The healthcare continuum
Edward M. Rafalski, Ross M. Mullner in Healthcare Analytics, 2022
Post-acute care includes: assisted living, skilled nursing, long-term care and most recently super skilled nursing facilities (Super-SNFs) a new designation created by certain states to accommodate the most skilled post-acute care for COVID-19 patients.14 Assisted living is housing for the elderly or disabled that provides nursing care, housekeeping and prepared meals as needed. Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It is healthcare given when skilled nursing or skilled therapy to treat, manage, and observe the condition, and evaluation of care is needed. Long-term care involves a variety of services designed to meet a person’s health or personal care needs during a short or long period of time. These services help people live as independently and safely as possible when they can no longer perform everyday activities on their own. Long-term care is provided in different places by different caregivers, depending on a person’s needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home or in the community, for example, in an adult day care center.15
Courses of formal service use
Tor Inge Romoren in Last Years of Long Lives, 2004
Admission to a nursing home usually occurs because the old person requires supervision and nursing due to a chronic, serious, functional impairment, or an incurable disease or because long-term rehabilitation is necessary in order for the elderly person to regain health after an acute illness. The basic norms and decision-making criteria are more diffuse, and the decisions tend more to be the subject of negotiations among several partners: the elderly person, the family, and the health services. An application for a place in an assisted living facility is usually founded on less serious functional impairment or on the need to live in a communal household. The old person's wishes are usually the primary reason for this type of institutionalization. During the study period, however, the stay in the home or centre could last only as long as the old person's need for care did not overtax the resources, competence, and objectives of this type of service.
Management of Diabetes in Chronic Care Settings
Medha N. Munshi, Lewis A. Lipsitz in Geriatric Diabetes, 2007
Assisted-living facilities are a relatively new and unresearched entity, and the regulations regarding care provision vary greatly from state to state. Additionally, since there is no federal oversight and very little state oversight, care capabilities may vary significantly from facility to facility. Many physicians have little or no idea what services the facilities provide. Current medical training, even geriatric training, does not mandate any familiarity with this level of care. Physicians may assume that assisted-living facilities have capabilities similar to skilled nursing facilities and mistakenly delegate such care issues as capillary blood glucose monitoring, sliding scale insulin administration, glucagon administration, and dietary education to facility staff who have no training or resources with which to deliver this care. This population is similar in frailty and impairment to the skilled nursing population (15). However, the principles of physician management need to be those used for elders in the ambulatory setting. Patients in assisted-living facilities “may” have access to on-site services such as podiatry, optometry, nutrition, physical therapy, and skilled nursing. However, no facility is mandated to provide the services, and it is the primary physician’s responsibility to oversee this care and monitor patient compliance and utilization. Table 2 outlines some important differences between SNF and assisted-living facilities.
Older Adults Who Meditate Regularly Perform Better on Neuropsychological Functioning and Visual Working Memory Tests: A Three-month Waitlist Control Design Study with a Cohort of Seniors in Assisted Living Facilities
Published in Experimental Aging Research, 2020
One important factor that influences various aspects of cognitive and executive functioning of older adults is living arrangement (Newcomer, Kang, LaPlante, & Kaye, 2005). Living arrangements are generally home-based, institutional (including hospitals, hospices, and nursing homes) and assisted living (including community-dwelling paid facilities and special care facilities), though there may be cross-cultural variations. In general, independent home-based dwelling is considered to be a positive stimulant for cognitive performance of older adults, though there may be several confounders such as family configuration, marital relationship quality, health/morbidities, social networks and abuse risk vulnerability. Assisted living is a special kind of arrangement, distinct from institutionalization, wherein personal care services assistance and general social support is available, in close proximity, easily accessible for older adults unable to or unwilling to live alone/independently (Dabelko & Zimmerman, 2008). Assisted living facilities (henceforth ALF), however, do not pose the same daily challenges/stimulations, as home-stay, as most basic needs are taken care of (Kuzuya et al., 2006). So, for older adults in ALF, apart from physical healthcare and wellbeing, maintaining cognitive and executive functions as crucial quality of life indicators is important (Lund & Engelsrud, 2008). This is especially critical for those on the threshold (not diagnosed with impairment, but still vulnerable to age-related neuropsychological and working memory decline) (Schmitt, Sands, Weiss, Dowling, & Covinsky, 2010).
Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents
Published in Journal of Gerontological Social Work, 2020
Rebecca L. Mauldin, Kathy Lee, Weizhou Tang, Sarah Herrera, Antwan Williams
Assisted living facilities generally provide room and board, personal care, assistance with household tasks, and monitoring services to enable residents to live independently in their own apartments or rooms, but do not provide the high level of care that a nursing home provides (Park-Lee et al., 2011). Most residents of assisted living facilities pay for their services privately, but some use Medicaid for services (Harris-Kojetin et al., 2019). Assisted living is a newer model of care and there is evidence that non-Hispanic Whites have selectively opted for care in assisted living facilities over nursing homes which has increased the portion of ethnic and racial minority residents in nursing homes (Konetzka & Werner, 2009). Certification and regulation of assisted living facilities occurs at the state level, but a sizable minority (47%) receive Medicaid funding and are subject to federal oversight through Medicaid certification guidelines (National Center for Assisted Living, n.d.).
Room Arrangement and Social Cohesion in Senior Homes – A Study in China
Published in Journal of Gerontological Social Work, 2022
To further analyze the data and control for confounding variables at the facility level, second-level analyses were conducted using individual facility datasets. Based on theoretical considerations, participant facilities were grouped by care level: independent living, assisted living, or nursing care (Table 2). Before conducting the analysis on room arrangement, the first-level analyses on personal factors were re-conducted; the influence of personal factors on social cohesion was confirmed to be insignificant or statistically controlled. Based on the second-level analyses, no differences in social cohesion by room arrangement was found in independent-living residents. However, significant differences were found in both assisted-living and nursing-care facilities.
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