Unit8 - Unit 8 Topics Special Populations& Public Health LongLong-term care Mental Health Public Health Health Promotion and Disease Prevention

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Unformatted text preview: 10/26/2010 Unit 8 Topics Special Populations & Public Health LongLong-term care Mental Health Public Health Health Promotion and Disease Prevention Chapters 12, 15, 17 & 18, PLB 10/26/10 AHS 330 - Fall 2010 - Unit 8 1 AHS 330 - Fall 2010 - Unit 8 10/26/10 LongLong-Term Care Long Term Care Definition: LongLong-term care is defined as a range of health, personal care, social and housing services provided to people who have lost or never developed the capacity to care for themselves independently as a result of chronic illness or mental or physical disability. It is an umbrella disability. term that covers a lot of different concepts, services and people. A wide range of services including health and personal care custodial social & housin ing For people who cannot care for themselves independently due to: AHS 330 - Fall 2010 - Unit 8 10/26/10 3 Goals of Long Term Care lost capacity never having developed the capacity Duration: Relatively long and indefinite 10/26/10 Promote and maintain: Sudden onset For those with terminal illness to help them die peacefully and with dignity Responds to treatment Hospice 10/26/10 AHS 330 - Fall 2010 - Unit 8 Long term/chronic illness Gradual onset Limited duration Opportunity for recovery Medical management LowLow-tech (some true but changing) Crisis oriented 5 HighHigh-tech care 10/26/10 4 Long Term Care Health Independence in functional abilities and quality of life life AHS 330 - Fall 2010 - Unit 8 Acute Care 2 AHS 330 - Fall 2010 - Unit 8 6 1 10/26/2010 Who Uses Long Term Care 85+ years old is the fastest growing population in the U.S. Longer life spans Disabled Elderly Functional Disabilities All ages Ex.: MS, stroke, AIDS, accidents, etc. Mentally Ill 12 million individuals in 1998 in long term care facilities – nearly half were non-elderly non- 10/26/10 AHS 330 - Fall 2010 - Unit 8 Activities of Daily Living (ADL) A measure of a person’s dependence on others Examples: Bathing Dressing Eating Walking Toileting Instrumental Activities of Daily Living (IADL) measure of a person’s ability to perform household & social tasks Examples: Examples: preparing meals heavy housework light housework using telephone managing finances shopping http://www.pbs.org/wgbh/caringforyourparents/caregiver/pdf/cfyp_adl_checklist.pdf http://www.abramsoncenter.org/PRI/documents/IADL.pdf 7 AHS 330 - Fall 2010 - Unit 8 10/26/10 8 One in Five Disabled Persons Needs Help with Basic Daily Activities Source: RWJ 10/26/10 AHS 330 - Fall 2010 - Unit 8 9 10/26/10 The Elderly Population Continues to Grow AHS 330 - Fall 2010 - Unit 8 10 Greater Numbers of People Will Be Limited by Chronic Conditions (In thousands) 10/26/10 AHS 330 - Fall 2010 - Unit 8 11 10/26/10 AHS 330 - Fall 2010 - Unit 8 Source: RWJ 12 2 10/26/2010 Who Provides Long Term Care Nursing Home Care Informal caregivers provide 80% of LTC Formal Care: Institutional-based LTC & LTC CommunityCommunity-based LTC Skilled Nursing Facility (SNF) Example: Family and friends Most informal caregivers are women Examples: nursing homes and adult day care nursing care provided by and overseen by licensed health care providers 2007: 16,701 nursing homes; 1.7 million certified or licensed beds Ownership: ForFor-profit 67% Not-forNot-for-profit 27% Government 6% These two forms of LTC are not mutually exclusive AHS 330 - Fall 2010 - Unit 8 10/26/10 An institution or a distinct part of an institution such as a skilled nursing home or rehabilitation center, is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care; or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. NURSING FACILITY OR NURSING HOME 10/26/10 Residence facility that provides a room, meals, and help with activities of daily living and recreation. Generally, nursing home residents have physical or mental problems that keep them from living on their own. They usually require daily assistance. assistance. AHS 330 - Fall 2010 - Unit 8 15 Trends in the Nursing Home Industry Average occupancy rate approximately 90% Median length of stay is just over 3.5 Median