HP 626 week 5 discussion social perspectives cost of long term care and ethical viewpoints discussion questions

Sample Answer

Describe what surprised you in the learning materials around the cost of long-term care.

I really didn’t have a complete notion as to the out of pocket cost for long term care. Medicare does not cover these services and it is the responsibility of the individual or their families (Willink et al., 2019). Lower income clients may or may not qualify for Medicaid, however, even if they do, Medicaid payments to the institution vary from state to state (Willink et al., 2019).

What I am now surmising, is that those clients who are in long-term care facilities, are either paying for the service with their life savings, or they have long-term health insurance.

Explain the financial challenges and realities that older adults face as they age.

Many older adults have limited financial means and meeting their physical needs can be a challenge. This older group who may have long term services and support ( LTSS), may not have enough funds to pay for food, rent or heat (Willink et al., 2019).

In some cases, this population is faced with the inability to pay for needed prescription medications as well. According to Willink et al.(2019), when older adults are unable to pay for their housing or food, many are placed in nursing homes. This is not the purpose of nursing homes, as they are intended to provide skilled nursing services.

“They are not meant to be the default option for older Medicare beneficiaries needing long-term services and supports because the financial burden of these costs results in an inability to pay for rent or utilities” (Willink et al., 2019). I felt the need to quote this directly as I found it astounding that this is the course of events when funds are at a minimum

Describe the ways in which long-term care is paid for by aging adults and patterns over time.

How would this impact your work as the leader of a long-term care organization?

When planning for age related care, there are those individuals who have saved over their lifetime to provide for this eventuality, as well as leaving enough behind for the next generation; this can provide peace in old age (Peters & Pinkston, 2002).

There are others who made similar plans, but were forced to use all of their savings for unexpected changed in health needs. Most long-term care is first paid with the client’s social security check, followed by pensions and savings (Peters & Pinkston, 2002).

As ability to pay is decreased, and clients are moved to use Medicaid, the reimbursement to the long-term organization would be adjusted and thus cause a lowering of funding. Since funding is at the heart of an organization, this now puts stress on the overall function of the facility.

Nursing home care is common and costly.

Describe how accountable care organization (ACO) payment models have incentives for care that is better coordinated and less reliant on acute settings.

ACO are groups of doctors, and other health care providers who work together to give coordinated high quality care to Medicare patients (Centers for Medicare & Medicaid Services, 2021).

The aim is to avoid duplication of services and avoid medical errors. According to Centers for Medicare and Medicaid Services (2021), this results in spending health care dollars more wisely, which then reflects this savings back to the Medicare program

Describe ways in which long-term care is reimbursed for services and the impacts of pay-for-performance models. Does this have the potential to improve care for this high-cost population?

Pay for performance , particularly at the Medicaid level, surely has potential to improve care in long term health centers. Many states are using a P4P as a means of evaluating, recognizing and motivating for high quality care in nursing home.

The intention is to reward those facilities who meet the goals of quality care and is based on clinical measurements and policies related to the direct care workers (Executive Office of Health and Human Services of Massachusetts.

The particular focus is on long-stay patients who are on antipsychotic medications and those who are incontinent of bowels or bladder. Staff are examined for quality and quantity as well as turnover and there must be evidence of meetings regarding quality improvement. I think this is a wonderful strategy in addressing the quality of life of the residents.

As a leader of a long-term care organization, do you think it is cost effective to provide a more comfortable setting through cultural change?

Yes, I believe that it is cost effective to provide a more comfortable setting through cultural change. Cultural change helps companies and institutions remain competitive. By adjusting to consumer needs and requests, there is increased interest in participating in, or utilizing ,the services of a highly appointed facility.

Does the pay-for-performance model for reimbursement have advantages?

I am from the generation of merit raises. I completely agree with this strategy. It is, generally believed to be a strategy that links pay raises or bonuses to the goals set for the employee and their job description. I feel that it is an excellent approach to managing motivation and job performance.

How do low reimbursement rates impact the quality of care delivered to aging adults living in a long-term care setting?

Medicaid is the primary source of reimbursement for nursing homes; 60% of all nursing home residents and 50% of all long-term care services are provided by Medicaid ; these payments only cover 70-80% of the actual cost of nursing home care (American Health Care Association & National Center for Assisted Living Office, 2024).

Half of the nursing homes are reported to be operating at a loss and 72% state that will not be able to absorb this loss. Permanent closures are occurring and residents are at a loss for placement (American Health Care Association & National Center for Assisted Living Office, 2024).

References

• American Health Care Association & National Center for Assisted Living Office. (2024). Financial struggle of nursing homes puts Medicaid reimbursement rates back in the spotlight. (n.d.). https //www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Financial-Struggle-of-Nursing-Homes-Puts-Medicaid-Reimbursement-Rates-Back-in-the-Spotlight.aspx
  
• Centers for Medicare & Medicaid Services. (2021). Accountable care organizations (ACOs) General Information | CMS. https //www.cms.gov/priorities/innovation/innovation-models/aco# ~ text=Accountable%20Care%20Organizations%20(ACOs)%20are,the%20Medicare%20patients%20they%20serve.
  
• Office of Health and Human Services, Massachusetts. (n.d.). MassHealth nursing home pay for performance program. mass.gov. https //www.mass.gov/doc/nursing-home-pay-for-performance-p4p-stakeholder-meeting-1/download
  
• Peters, C. M., & Pinkston, E. M. (2002). Controllers and noncontrollers A typology of older Americans and their caregivers’ approaches to managing the private funding of long-term care. Qualitative Health Research, 12(9), 1161–1183.
  
• Willink, A., Davis, K., Mulcahy, J., Wolff, J. L., & Kasper, J. (2019). The financial hardship faced by older Americans needing long-term services and supports (PDF). Issue Brief (Commonwealth Fund), 2019, 1–12.