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Learning Objectives


  • Discuss components and characteristics of contemporary long-term care.

  • Analyze key licensing, accreditation, and reimbursement requirements.

  • Analyze the work of physical therapists in long-term care.

  • Determine the role of the care team, particularly certified nursing assistants, in the accomplishment of patient rehabilitation goals.

  • Determine the importance of family education in long-term care.

  • Determine managerial roles and challenges to managerial responsibilities in long-term care.

  • Analyze managerial decision-making in given situations.

Part 1 The Contemporary Setting

Overview of Long-Term Care

The provision of social and medical services is intertwined tightly in long-term care to meet the needs of people with complex, multisystem problems across the life span. Only 53% of people who require long-term care are elderly. Many younger people who require long-term care have cognitive deficits and mental illnesses. The focus of long-term patient care shifts toward the ability of a person to function rather than on diagnoses and treatment of their diseases.1

Long-term care may be best represented as a continuum of care, which is anchored with skilled care and nonskilled on opposite ends as shown in Figure 13.1. Skilled care is defined as the provision of care by professionals (nursing and rehabilitation) who manage, observe, and evaluate patients. Care provided safely by nonprofessionals is considered nonskilled service. For example, staff or family members assisting patients with personal care and activities of daily living are nonskilled. Professionals play an important role in teaching nonskilled caregivers about these patient responsibilities.


Healthcare continuum.

Long-term care can occur in a variety of settings represented by the circles in Figure 13.1. Note that home care (provided in the patient's home) is a unique form of long-term care. It is discussed separately in Chapter 16. Because the need for skilled interdisciplinary care is a requirement for admission into skilled long-term care, most patients who qualify for admission are admitted directly from an acute care hospital.

Nonskilled residential care may be provided in many types of long-term care and assisted living facilities under a variety of names that may overlap and cause confusion. These facilities are inconsistently and variably regulated from one jurisdiction to another, but their services attend to the personal needs of their residents using nonskilled employees to help them with self-care. Some residential facilities may cater to particular populations, such as adults with mental retardation. Often there are restrictions for admission related to a required level of mobility. For example, patients may need to be, minimally, independent in wheelchair mobility to live in some centers.

A special type of residential care is the adult (congregate) living facility in which people maintain a private or semiprivate residence within a large building while sharing common areas for meals and activities. Transportation ...

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