. In doing so, it reduces the anxiety linked with the disease. Massage also provides stimulation, which helps the residents communicate physically. Pain is very common in many senior’s lives not matter what condition they have, which is why massage therapy is very important. About 80 to 85% of people past the age of 65 will experience pain caused by a health problem. Of these elders, 25 to 50% will admit to having significant pain, and of those living in nursing homes, this percentage increases to 45 to 80%. (massagebysuzanne.com) Massage therapy can help reduce the pain of chronic disease and minor injuries, decrease muscle spasms and stiffness, and increases mobility. However, the only reason massage therapy is important is not only because of the pain. Decreased social contact at this point in their lives makes massage therapy an effective treatment approach for seniors. Basically, massage therapy can be used to help loneliness that the elderly encompass. Just the simple touch of another human being helps the feeling of being lonely decrease.
Another technique that would be useful would be meditation practices. Meditation is used as for pain control as well. It is a way of healing the body, and is used for relaxation and stress relief. It is a simple practice, a skill that can be tremendously beneficial to the body as well as the mind. A guide to meditation is a must when you want to conduct yourself towards enlightenment and inner peace. This is something that may be very important to elderly. Therefore, not only does meditation help their body physically, but it helps their spiritual and mental health as well.
Using these different therapies and techniques would develop a great improvement in residents of long-term facilities. It is a different approach then what is regularly used, and could also be a good way for residents to have fun and socialize. Even if facilities would have a therapy session once a week for the residents it could improve their mental, spiritual, and physical health.
http://www.holisticnetwork.org/about_the_discipline.cfm
http://www.healthynewage.com/
http://www2.kenyon.edu/khistory/holistic/definitions.htm
http://www.massagetherapy.com
http://www.massagebysusanne.com/massage-for-the-elderly.htm
http://www.project-meditation.org
Monday, March 1, 2010
Reform Proposal 1
I am proposing a reform for a shift from nursing home care to home health care, which is much more affordable for patients and long-term care facilities.
One of the major problems with long-term care in our country is all of the costs that go into it. In Wisconsin, it costs an average of $36,594 per year for assisted living and an average of $86,505 per year to live in a nursing home. (aarp.com) The answer is not to reduce costs and lower the wages of these dedicated health care workers, but to try and shift a far greater percentage of people who require long-term care into home and community based settings instead of nursing homes. This way, the quality of care and the quality of life can be drastically improved for those in need of long-term care.
So much money goes into operating nursing homes and many of the residents do not necessarily need to be in these facilities in the first place. I currently work as a Certified Nursing Assistant in a nursing home and at least twenty-five percent of the residents I work with would greatly benefit from home health care. They do not need to rely on caretakers for every moment of the day and are mostly independent. I believe they would also enjoy being able to stay in their own homes instead of a facility.
This reform will allow many people who currently live in nursing homes be evaluated and find out if they can possibly do just as well in the comfort of their own home through home health providers or outpatient visits to rehabilitative or care centers in their community. While the aim is to shift many people to home health care services, some people will still need to be in nursing homes, either for constant care or because they have no family or other support. This way, these changes will not necessarily be detrimental to nursing homes and the services they provide.
Someone might be opposed to this is they think that nursing homes are doing a great job for their residents. While the staff may be dedicated and the facility may be working very hard, it will never be hard enough. Nursing homes are hardly like a “home” at all. They are more like a hospital or some other type of warehouse facility. They are understaffed according to law and in order for care to improve, this law or something about it must change. I think it is important to begin with the shift to home health care to improve the quality of each and every aspect of long-term care.
As mentioned earlier, nursing home care costs $86,505 per year in Wisconsin but having a home health aide in the home for two hours of daily care would cost about $16,060 ($22 per hour) for one year. This would definitely save costs for insurance companies and Medicare as well as those individuals who have to pay out of pocket in the current health plan our country has. By moving from overcrowded nursing homes to home health care and assisted living, access would increase for individuals who are most in need of the services offered by nursing homes. The quality of care would increase for those who are able to move to their own homes and their quality of life would improve.
1. "Long-Term Care: Early Planning Pays Off" MayoClinic.com. 16 Jan. 2010. Web. 28 Feb. 2010.