length of stay is just over 3.5 years years 10/26/10 Post-acute care (Medicare patients) ost(M Long-Term custodial care (Medicaid patients and Longprivate pay in nursing homes) Increased requirement for high quality nursing home care AHS 330 - Fall 2010 - Unit 8 AHS 330 - Fall 2010 - Unit 8 16 Demographics: Increase in integration of nursing homes (vertical and horizontal) Increased demand for: 10/26/10 14 Nursing Homes AHS 330 - Fall 2010 - Unit 8 10/26/10 SKILLED NURSING FACILITY (SNF) (SNF) http://www.statehealthfacts.org/comparebar.jsp?ind=412&cat=8 13 17 43% are 85 years of age or older 70% are female 86% have no relatives 52% have Alzheimer's or other dementia (inability to think or reason) ½ need help with 5 activities of daily living and 24% with 4 ADLs. 95% required help with bathing, 87% with dressing and 51% with eating. 53% have an advance directive of some type (living will, do not resuscitate order, etc.) 10/26/10 AHS 330 - Fall 2010 - Unit 8 18 3 10/26/2010 Nursing Homes Bed Size Average size = 107 beds (tend to be small compared with hospitals) Number of beds in thousands had continued to rise since 1976 Number of beds per 1,000 population 85 years & older has decreased since 1976 Why? AHS 330 - Fall 2010 - Unit 8 10/26/10 19 Aging population and the supply of nursing home beds has not been able to catch up AHS 330 - Fall 2010 - Unit 8 10/26/10 Nursing Home Beds and Nursing Home Bed Rate: United States 1976-1991 20 Nursing Home Beds Down, Home Care Expenditures Up More people are replacing nursing home care with home health care Source: RWJ AHS 330 - Fall 2010 - Unit 8 10/26/10 21 How much does long-term care cost? long Nursing Home Care 22 National Spending on Nursing Home and Home Health Care, 2003 Nursing Home Care average annual cost is $74,000 Home Health Care Private Other 6% Insurance 8% Personal Care AHS 330 - Fall 2010 - Unit 8 10/26/10 Other 5% Private Insurance 21% average annual cost is $9,000 Out-ofPocket 28% Home Health average rate for home health aide is $19/hour Medicaid 46% Medicaid 25% Out-of-Pocket 17% Medicare 10/26/10 AHS 330 - Fall 2010 - Unit 8 Kaiser Edu.org23 Medicare 12% 32% Total = $110.8 billion Total = $40 billion SOURCE: CMS, National Health Accounts, 2005. 10/26/10 AHS 330 - Fall 2010 - Unit 8 Kaiser Edu.org24 4 10/26/2010 Number of nursing homes, beds, current residents, and discharges: United States, selected years 1973-2004 1973- http://www.cdc.gov/nchs/about/major/nnhsd/nnhschart.htm 10/26/10 AHS 330 - Fall 2010 - Unit 8 25 10/26/10 91.3% were enrolled in Medicare; 62.2% were dually eligible for Medicare and Medicaid; 4.5% were eligible for Medicaid only l 27 Residential Care Facilities Assisted Living Adult Day Care Home Health Care Rehabilitation Hospice Respite Care 10/26/10 AHS 330 - Fall 2010 - Unit 8 AHS 330 - Fall 2010 - Unit 8 28 Adult Day Care “S “Spending down” – nursing home residents must spend all income and assets until they become poor enough to be eligible for Medicaid. Private insurance 3% Medicare 4% (does not cover custodial care) 10/26/10 Other types of long term care projected to be 70% in next 30 years Out of pocket 37% AHS 330 - Fall 2010 - Unit 8 Medicaid approximately 47% 10/26/10 26 http://www.cdc.gov/nchs/data/nnhsd/nursinghomes1973-2004.pdf Who Pays For Nursing Home Care? What Types of Health Insurance Do Nursing Home Residents Have? AHS 330 - Fall 2010 - Unit 8 29 Social, medical/health, specialized models 150,000 people in ADC 78% non-profit non35% live with adult child, 11% live alone 2/3 were women were women Average age is 72 Reimbursement - Medicaid, Private pay and charities, Medicare does not pay Average cost to attend about $61 per day About half operate at a loss 10/26/10 AHS 330 - Fall 2010 - Unit 8 30 5 10/26/2010 Case Management Home Health Care Goal: Highest level of independent functioning Joint decision making decision making Treat the whole patient AHS 330 - Fall 2010 - Unit 8 10/26/10 Nursing, therapy, and support services provided to patients in their own residence Patient is homebound, but capable of ADLs 31 10/26/10 AHS 330 - Fall 2010 - Unit 8 32 33 10/26/10 AHS 330 - Fall 2010 - Unit 8 34 Increasing Numbers of Persons with Chronic Conditions Receiving Care at Home Source: RWJ 10/26/10 AHS 