A Handbook for Nursing Home (LTC) Ministry - 5th Edition
The commercial industry of long-term care, as it has developed in our western culture, is unique in the history of the world. At no other time, nor in any other place, has institutionalized care been seen on the scale of what we have today. In localities where nursing homes numbered five or six just a few decades ago, today there are fifteen or twenty. Nationwide, in nursing homes alone, there are 1.4 million residents living in 15,679 facilities (CMS OSCAR Data Survey, December 2009, from the website of the American Health Care Association). As "in-home care" becomes more and more popular (and subsidized by insurance and Federal programs), the percentage of elderly and handicapped who are able to stay in their own residence will significantly increase; but, because of the "baby boomer" phenomenon, the total number of individuals who live in long-term care facilities (especially "retirement communities") will probably increase in the foreseeable future. In 2010, about nine million people over the age of 65 need long-term care. By 2020, twelve million older Americans will need long-term care. Most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly who need "long- term care." But, a study by the U. S. Department of Health and Human Services says that people who live to the age of sixty-five will have a 40 percent chance of entering a nursing home. (Medicare Website May, 2010) This suggests that at least 10% of our elderly who are cared for at home will eventually reach a stage of needing institutional care.
Nearly one of every two women and one of four men over age 65 will enter a long-term care facility at some time in their lives. More than a third of all nursing facility stays last more than a year, and many last three years or more. About 10 percent of the people who enter nursing homes will stay there five-plus years.
According to the Kaiser Family Foundation, on the figure of 1.5 million total population in nursing homes, 77% are women. On the estimate of 2.5 million receiving long-term care at home, 68% are women.
In addition to the numbers, the nature of long-term care has changed too. Fifty years ago there were two basic types of facilities: "old folks' homes" and "convalescent homes." Both often looked and smelled more like insane asylums than homes. As described later in this section, today there are different levels of adult care such as "nursing" care facilities, assisted living facilities, retirement homes, adult family homes, adult day-health care centers, and multi-level care complexes. Through education, community involvement and responsible regulation, these long-term care facilities are generally more clean, pleasant, and professionally managed than their predecessors.
Until recently, as the type and number of facilities has increased, so has the number of residents increased in the average facility. Where nursing homes might have housed 20 patients in old, three- story converted homes 70 years ago, today, 120 residents live in sprawling, well maintained commercial buildings designed particularly for that purpose.
We see at least five major factors in the United States affecting the population of care facilities.
Factors In Care Facility Population
1. Modern medicine is more successful in treating major illness and injury. Therefore, more people are surviving serious trauma and disease.
2. The average life-span is increasing. People are just naturally living longer than in past centuries. By the year 2020, more than 200,000 living Americans will be over the age of 100.
3. Due to the "baby boomer" phenomenon, the proportion of elderly people in the general population is increasing. Over fifty percent of our population is 50 years old or older.
4. Since 1964, Medicare and Medicaid have dramatically increased funding available for long- term care.
5. In increasing numbers, disabled people have no family or friends who are able to care for them.
The "long-term care facility industry" is the focus of the ministry of Christian Concourse. Though the type of ministry that we do is often referred to as "nursing home ministry," the type of LTC facilities to which we go are actually very diverse. It is safe to say, in all cases (except Adult Day-Health Care Centers) they provide residence and care for frail elderly and/or the infirm. The following list is our attempt to identify in laymen's terms these different types of homes. [As mentioned in our discussion on the scope of this handbook, please note that the material in this manual does not address the special volunteer needs of hospitals or hospice institutions]
Augmented by our own observations, resources for this information are the Medicare website (a comprehensive description of types of LTC) and the New LifeStyles Guide to Senior Residences and Care Options (both resources are listed in our Bibliography section).
Nursing Homes - A nursing home is a residence that provides room, meals, recreational activities, help with daily living, and protective supervision to residents. Generally, nursing home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional).
Occasionally called convalescent centers, "nursing homes" is a term often used in general reference to long-term care facilities. Its proper technical use would be to identify facilities which provide some level of 24-hour, professional nursing services to residents. Nursing homes often serve residents needing short-term rehabilitation after accidents or illnesses. Though the same facility may house both levels, they are officially divided into two types based on the degree of nursing care they offer:
Skilled Nursing Facilities (SNF) - provide around-the-clock nursing supervision. Many of their residents are completely or partially confined to their bed, and they are often incontinent. Medical treatment is provided under the supervision of licensed nursing professionals. At least one registered nurse must be on duty during the day. An SNF may include a special unit for residents suffering with Alzheimer's disease and other forms of dementia.
Intermediate Care Facilities (ICF) - residents are able to get out of bed and move about with or without assistance from staff personnel (whether ambulatory - able to walk - or in a wheelchair). These residents may be incontinent and will require intermittent professional care. An ICF may include a special unit for residents suffering with Alzheimer's disease and other forms of dementia.
Assisted Living Homes - provide an option for full-time, long-term care on a level between ICF nursing homes and retirement communities. They offer assistance with medications, bathing, dressing and usually serve full meals. These homes may include a special unit for residents suffering from Alzheimer's disease and other forms of dementia.
Retirement Communities - offer retired and elderly individuals the option of living in a community with other seniors in a fairly independent atmosphere. Residents of retirement communities are usually offered organized social programs, meal service, transportation, recreation, and assistance for shopping needs and medical services. Very often, the larger of such facilities will include an "assisted living" section on their premises.
Adult Family Homes (or Residential Care Facilities, or Adult Care Residences) - actual homes usually in residential areas having four or more beds providing care for a small group of seniors and/or mentally or physically challenged persons. Residents may be ambulatory or non- ambulatory and will be supplied room and board as well as supervision and assistance with daily activities such as bathing and dressing. Residents may suffer from Alzheimer's disease and other forms of dementia. Programs are designed to help the residents be as independent as they can be. Such facilities are staffed around the clock.
Adult Day-Health Care Centers - weekday, daytime-only facilities for seniors and disabled individuals who generally live with relatives or friends during non-working hours. Staff- supervised group activities of a recreational nature are provided throughout the day. Snacks and lunch are usually served. Programs vary widely, but services may also include nursing and rehabilitation.
Multi-Level Care Complexes (or Continuing Care Retirement Communities, CCRC's) - offer a variety of independent and retirement living options, coupled with full medical and nursing services designed to accommodate the contingencies of progressive aging disabilities. CCRC's are usually equipped to be self-contained communities that offer a full range of activities, recreational opportunities and services for the active resident.
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