Modes of Long-term Care Delivery
Long-term care facilities are institutions such as nursing homes, skilled nursing facilities (SNFs), and assisted living facilities that provide healthcare to people who are unable to manage independently in the community. The care may represent custodial or chronic care management or short-term rehabilitative services. The site of care delivery categorizes long-term care programs. Institution-based services are those long-term care services provided within an institution such as a nursing home, hospital with inpatient extended care or rehabilitation facility, or inpatient hospice. Community-based services coordinate, manage, and deliver long-term care services such as adult day care programs, residential group homes, or care in the recipient’s home.
What is Skilled Nursing Care
A SNF that is Medicare and Medicaid certified provides skilled nursing care and the related services for people requiring medical or nursing care and/or rehabilitative services. Licensed nursing personnel such as registered nurses and licensed practical nurses provide skilled nursing care. It usually consists of 24-hour nursing care and other services. Nursing home residents can be of any age. However, most are elderly adults. The typical nursing home resident is an older woman with cognitive impairment who (before admission into the nursing home) was living alone on a limited income. The decreased ability to function independently and lack of family or friend caregivers increase a person’s likelihood for nursing home admission.
Are Older Americans Using SNFs
In 2013, the Centers of Medicare and Medicaid reported 1.4 million Americans in nursing homes—(15,634 facilities) (Nursing Home Data Compendium, 2013). 14 percent of nursing home residents are younger than 65 years of age or older and 86 percent are 65 years of age or older (Fact Sheet: Abuse of Residents of Long Term Care Facilities, 2012). Nursing home occupancy rates have declined from 84.5 percent in 1995 to 80.8 in 2013. The downward trend is very interesting as the US is experiencing a drastic increase in older Americans. Today’s older Americans are healthier, which delays the need for residency at nursing homes. The availability of community-based assistance through adult day care programs and home care also curb necessity for nursing homes.
How do SNFs Operate
Typical staffing in SNFs includes a physician medical director, a nursing home administrator, a director of nursing, at least one registered nurse on the day and evening shifts, and either a registered nurse or a licensed practical nurse on the night shift. Certified nursing assistants provide direct custodial care under the supervision of licensed nursing personnel and represent the majority of all nursing staff employed by SNFs. SNFs incorporate a diverse mix of allied health professionals into care delivery. These professionals typically include physical therapists, occupational therapists, pharmacists, nutritionists, recreational therapists, podiatrists, and dentists. Nursing homes usually have laboratory and hospice capabilities as well. SNFs also have an array of support staff including dietary, laundry, housekeeping, and maintenance workers. Each SNF must have a licensed nursing home administrator. This individual along with the owner and operator must oversee and carry out regulatory responsibilities.
Centers of Medicare and Medicaid Services: CMS Nursing Home Data Compendium, 2013. http://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcompliance/downloads/nursinghomedatacompendium_508.pdf
National Center on Elder Abuse. Fact Sheet: Abuse of Residents of Long Term Care Facilities. February 2012. http://ncea.acl.gov/resources/docs/abuse-longtermcare-facilities-2012.pdf