¶ … elderly population is continues to rise nationally and this also true for the Sunnydale and Shadyville communities. In order to be prepared for both the rise in the aging population and any competition in the healthcare from Shadyville it is important to consider all potential providers. This paper will briefly look at the facets of nursing homes, assisted living, home health care, and hospice in this context.

Nursing homes

Nursing homes are the highest level of care for elderly adults outside of having them formally hospitalized (Santerre & Neun, 2012). The residents in nursing homes typically need significant help with their Activities of daily Living (ADLs). Nursing homes provide custodial care which means that the home assists with all daily activities including getting in and out of bed, providing assistance with feeding, bathing, and dressing. Most nursing homes also provide for activities for their higher functioning residents such as crafts, games, shopping trips or other types of activities.

The funding for nursing home services comes from four primary groups: the Medicaid program, the Medicare program, the consumers themselves, and private health insurers (Santerre & Neun, 2012). The single largest payer to nursing homes is Medicaid program (32% of nursing home expenditures) followed Medicare (22% of total funding; Santerre & Neun, 2012). However, Medicare does not pay for long-term care in a nursing home facility.

Quality control measures for nursing homes are most often staffing census, health-related survey deficiencies, and Minimum Data Set (MDS) quality indicators. The results of these are variable but do allow for the maintenance of minimally defined quality of care standards that must be maintained by each facility.

Assisted Living Services

Assisted living facilities are suitable for elderly individuals who need very little assistance with their daily care. These facilities only provide minimal help in terms of ADLs compared to nursing homes that provide minimum to maximum assistance. In terms of a person's medical needs these facilities typically provide assistance with medication or intermittent skilled nursing care.

Funding for assisted living comes primarily from private sources such as out of pocket payers and some private insurance (Stevenson & Grabowski, 2010). From the perspective of the consumer, assisted living is largely positive. Consumers, most of whom are private pay, vote with their dollars in favor of the facility. As such the entrance barriers into this market are less stringent in terms of federal regulations and guidelines to follow; however, nationally there remains quite a bit of variability in the capacity of these facilities and the services offered. Lower-income individuals and people living in rural areas have significantly less access to this option. The access to assisted living is greatest in areas where a greater proportion of the Medicaid long-term care funding is going into community and home-based services (Stevenson & Grabowski, 2010). Thus, assisted living facilities are best situated in areas where the population is of a higher socio-economic status.

Quality assessment for assisted living facilities often comes from census data, surveys and the self-report data of consumers indicating that assisted living services are typically rated higher than nursing homes (Stevenson & Grabowski, 2010).

Home Health Care

Home health care services describe a wide range of health care services that are administered in an individual's home following some type of illness or some type of injury (Kovner, Mezey & Harrington, 2002). The consumers are most often elderly individuals but can really be of any age. The advantage here is that home health care is less expensive offers greater convenience, and is just as effective as care delivered from a hospital or skilled nursing facility. Typically these services include: care for surgical wounds, care for pressure sores, intravenous therapy, nutrition therapy, injections, education for patients and caregivers, or monitoring serious illness or an unstable health status. Home health care is a short-term program where the goal is to assist someone to get better following an illness or surgery, regain their independence, and to become as self-sufficient as possible.

The primary funding for home health care services are Medicaid, Medicare, and private insurance programs. This results in some rather stringent entrance barriers into the home health care market including strict federal and state regulations and strict monitoring of the requirements for payment (Kovner et al., 2002). From the consumer's point-of-view home health care is advantageous to remaining in a hospital or nursing home as most patients prefer to be at home during recovery; however, the also means that consumers must be able to function independently or have someone at home to assist in their care. The home health care market has doubled since 2002 indicating that many individuals are looking to this option for short-term care (Stevenson & Grabowski, 2010).

Quality control measures for home health care like nursing homes are most often staffing census, health-related surveys, and MDS quality indicators. The results of these are variable but do allow for the maintenance of minimally defined quality of care standards that must be maintained by each company.

Hospice Care

Hospice care is a specialized care to provide support for individuals in the advanced stages of a terminal illness (National Hospice and Palliative Care Organization [NHPCO], 2012). Hospice care places the focus on comfort and quality of life as opposed to attempting a cure. The goal of hospice care is to enable a patient to have an alert, pain-free life in the final days. Hospice care can be performed at home or in a community center. Hospices receive funds from a number of different sources including government insurance programs such as Medicaid and Medicare, private insurance, from donations made by the public, corporations, and from grants. These services are paid on a per-diem basis.

As a result of the participation in federally funded insurance and private insurance programs hospice care facilities are subject to strict regulations regarding providers, billing, and procedures. Nonetheless, participation in hospice care has steadily risen in the past several years. Consumers, which include both patients and their families, find this approach to be one that brings peace to terminal patients and allows them to die with dignity (NHPCO, 2012). Quality performance measures include self-reports of consumers who rate the quality of care for hospice stay greater than hospital or nursing home enrollment and figures from the NHPCO indicating that participation in hospice care results in a substantial savings of government funded insurance payouts (Kelley, Deb, Du, Carlson, & Morrison, 2013).

Continuing Care Retirement Community

Community Care Retirement Communities (CCRCs) offer care around the entire residential continuum ranging from independent housing for seniors to 24-hour nursing care services (Ayalon & Green, 2013). Thus, all of the aforementioned services provided by other programs are offered. The residents of CCRCs pay an entry fee and they also pay an adjustable monthly rent fee in return for receiving the assurance of health care services for the rest of their lives. An advantage here is that because CCRCs maintain the entire assortment of medical services and social services on-site any resident can enter the community while they are healthy and then move on to more intensive medical care as needed. Nursing care is either located in the CCRC or close by. CCRCs will also provide meals, housekeeping services, maintenance, transportation for residents, social activities, and security services for the residents. Funding comes from private pay and can be quite expensive. Moreover, medical services may also bill insurance. Given the wide range of services provided these facilities are subject to government regulations and their private pay format indicates that in order for them to be solvent they must have adequate access to potential consumers. Quality control measures range from self-report data to staffing counts, health-related survey deficiencies, and MDS quality indicators. Results can be variable, but independent residents typically rate their quality of care as good and quantitative measures for dependent residents set minimal acceptable standards of care.

Why Continuing Care Retirement Communities are Best for Sunnydale

If the goal is to compete with other communities that offer services for elderly individuals and to provide overall quality care for this group then Sunnydale should consider a CCRC over the other options. Home health care, hospice services, and assisted living services are too specialized to provide the full spectrum of need services and nursing home care is included in the CCRC. This will allow Sunnydale to offer a full care and to exploit the entire set of needs for this group.

References

Ayalon, L., & Green, V. (2013). Social ties in the context of the continuing care retirement community. Qualitative health research, 23(3), 396-406.

Kelley, A. S., Deb, P., Du, Q., Carlson, M. D. A., & Morrison, R. S. (2013). Hospice enrollment saves money for Medicare and improves care quality across a number of different lengths-of-stay. Health Affairs, 32(3), 552-561

Kovner, C. T., Mezey, M., & Harrington, C. (2002). Who cares for older adults? Workforce implications of an aging society. Health Affairs, 21(5), 78-89.

National Hospice and Palliative Care Organization (2012). Figures: Hospice Care in America. Alexandria, VA: Author.

Santerre, R., & Neun, S. (2012). Health economics. Mason, OH: Cengage Learning.

Stevenson, D. G., & Grabowski, D. C. (2010). Sizing up the market for assisted living. Health Affairs,…