concurrently with deficits in adaptive behavior. It is manifested during the developmental period.
• NF—The federal certification of a skilled nursing facility that enables a facility to admit
Medicaid but not Medicare patients.
• Noncertified—A nursing facility that cannot admit Medicaid or Medicare patients.
• PACE—Program of All-inclusive Care for the Elderly. PACE is an example of the integrated
• Private-pay patients—Patients not covered by either Medicare or Medicaid.
• Quality of life—A sense of satisfaction, fulfillment, and self-worth. In LTC, it is a multifaceted
concept that recognizes at least five factors: lifestyle pursuits, living environment, clinical
palliation, human factors, and personal choices.
• Respite care—Either community- or institution-based long-term care service that takes over the
injections, care of wounds and bed sores, tube feedings, and clearing of air passages.
Rehabilitation therapies often form an important component of skilled nursing care.
• SNF—The federal certification of a skilled nursing facility that enables the facility to admit
Medicare patients.
• Social managed care plan—A managed care plan that provides the full range of Medicare
REVIEW QUESTIONS
1. Long-term care services must be individualized, integrated, and coordinated. Elaborate on
this statement, pointing out why these elements are essential in the delivery of long-term
care.
There are wide variations in individual needs. Accordingly, long-term care includes a wide
2. Age is not the primary determinant for long-term care. Comment on this statement,
explaining why this is or is not true.
Age is not the primary determinant for long-term care; functional impairment and ensuing
dependency are. Although functional impairment may be more common among the elderly,
3. What is meant by “quality of life?” Briefly discuss the five main features of this
multifaceted concept.
Quality of life produces a sense of satisfaction, fulfillment, and self-worth. In LTC, it is a
multifaceted concept that recognizes at least five factors:
(a) Lifestyle factors are associated with personal enrichment and making one’s life
meaningful through activities one enjoys. Many older people still enjoy pursuing their
former leisure activities.
4. What are some of the challenges in the delivery of mental health services for the elderly?
Assessing psychiatric illness in geriatric patients can be difficult mainly because medical
comorbidity may obscure a psychiatric diagnosis. For example, the patient with multiple
5. Discuss the preventive and therapeutic aspects of long-term care.
In the context of LTC, prevention generally refers to preventing or delaying
institutionalization. Various community-based LTC services have a preventive function, as
6. How do formal and informal long-term care differ? What is the importance of informal care in
LTC delivery?
Formal LTC is provided by various community-based and institutional agencies which get
reimbursed for the services they deliver. Informal LTC is provided by family, friends, and
7. What are the main goals of community-based and institution-based long-term care services?
Community-based long-term care has a four-fold objective: (1) To deliver LTC in the most
8. What is respite care? Why is it needed?
Respite care is the most frequently suggested intervention to address family caregivers’
feelings of stress and burnout. The objective is to provide relief or assistance to caregivers for
9. Distinguish between supportive housing and institutional long-term care.
Housing refers to non-institutional housing apart from a person’s own home. It includes
independent living facilities and retirement living centers/communities—both private and
10. Why do some children and adolescents need long-term care?
Some children and adolescents need LTC if they have birth related functional impairments,
such as brain damage, which can occur before or during childbirth. Examples of birth-related
11. Why has long-term care become an important service for people with HIV/AIDS?
With the increased use of highly-active antiretroviral therapy, AIDS has evolved from an end-stage
terminal illness into a chronic condition. With reduced mortality, the prevalence of HIV in the
12. Briefly discuss the three main models of case management in the delivery of long-term care.
A. Brokerage model: Freestanding case managers assess needs and arrange services through other
providers. Need assessment, development of a service plan, and making referrals are the main
functions of case management in this model. There is minimal coordination and monitoring of actual
services received.
13. What is meant by the continuum of institutional long-term care? Discuss the clinical services
delivered by residential/personal care facilities, assisted living facilities, and skilled nursing
facilities.
14. What is the difference between licensure and certification? What are the two types of
certifications? What purpose does each serve from (1) a clinical standpoint, and (2) a financial
standpoint?
Long-term care facilities are licensed according to the licensing standards of each state. A
facility must be licensed in order to operate. However, the operator may choose not to have
the facility certified. In that case, the facility would be able to admit only private-pay
15. Describe a continuing care retirement community? Include in your response the financing
and contractual arrangements.
A continuing care retirement community (CCRC) integrates and coordinates independent
living and institutional components of the LTC continuum. As a convenience factor, different
16. Why has private long-term care insurance not gained popularity with the consumers?
Four main reasons can be cited for the slow growth of private LTC insurance:
(1) Because of many variables in policies, trying to decide the right coverage is a daunting
task.
(4) Public policy has created few incentives to spur the growth of LTC insurance. Most