Chapter 9
The Continuum of Long-Term Care
Pasted from

Long term care Goal

Maximize independence Who
People with functional disabilities What
Health,
mental health, residential, social support Basis
80% - 90% informal by family & friends

10% - 20% formal to sustain the informal Ideal
Integrated set of services

Continuity of care

Over time and setting Reality
Highly fragmented due to:

- financial drivers - local community variations - no uniform federal, state policies

Functional ability
A person's ability to perform basic daily activities

Or instrumental daily activities
ADL
Activities of daily living

Large motor skills lost in a predictable order

Eat, walk, dress, bath, grooming, bowel & bladder continence, transfer from bed to chair

Initially defined by Katz & colleagues through research, 1963
IADL
Instrumental activities of daily living

More loosely defined
Cognitive reasoning, finer motor skills

Using phone, managing money, shopping, using transportation, doing chores, taking medication, house keeping
% of population
Stat 2005 - 12% of US population needs some form of long term care

Chronic condition A condition lasts more than 3 months/90 days
Results from health or mental or both issues
Can be life-threatening or harmless
Can result in functional disabilities
Impairment
Chronic or permanent defects Usually static in nature

Due to diseases, injury, congenial malformation Leads to decreased / lost of functional ability

Limb amputee, blindness, hearing lost

The ideal of continuum of long-term care
A client oriented system
THE FRAMEWORK OF
Operating an array of services in an integrated manner (or with integrated mechanism) Tracks and guides clients over time and level of intensity of care

Comprehensive services in health, mental & social services

- A formal care system to compliment the informal system - Comprehensive and coordinated care system - To meet the multifaceted need of a person with complex or ongoing problems - Executed effective and efficiently

Integrated continuum of care

4 integrated management systems

Inter-entity structure and management

care coordination

Integrated information system

Integrated financing
7 service categories
Extended

Acute

Ambulatory

Home

Outreach

Wellness

housing

What continuum of care do
Match resources to client's health and family's circumstances

Monitor client's condition and change care when needed

Coordinate the cares provided by many professionals and disciplines

Integrate care provided in a range of settings Enhance efficiency, reduce duplication and streamline client flow

Pools or enhances financing so services are based on needs rather than narrow eligibility criteria

Maintains comprehensive record for clinical, financial and utilization data

3 Goals of continuum care
Provide health and related services to foster independence for the client and the family

Achieve cost effectiveness through maximizing the resources

Increase quality of care through appropriateness and continued care

In-patient long term care
Nursing