330 - Fall 2010 - Unit 8 Hospice Rehabilitation Inpatient, Outpatient, In home Following acute illness or injury Goal: Complete recovery or independence Maintenance Drug 10/26/10 or slowed decline and alcohol addiction treatment AHS 330 - Fall 2010 - Unit 8 35 For terminally ill “Palliative Care”--treatment given to Care”--treatment relieve symptoms of disease rather relieve symptoms of disease rather than than attempting to cure disease itself. Focus: Quality of life & comfort 10/26/10 AHS 330 - Fall 2010 - Unit 8 36 6 10/26/2010 Number of US Hospice Programs by Year Hospice Facts 1974: First hospice in US Funding Sources: grants and philanthropy philanthropy 1983: Hospice becomes more popular Source: Nation Hospice Organization www.nho.org 10/26/10 AHS 330 - Fall 2010 - Unit 8 37 10/26/10 AHS 330 - Fall 2010 - Unit 8 38 39 10/26/10 AHS 330 - Fall 2010 - Unit 8 40 http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-figures_2008.pdf 10/26/10 AHS 330 - Fall 2010 - Unit 8 Respite Care In-home In- or institution-based institution Gives informal caregivers a break Short term and intermittent term and intermittent Very limited coverage http://www.nhpco.org/files/public/Statistics_Research/NHPCO_facts-and-figures_2008.pdf AHS 330 - Fall 2010 - Unit 8 10/26/10 41 10/26/10 AHS 330 - Fall 2010 - Unit 8 42 7 10/26/2010 An Individual’s Costs Physician Shortage Areas 44.5 million individuals over 65 in 2008 (Census) 133 million individuals with at least one chronic condition in 2005 (CDC) 9,247 geriatricians and geriatric psychiatrists geriatricians and geriatric psychiatrists (2008) (2008) 4,600 physical medicine and rehabilitation (physiatrist) physicians Pay for aides, nurses, and doctors is low relative to similar jobs in acute care setting 10/26/10 AHS 330 - Fall 2010 - Unit 8 Average LTC policy (65 yr old) Covers: 4 years of care $100 per day to cover nursing home $100 expenses Cost: $1,002 annual ($300 annual for 40 YO) 43 10/26/10 AHS 330 - Fall 2010 - Unit 8 44 45 10/26/10 AHS 330 - Fall 2010 - Unit 8 46 Innovations in Long Term Care Aging in Place Continuing Care Retirement Retirement Communities Communities High-tech Home HighCare 10/26/10 AHS 330 - Fall 2010 - Unit 8 Mental Health Mental Health is a state of successful performance of mental function, resulting in: productive activities fulfilling relationships with other people relationships with other people the ability to adapt to change and to cope with adversity. 10/26/10 AHS 330 - Fall 2010 - Unit 8 47 10/26/10 AHS 330 - Fall 2010 - Unit 8 48 8 10/26/2010 Mental Illness is the term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are Mental disorders are health conditions that are characterized characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning AHS 330 - Fall 2010 - Unit 8 10/26/10 49 AHS 330 - Fall 2010 - Unit 8 10/26/10 50 Percentage of people experiencing disorder during their lives US Pharm. 2006;11:8. AHS 330 - Fall 2010 - Unit 8 10/26/10 51 # Individuals 20.9 million 2.4 million 40 million million 7.7 million %Total DALYs* Cost $83 billion $62.7 billion >$42 billion $1.8 billion 4.1 million $31.6 billion 1. All Cardiovascular Conditions 2. All Mental Illness 3. All Cancers 15.0 15.4 * DALYs--Disability Adjusted Life Years http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml AHS 330 - Fall 2010 - Unit 8 18.6 A Total cost: apprx. $ 193.2 billion 10/26/10 52 Global Burden of Disease, 1990 Mental Disorders in America, 2008 Illness Depression Schizophrenia Anxiety Disorder Disorder Post Traumatic Stress Disorder ADHD AHS 330 - Fall 2010 - Unit 8 10/26/10 53 Common Measure for Describing the burden of disability and premature death from the full range of physical and mental disorders 10/26/10 AHS 330 - Fall 2010 - Unit 8 54 9 10/26/2010 Mental Health Services Post WWII: The Deinstitutionalization Movement • 1946 National Mental Health Act • Creates National Mental Health Institute • Increase in federal $ for MH therapy and research • 1950’s Antipsychotic Drugs • 1963 Community Mental Health Centers Act • 1970’s Presidential Commission of Mental Health lessened the severity of many mental illnesses • • Poor Planning --> Inc. Homelessness and Jail Populations --> • • Medicaid Expansions • Need for Services