2. "Medicare.gov - Types of Long-Term Care." Medicare.gov - The Official U.S. Government Site for People with Medicare. 25 Mar. 2009. Web. 28 Feb. 2010.
3. Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. 4th ed. Sudbury: Jones and Bartlett, 2008. Print.
4. "What Does Long-term Care Cost In Your State?" AARP Public Policy Institute. 25 Oct. 2006. Web. 28 Feb. 2010.
5. "What is LTC ?" National Clearinghouse for Long Term Care. 22 Oct. 2008. Web. 28 Feb. 2010.
Wednesday, February 17, 2010
History & Overview
Long-term care services are available to many different populations, and to many varying degrees. What is often the most thought of form of long-term care is nursing homes for the elderly population. Another type of long-term care that is provided for adults is adult daycare. This is available to provide assitance to those who are cognitively or functionally impaired, but are not in need of 24 hour care. Home healthcare is a third mode of long-term care that is available to many different populations. This type of care enables those with disabilities (either physical or cognitive) to maintain a certain level of independence while living in their own home (Medicare.gov, 2009).
While the different types of long-term care have different costs, overall it is a very expensive form of healthcare. In 2008, it cost $68,000 for one person to reside in a semi-private room for only that year. While home healthcare costs have a significantly cheaper facevalue than nursing homes, an average of $18,000 for the year of 2008, the patient would only receive an average of three visits per week rather than the round-the-clock-care provided by nursing homes. These are just two examples of the extremely high costs of long-term care, which of course do not include medication or anything else that may arrise (What, 2008).
Due to the extremely high costs of long-term care, access to this form of healthcare is very limited. In fact, nearly 79% of people who need long-term care live at home or in community settings rather than the potentially more helpful institutional setting. Also, 84% of the hours of assitance provided to patients were unpaid, meaning that it would be classified as informal care provided by friends or family (FCA, 2005). This poses many issues; the first one being that the friend or family member likely has little to no training in geriatric or disability care, putting both themselves and the patient at potential risk for physical harm. Also, an informal caregiver is put under a financial, and many times emotional, to care for this person with no stipend, often in addition to a caring for a family and/or working a full time job.
There is a huge incentive for long-term care providers and facilities to abide by the quality standards set by the federal government through the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). If the provider or facility does not meet the minimum standards, they are not eligible to admit Medicare or Medicaid. (Shi, 2008). After seeing the enormous costs of long-term care, it is easy to see that without the ability to admit Medicaid or Medicare, any long-term facility or provider would sink like a brick. There are approximately 185 standards that need to be met, and they are organized into seventeen categories. They include things from dietary services to resident rights. The sixth category is “Quality of Care,” which states “Each resident must receive, and the facility must provide, the necessary care and sevices to attain or maintain the highest practicable physical, mental, and psychosocial well-being…” (Shi, 2008). It goes on to provide specific services that need to be offered in order to maintain a high standard of living.
Overall, while the quality of long-term care is excellent, the costs are outrageous. Hopefully, our blog will help in discovering a way to make these high-quality services more accessible to those in need of long-term care. Stay tuned for our reform proposals, and we are looking forward to your feedback to help us in making our reforms more effective!
"FCA: Selected Long-Term Care Statistics." Family Caregiver Alliance. National Center on Caregiving, 2005. Web. 17 Feb. 2010..
"Medicare.gov - Types of Long-Term Care." Medicare.gov - The Official U.S. Government Site for People with Medicare. 25 Mar. 2009. Web. 17 Feb. 2010..
Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. 4th ed. Sudbury: Jones and Bartlett, 2008. Print.
"What is LTC ?" National Clearinghouse for Long Term Care. 22 Oct. 2008. Web. 17 Feb. 2010..
While the different types of long-term care have different costs, overall it is a very expensive form of healthcare. In 2008, it cost $68,000 for one person to reside in a semi-private room for only that year. While home healthcare costs have a significantly cheaper facevalue than nursing homes, an average of $18,000 for the year of 2008, the patient would only receive an average of three visits per week rather than the round-the-clock-care provided by nursing homes. These are just two examples of the extremely high costs of long-term care, which of course do not include medication or anything else that may arrise (What, 2008).
