LONG-TERM vs. SHORT-TERM CARE: INSTITUTIONAL OPTIONS
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Overview of the differences between long-term and short-term rehabilitation services, the advantages and disadvantages of each, as well as financial and other considerations for health administrators per type of service.
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LONG-TERM vs. SHORT-TERM CARE: INSTITUTIONAL OPTIONS
- 1. LONG-TERM vs. SHORT-TERM CARE:LONG-TERM vs. SHORT-TERM CARE: INSTITUTIONAL OPTIONSINSTITUTIONAL OPTIONS ZABIAN R CROSBY
- 2. Beyond Immediate Medical AttentionBeyond Immediate Medical Attention There are many forms of health care that extend beyond traditional emergency and outpatient services.
- 3. Long-Term or Short-Term Care?Long-Term or Short-Term Care? FOR MORE INFO... Indemnity Health Group (IHG) operates the largest acute care hospital system in the western region of the U.S., with nearly 60% of its patients consisting of Medicare beneficiaries. Access the IHG report on patient and funding data on the IHG Intranet at IGH:Reports.
- 4. The Role of Long-Term CareThe Role of Long-Term Care To provide medical and holistic care in excess of 60 days May occur in a facility or at home Professional staff on-call 24 hours Requires combination of government and private insurance (e.g., Medicaid) May also be administered by family (Austin & Wetle, 2012)
- 5. Long-Term Care Organizational StructureLong-Term Care Organizational Structure LTCs may be non-profit or for-profit Usually have a CEO and Board of Directors Liability through Ostensible Agency Normal license and degree requirements apply to staff Responsible to the community for the treatment of its patients (Dunn, 2012)
- 6. Long-Term Care Example: Golden YearsLong-Term Care Example: Golden Years Golden Years Residential Care in Highland, California 1- Private Living Spaces 2- Meals 3- Housekeeping 4- Medication 5- On-Call Staff
- 7. The Role of Short-Term CareThe Role of Short-Term Care To provide medical care for duration of less than 60 days Usually occurs in a hospital setting Resident medical staff available Usually covered by Medicare (for seniors and permanently disabled) Intervention of family not necessary (Austin & Wetle, 2012)
- 8. Short-Term Care Organizational StructureShort-Term Care Organizational Structure STCs may be public, private, non-profit, or community-based Usually have a CEO and Board of Directors The organization assumes liability under respondeat superior Direct marketing to the community for patient and public relations (Dunn, 2012)
- 9. STC Example: Citiview Residential CareSTC Example: Citiview Residential Care Located in Riverside, California 1- Respite Care 2- Hospice Care 3- Aging in Place 4- Meals 5- Medication 6- Transportation
- 10. Advantages of Long-Term CareAdvantages of Long-Term Care 1- Applicable to large demographic 2- Allows for continuous income 3- Relies on non-clinical staff with medical support as needed 4- May be provided in patient’s home
- 11. Disadvantages of Long-Term CareDisadvantages of Long-Term Care Not covered by Medicare Many patients do not have LTC insurance Care provided in facilities requires added buildings, maintenance, etc… Potential for burnout among LTC employees
- 12. Advantages of Short-Term CareAdvantages of Short-Term Care Covered by Medicare and most other health insurance Can be provided at the hospital using separate beds designated for STC Existing staff can be used for STC Continuous onsite supervision Minimal need for voluntary support
- 13. Disadvantages of Short-Term CareDisadvantages of Short-Term Care Smaller demographic requiring STC than LTC, thereby reducing the potential for profit May require additional staff to prevent burnout of existing staff Specialized care may require additional buildings, equipment
- 14. Recommendations: IHG Short-Term CareRecommendations: IHG Short-Term Care IHG is advised to consider adding a Short-Term Care unit to its hospital facilities, by designating 50 beds per hospital for therapeutic and rehabilitative services.
- 15. Closing ThoughtsClosing Thoughts IHG has enjoyed a reputation for quality health care in the community Adding Short-Term Care to its existing organizational structure affords greater revenues with minimal cost
- 16. ReferencesReferences A Place for Mom. (2014). Citiview Residential Care. Retrieved from http://www.aplaceformom.com/community/citiview- residential-care-1366087 Assisted-Living-Directory. Golden Years Residential Care. Retrieved from http://www.assisted-living- directory.com/content/golden-years.cfm Austin, A., & Wetle, V. (2012). The United States health care system: Combining business, health, and delivery (2nd ed.). Upper Saddle River, NJ: Pearson Education.
- 17. References (cont.)References (cont.) Dunn, R. (2012). Dunn & Haimann’s healthcare management (9th ed.). Chicago, IL: Health Administration Press. Farber N., Shinkle D., Lynott, J., Fox-Grage, W., & Harrell, R. (2011). Aging in place: A state survey of livability policies and practices. Retrieved from http://www.aarp.org/home-garden/livable- communities/info- 11-2011/Aging-In-Place.html National Care Planning Council. (2014). About Medicare Long Term Care. Retrieved from http://www.longtermcarelink.net/eldercare/medicare_lon g_term_care.htm
- 18. References (cont.)References (cont.) WebMD. (2014). Choosing Long-Term Care. Retrieved from http://www.webmd.com/healthy-aging/choosing- long-term-care
Editor's Notes
- Other types of care include long-term facilities, short-term facilities, and may exist as a separate branch of other facilities to provide services that utilize medical professional staff intermittently (Austin & Wetle, 2012).