Overwhelm System 1980’s Reagan Administration Decreases in Federal Funding Block Grant Programs • • Fig. 1: WHO Study “Global Burden of Disease”, Murray & Lopez 2001 • Deinstitutionalization has led to “revolving door” phenomenon 10/26/10 AHS 330 - Fall 2010 - Unit 8 55 10/26/10 AHS 330 - Fall 2010 - Unit 8 56 10/26/10 AHS 330 - Fall 2010 - Unit 8 57 10/26/10 AHS 330 - Fall 2010 - Unit 8 58 Community Mental Health Services Rationale: Least Restrictive Setting is Most humane Target Population: Severely Mentally Ill Financial Incentive for the State: Shift mentally ill from mental health institutions to nursing homes & Community Based Care Centers Money Source: Federal Block Grants 10/26/10 AHS 330 - Fall 2010 - Unit 8 59 10/26/10 AHS 330 - Fall 2010 - Unit 8 60 10 10/26/2010 Trends in the Population in State Mental Health Facilities Mental Illness in the Jails-Jails-An Ongoing Social Problem In 1950: 513,000 inpatients In 1955: 560,000 inpatients (peak) In 1965: 475,000 inpatients 1965: 475 inpatients In 1990: 92,000 inpatients 10/26/10 AHS 330 - Fall 2010 - Unit 8 More than a quarter million mentally ill individuals are either behind bars or on probation. 61 10/26/10 AHS 330 - Fall 2010 - Unit 8 62 Symptoms of mental disorders among inmates, 2006 AHS 330 - Fall 2010 - Unit 8 63 Mania disorder-43.2% of State, 35.1% of disorder 43 of State 35 of Federal, Federal, and 54.5% of local 10/26/10 Major depressive disorder-23.5% of State, 16.0% disorderof Federal, 29.7% of local Psychotic disorder-15.4% of State, 10.2% of disorderFederal, and 23.9% of local 10/26/10 AHS 330 - Fall 2010 - Unit 8 64 Mental Illness & Homelessness Percent of Mentally Ill among violent Offenders 65 1/3 have a severe mental illness have severe mental illness AHS 330 - Fall 2010 - Unit 8 At least ½ of the homeless have or had an alcohol or substance abuse problem 10/26/10 ¾ of adult homeless men have been instituitionalized at some point (incarcarated, mental health hospital or a drug & rehab facility) 10/26/10 AHS 330 - Fall 2010 - Unit 8 66 11 10/26/2010 Trends in Patient Care Episodes Mental Health Services in the 1990’s Shift toward Partial Hospitalization Outpatient Services Managed Care--> Carve Outs Care Carve Outs # of Patient Care Episodes 1955 1.7 Million Milli 1980 1980 7.0 Million 1990 8.6 Million (21% Treated in an Inpatient Setting) 1996 and 2007 Mental Health Parity Act (no newer data are available) 10/26/10 AHS 330 - Fall 2010 - Unit 8 67 10/26/10 AHS 330 - Fall 2010 - Unit 8 68 Distribution of Mental Health Services and Substance Abuse Treatment Expenditures by Payer, 2001 Organization of the Mental Health System Health System Mental Health and Substance Abuse Treatment = $103.7 billion Source: SAMHSA. National Estimates of Expenditures for Mental Health Services and Substance Abuse Treatment: 1991-2001(page 10) 10/26/10 AHS 330 - Fall 2010 - Unit 8 69 10/26/10 General Medical/ Primary Care Sector Types of Professionals: General Internists Pediatricians Nurse Practitioners Practitioners 10/26/10 70 Specialty Mental Health Sector Types of Professionals Psychiatrists Psychologists Psychiatric Nurses Psychiatric Social Workers Population Usage Adults: less than 6% Children (ages 9-17): 9Approximately 8% Population Usage: Adults: >6% Children: 3% AHS 330 - Fall 2010 - Unit 8 AHS 330 - Fall 2010 - Unit 8 71 10/26/10 AHS 330 - Fall 2010 - Unit 8 72 12 10/26/2010 Human Services Sector Voluntary Support Network Sector Population Usage: Examples: Adults: 5% Social Services SchoolSchool-Based Counseling Children: Residential Rehab Services Rehab Services School-based ~ 16% 16% Vocational Rehab Child Welfare Juvenile Criminal Justice/Prison-based Justice/PrisonSystem ~ 3% Religious Professional Counselors AHS 330 - Fall 2010 - Unit 8 10/26/10 73 AHS 330 - Fall 2010 - Unit 8 science and art of preventing disease, prolonging life, and promoting health and efficiency through community effort for: mm 75 10/26/10 AHS 330 - Fall 2010 - Unit 8 76 Other definitions of the environment Control of communicable diseases Education of individuals on personal hygiene The organization of medical and nursing The organization of medical and services services for early diagnosis and preventive treatment of diseases The development of social