Due to the extremely high costs of long-term care, access to this form of healthcare is very limited. In fact, nearly 79% of people who need long-term care live at home or in community settings rather than the potentially more helpful institutional setting. Also, 84% of the hours of assitance provided to patients were unpaid, meaning that it would be classified as informal care provided by friends or family (FCA, 2005). This poses many issues; the first one being that the friend or family member likely has little to no training in geriatric or disability care, putting both themselves and the patient at potential risk for physical harm. Also, an informal caregiver is put under a financial, and many times emotional, to care for this person with no stipend, often in addition to a caring for a family and/or working a full time job.
There is a huge incentive for long-term care providers and facilities to abide by the quality standards set by the federal government through the Omnibus Budget Reconciliation Act of 1987 (OBRA-87). If the provider or facility does not meet the minimum standards, they are not eligible to admit Medicare or Medicaid. (Shi, 2008). After seeing the enormous costs of long-term care, it is easy to see that without the ability to admit Medicaid or Medicare, any long-term facility or provider would sink like a brick. There are approximately 185 standards that need to be met, and they are organized into seventeen categories. They include things from dietary services to resident rights. The sixth category is “Quality of Care,” which states “Each resident must receive, and the facility must provide, the necessary care and sevices to attain or maintain the highest practicable physical, mental, and psychosocial well-being…” (Shi, 2008). It goes on to provide specific services that need to be offered in order to maintain a high standard of living.
Overall, while the quality of long-term care is excellent, the costs are outrageous. Hopefully, our blog will help in discovering a way to make these high-quality services more accessible to those in need of long-term care. Stay tuned for our reform proposals, and we are looking forward to your feedback to help us in making our reforms more effective!
"FCA: Selected Long-Term Care Statistics." Family Caregiver Alliance. National Center on Caregiving, 2005. Web. 17 Feb. 2010.
"Medicare.gov - Types of Long-Term Care." Medicare.gov - The Official U.S. Government Site for People with Medicare. 25 Mar. 2009. Web. 17 Feb. 2010.
Shi, Leiyu, and Douglas A. Singh. Delivering Health Care in America A Systems Approach. 4th ed. Sudbury: Jones and Bartlett, 2008. Print.
"What is LTC ?" National Clearinghouse for Long Term Care. 22 Oct. 2008. Web. 17 Feb. 2010.
Saturday, February 13, 2010
Beliefs/Values
Down the road, we will either be a member of the United States long-term health care system or we will know someone who is affected by it. Long-term care is usually associated with the care that is being provided by nursing homes, but also involves home care from family members and other health care workers.
We believe that patients should be allowed to live their life independently if they choose. We feel that the dignity and independence of the patients who are receiving long term care to be a top priority because that has a major impact on their lives. If the the patient is comfortable then the patient's life will be more worth while. We need to make the long-term health care for patients more accessible to those in need. We need to improve the quality of the care, and we need to lower the cost and make it more affordable for many more patients.
My grandma was a member of this long-term care health care up until she passed away, and it was a long and educated experience. I watched as my family tried to figure out the best way to give my grandma the best health care possible while still respecting her wishes of dying at home. This experience showed me how expensive the long-term health care would be, and just how difficult it would be in order to get hospice care at home in her town.
As we all age, we would like to maintain our independence. As we are growing up the last thing we think about is having someone else helping us with our everyday tasks. When we reach the age where we ask for assistance whether it be from family members, or from professional health care workers, we would like to at least be able to maintain our dignity. Lets help patients get the best long-term health care that they can get. Lets make it affordable, lets increase the quality of care, and lets improve the accessibility for patients to get the best out of their long-term care! We want to have the best experience as possible, so take into consideration that you will be in that situation someday too!
Thursday, February 11, 2010
Welcome!
Hello everyone! We'd all like to welcome you to our U.S. Health Care Blog concerning our long-term care system. We would like to encourage everyone to comment on various topics. We look forward to reading your posts!! Within the next couple of days we will have our beliefs and values of the long-term care system posted for you to read our view on this topic. Happy Blogging! :-D
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