The changing face of long-term care

In this article, we present population estimates of individuals with disabilities and discuss the manner in which the composition of this population is changing. We then highlight aspects of service delivery systems that are evolving in response to the changing long-term care (LTC) population. Following a summary of financing issues, we discuss several cross-cutting issues related to the organization of service delivery, quality assurance (QA), and financing. Current and future Health Care Financing Administration (HCFA) research and demonstrations emerging from these issues are then described.     

A new approach to the design of information systems for foodservice management in health care facilities

An organizational framework for integrating foodservice data into an information system for management decision making is presented. The framework involves the application to foodservice of principles developed by the disciplines of managerial economics and accounting, mathematics, computer science, and information systems. The first step is to conceptualize a foodservice system from an input-output perspective, in which inputs are units of resources available to managers and outputs are servings of menu items. Next, methods of full cost accounting, from the management accounting literature, are suggested as a mechanism for developing and assigning costs of using resources within a foodservice operation. Then matrix multiplication is used to illustrate types of information that matrix data structures could make available for management planning and control when combined with a conversational mode of computer programming.     

Contrasting acute care and long-term care information systems needs

Information systems in nursing facilities have their own set of requirements. While these may appear to be less complex than those required of acute care systems, they offer their own series of traps and pitfalls and the information systems manager should be wary of vendors who suggest that acute care systems can be readily modified for long-term care usage. Well-designed and implemented long-term care applications demand the same challenges to integration as do acute care products. Information provided by these systems must be designed to support not only the routine transactions of the facility, but also the strategic planning necessary for intelligent management decision making. It is not sufficient in this era to record and replay data. Data must be synthesized into meaningful summaries in order to be effectively used by executives. [7] This is also true for clinicians. Assessment data are increasingly used to position a patient in a case-mix or reimbursement group. Whereas acute care revolves around DRGs and ICD-9 codes (soon to be ICD-10), long-term care uses a patient review instrument (PRI), resident assessment protocols (RAPs), and resource utilization groups (RUGS). The successful information systems manager will have all of these measures at his or her disposal by financial class, insurance class, and days receivable if eyes are kept on the goal of planning all of the systems with equal care and an eye to the future.     

Establishing and refining hurricane response systems for long-term care facilities

In February 2006 the John A. Hartford Foundation funded a long-term care "Hurricane Summit," sponsored by the Florida Health Care Association. Representatives from five Gulf Coast states that sustained hurricane damage during 2005 and from Georgia, a receiving state for hurricane evacuees, attended. Summit participants evaluated disaster preparedness, response, and recovery for long-term care provider networks and identified gaps that impeded safe resident evacuation and disaster response. The meeting identified emergency response system issues that require coordination between long-term care providers and state and federal emergency operations centers. Five areas warranting further attention are presented as lessons learned and potential areas for grant making.     

Advance care planning in long-term care facilities

Residents of long-term care facilities are at risk of serious medical illnesses and being unable to express choices when difficult treatment decisions must be made. Advance care planning (ACP) allows residents to consider, make, and communicate their preferences for how medical decisions should be made if they are unable to participate in the decision-making process. This article reviews the three steps in ACP: consideration of options and expression of values, communication of decisions, and documentation of the choices. The article defines and describes the particular value of ACP in long-term care facilities, reviews the literature on successful ACP programs in long-term care, and concludes with practical suggestions on how to develop and implement ACP programs.     

Quality of care assessment in long-term care facilities

Quality of care assessment is in a rather rudimentary state of development in most long-term health care settings. Some of the mandates and initiatives in this area of evaluation are described and discussed. A few caveats are presented and suggestions made as to appropriate approaches to quality assessment in chronic care facilities, which are different in many respects from the more traditional approaches used in acute care hospitals. Of particular importance, and at the same time of greatest difficulty, is the assessment of quality of life in institutions where many patients spend the remainder of their lives.