machinery to insure everyone’s health Efforts made by communities to cope with health problems that arise when people live in groups. Endemic – usual occurrence in a population Epidemic: an outbreak of a contagious disease that spreads rapidly and widely (http://www.thefreedictionary.com/Epidemic) 77 Unusual occurrence in a population Pandemic: (world-wide epidemic) Epidemic over a (worldwide geographic area and affecting a large proportion of the population: (http://www.thefreedictionary.com/Pandemic) Dr. Winslow, MIT AHS 330 - Fall 2010 - Unit 8 74 The Sanitation 10/26/10 AHS 330 - Fall 2010 - Unit 8 10/26/10 What is Public Health? Community Organizations Some Support Groups FaithFaith-Based Organizations What is Public Health? Public Health 10/26/10 10/26/10 Unusual occurrence of a disease that is spread around the world AHS 330 - Fall 2010 - Unit 8 78 13 10/26/2010 Ten Great Public Health Achievements -United States, 1900-1999 1900Word 2. 3. 4. 5. 6. 7. 8. 9. 10. 10/26/10 AHS 330 - Fall 2010 - Unit 8 430 BC – Peloponnesian War 165-180 AD – Antonine Plague 165 541 – Plague of Justinian (www.loyno.edu) 1300s – The Black Death 1300s Black Death Cholera (1816-1826) (1829-1851) (1852-1860) (1816(1829(1852(1863(1863-1875) (1899-1923) (1899 1918-1919 – Spanish Flu 1918 Modern day – AIDS? Future – Influenza, Ebola, SARS, avian flu, etc. 10/26/10 AHS 330 - Fall 2010 - Unit 8 81 En+demos In + people Epi + demos Upon + people Pandemic Examples of Pandemics Over Time English Epidemic 79 Greek Endemic Vaccination MotorMotor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard 1. Pan + demos All + people AHS 330 - Fall 2010 - Unit 8 10/26/10 Government’s Role in Public Health Federal – Funding and agencies DHHS CDC State – Funding, standards and regulations, provision Local – Hands on work 10/26/10 Levels of Prevention: AHS 330 - Fall 2010 - Unit 8 AHS 330 - Fall 2010 - Unit 8 82 Prevention Primary: prevent disease process from ever getting started (ex. Immunizations, water and air purification) Secondary prevention: early detection (high blood pressure, cholesterol, pap smear, mammogram, PSA, etc) Tertiary prevention: disease present, treat it so as to prevent further complications (cardiac rehab to prevent further heart attacks) 10/26/10 80 83 Estimate: 10% of early deaths could be prevented by medical treatment; 70% of early deaths treatment; 70% of early deaths could could be prevented through populationpopulation-wide public health approaches. 10/26/10 AHS 330 - Fall 2010 - Unit 8 84 14 10/26/2010 Significant Landmarks of Public Health Service Traditional Aspect of Public Health Identification of diseases that were causing death or disability Learning the cause of disease and its method of transmission Developing prevention methods Organizing effective application of prevention methods Historically, the preservation of society and prevention. 10/26/10 AHS 330 - Fall 2010 - Unit 8 85 1798 – Marine Hospital Service 1865 – Shattuck Report 1870 – National Hospital System (reformed Marine Hospital Service) 1933 1933 – Federal Emergency Relief Act Emergency Relief Act 1935 – Social Security Act of 1935 1939 – Federal Health Agency (Precursor of Health, Education and Welfare, public health moved from Treasury to this agency) 1946 – Federal Security Agency adds Children’s Bureau and FDA AHS 330 - Fall 2010 - Unit 8 10/26/10 NEXT WEEK Six Tasks of Public Health (Emerson 1945) (Emerson Vital Statistics (birth, death, marriage, divorce) Communicable disease control Sanitation Laboratory services Maternal and child health Health Education 10/26/10 AHS 330 - Fall 2010 - Unit 8 Unit 9 & Review Unit 8 Unit 8 Quiz Multiple Choice and True/False Questions Covering Assigned Textbook Chapter, Unit PowerPoint Slides, Assigned Textbook Chapter, Unit 8 PowerPoint Slides, & Lecture Lecture Unit 8 Discussion Question 87 86 10/26/10 Comment on a 200 word discussion question and post a 50 word response to another student’s blog AHS 330 - Fall 2010 - Unit 8 88 15 ...
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This note was uploaded on 08/21/2011 for the course AHS 330 taught by Professor Smith during the Fall '10 term at University of Alabama at Birmingham.

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