- Medicare is a government insurance plan for persons 65 years of age and older, and persons found permanently disabled. “Because of its universal availability almost everyone over age 65 in this country is covered by Medicare. There are about 40 million Medicare beneficiaries nationwide” (National Care Planning Council, 2014, p. 1). IHG should seriously consider a strategy that focuses on this demographic in its new extended-care plans.
- “In an ideal arrangement, the LTC services would be provided by a system that meets the needs of any person who needs assistance in the ADLs or IADLs” (Austin & Wetle, 2012, p. 105). Since patient satisfaction is of pivotal concern, many long-term care facilities include amenities that allow for individual choice as well as increased social interaction. Additionally, many seniors desire aging in place (Austin & Wetle, 2012). “The vast majority of older adults want to age in place, so they can continue to live in their own homes or communities” (Farber, Shinkle, Lynott, Fox-Grage, & Harrell, 2011, p. 1). To accomplish this, long-term care providers establish specially-adapted housing complexes for seniors and disabled residents, or provide the care in the patient’s existing home, with structural adaptations to facilitate greater independence.
- Administrative responsibilities also include the security of patient data. “Although it is the institution’s responsibility to develop security and confidentiality procedures, it is a supervisor’s responsibility to make employees aware of these procedures and to monitor compliance” (Dunn, 2012, p. 109).
- Golden Years Residential Care is an upscale assisted living community in Southern California. It relies upon non-clinical staff to administer the daily operations, but is located near hospitals and clinics, and offers transportation to all medical facilities within a 10-mile radius of the complex (Assisted Living Directory, 2014). As such, administrative duties include lease of the property, furnishings, appliances, utilities, non-clinical staff, insurance, and maintenance of the buildings.
- Most short-term care is the result of surgery requiring assistance in rehabilitation before returning home (Austin & Wetle, 2012). As the hospital has already treated the patient, and is likely receiving payment through some form of insurance, it is a logical next step to allocate beds for short-term care and receive payment instead of referral to another clinic. This also helps the patient to recover in one place instead of having to be transferred to another facility. Additionally, the costs of buildings, maintenance, equipment, and so forth, are already in place, and can be ‘rolled into’ the existing costs of care.
- Supervisors and the health care organization are obligated to “…follow proper admission and discharge procedures to avoid charges of false imprisonment, negligent failure to render treatment, or abandonment of care; properly select and credential providers; and ensure a safe work environment for employees” (Dunn, 2012, p. 113). Professionals assisting with short-term care in a hospital should therefore be properly vetted by the supervisor and human resources department to minimize the risk of negligence or malpractice.
- Citiview also provides 24-hour assistance with the activities of daily living as well as indoor/outdoor activities (A Place for Mom, 2014). Due to the need for more acute care of its patients, IHG is well advised to maintain board certified staff to participate in any short-term care facilities or departments it provides in the future.
- There is vast opportunity for expansion into long-term care services. “Only 3.5 percent of the population needing LTC is served by nursing homes and other institutional providers ( Older Americans 2008)” (Austin & Wetle, 2012, p. 107). Providing care in a facility or in the patient’s home by qualified clinical and non-clinical staff is an opportunity for IHG to better serve the community.
- “Long-term care can be very expensive. In general, health plans and programs do not routinely cover long-term care at home or in nursing homes” (WebMD, 2014, p. 2). The financial impact alone for providing long-term care should give pause to consider the benefits in revenues versus hiring staff, reimbursements, insurance, and other associated expenditures.
- Offering short-term care within the existing framework of the hospital organization presents the greatest advantage for IHG. “The business must be in compliance with the many state and federal laws that apply to all businesses, not just those in the health care industry” (Austin & Wetle, 2012, p. 90), thus the regulatory and liability statutes can be more easily adhered to with simple modifications to the existing framework.
- “Many other areas of healthcare can lead to liability risks for the institution, its supervisors,and its employees” (Dunn, 2012, p. 113). To minimize the risk of liability for short-term care, the same diligence should be followed in recruitment of clinical and non-clinical staff, and if contracting non-clinical services with other agencies (outsourcing), supervisors and the HR team should ensure that laws such as HIPAA are strictly enforced by those agencies to prevent disclosure of protected data.
- By adding STC to its existing infrastructure of services, IHG can increase revenues without significant costs in personnel, buildings, equipment, and insurance. The organization will benefit from its large senior demographic, and can access Medicare reimbursements for the added services. Other patients not part of the Medicare group can use their health insurance to pay for STC, and can avoid the inconvenience of being transferred to other facilities after surgery or other injury. The additional revenues from STC far outweigh the costs of added equipment and extra clinical and non-clinical staff to support these services.
- Short-Term Care can be implemented by housing an Intensive Care Unit at each hospital and reallocating existing staff, thereby saving patients the inconvenience of being transferred to another facility after surgery or emergency care. The projected revenues from Medicare reimbursement and other insurance will support the added costs in rooms, equipment, and other staff to not only create a self-sustaining unit, but to further add to the hospital general fund after all expenses are paid each quarter. IHG is advised to seriously consider the benefits of short-term care for its hospitals, its patients, and the communities it serves.