AGING IN OREGON
Understanding Long Term Care Services for the Older Adult
Module 2 – The Oregon System
What is long term care?
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“Long term care refers to provision of a range of
services to individuals who require assistance with
daily activities because of chronic illnesses and
functional impairments.” Noelker & Harel, 2001, p. 3
Long term care options in Oregon include:
 In-Home Care (IHC)
 Assisted Living Communities (ALF)
 Residential Care Communities (RCF)
 Memory Care Communities (MCC)
 Adult Foster Homes (AFH)
 Nursing Facilities (NF)
Oregon – A state leading the way in communitybased care of the older adult
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1981 Oregon Legislature calls for shift from nursing home
care to home and community-based care. First Medicaid
home and community-based care waiver in the country
granted.
1987 RNs permitted to delegate nursing care tasks to
unlicensed persons (nurse delegation). Assisted Living
Facility (ALF) concept introduced.
Read about how, when, and why Oregon’s long term care
system developed the way it did in this clip from the
“Campaign for Oregon’s Seniors and People with
Disabilities” website.
The Older Adult Living at Home
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The vast majority of older adults live
independently in their own homes.
Over 90% of older adults with chronic disabilities
receive informal (unpaid from family & friends)
and/or formal (e.g., paid) services.
Cost of full time care at home varies (e.g.,
private caregiver charges an average of $15 per
hour, through an in-home care agency the cost is
$20 – 24 per hour)
Family Caregivers
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Nearly 30% of the adult population are unpaid
caregivers;
Most caregivers are women, but increasingly caregivers
include men.
More than ½ of care recipients need help with at least
one ADL; almost all need help with an IADL (e.g.,
grocery shopping, transportation, paying bills).
The economic value of the unpaid, informal care
friends and family provide nationwide is $306 billion
per year.
Most caregivers are employed; the costs of the health
impact of caregiving on employees are estimated at
more than $13 billion annually.
Assistance for home dwelling older
adult and caregivers
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Adult day services
Older adult travels to a setting for services that include
recreation, socialization, physical activity, mental
stimulation, snacks/meal; may include some therapies.
Respite care services
Designed to provide ‘respite’ for caregiver. May be for a
few hours every week or for several days in a row once a
year. Happens in the home or in a group setting.
Companionship, light assistance, recreational activities and
security are provided.
Both services are usually paid for ‘out of pocket.’
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Oregon Department of Human Services
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In Home Care
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Seniors and people with physical disabilities can
receive services while living in their own homes.
In Home Care may be provided by different
providers depending on who is paying for the
service.
Care may be delivered on an hourly basis or as a
24-hour “live-in” shift.
In Home Care
Services may include help with:
 Bathing, dressing and personal hygiene
 Mobility and transfers
 Housekeeping and laundry
 Meal preparation or delivery (Meals on Wheels)
 Shopping and transportation
 Medical equipment
 Medication Assistance
Assisted Living /Residential Care Communities
Assisted living facilities (ALF) provide housing and supportive
services for six or more residents. These facilities are fully
wheelchair accessible. Residents of assisted living facilities
have private apartments, ranging from a studio to one or two
bedrooms. Each apartment unit has a kitchenette and private
bathroom with a wheelchair accessible shower.
Residential Care facilities (RCF) are like ALFs but are not
required to have private apartments, a kitchenette, or private
bathrooms with a shower.
Oregon Department of Human Services
ALFs and RCFs
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Are best suited for individuals who want to remain as
independent as possible and who are able to direct
their own care. However, acuity in both ALFs or RCFs
has increased considerably so that most residents are
dependent in at least one ADL and many have
significant cognitive impairment.
Are licensed and regulated by the Department of
Human Services, Seniors and People with Disabilities.
Require RN presence for some activities. Are not
required to have licensed registered nurses on staff 24hours-a-day.
ALFs and RCFs
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Duties and qualifications of direct caregivers vary among
facilities. Staff to resident ratio is typically lower than what
is required for nursing homes (may be 3 assistive staff on
PM shift for 70 residents).
Caregivers are not required to be certified, although
training prior to providing services to residents is
mandatory.
Basic monthly charge often covers only room/board.
Assistance with toileting, bathing, dressing, etc. are extra
charges.
Nurse delegation happens in these settings.
Adult Foster Homes
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Adult foster homes offer personal and health care to
individuals in private residences.
Adult foster homes are licensed, inspected and
monitored by Seniors and People with Disabilities.
People often choose adult foster care because it is
more affordable than other care facilities and care is
provided in a homelike setting.
These homes provide care for no more than five
individuals.
Oregon Adult Foster Home Administrative Rules
Memory Care Communities
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Some facilities/communities specialize in
providing care only to persons with dementia.
A community that specializes in the care for
people with memory impairment must receive an
endorsement and is governed by additional
regulations that are specifically intended to
support individuals with dementia.
Oregon Memory Care Communities Administrative
Rules.
Professional Support Services
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Home Health
 Provides
short-term, skilled care for home-bound
individuals. Services may include nursing, physical
therapy, occupational therapy, speech therapy, social
work, and/or home health aide care.
 Is time limited and usually paid for by insurance
 May provide services in assisted living, residential
care, and foster home settings.
 Oregon Home Health Agency Administrative Rules
Professional Support Services
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Hospice
 Provides
palliative and end-of-life support
 Services are available in the client’s ‘home’ that
includes nursing homes, assisted living, residential
care, memory care and foster care.
 Team members include nurses, physical therapists,
occupational therapists, social workers, chaplains,
hospice aides, and volunteers.
 Oregon Hospice Agency Administrative Rules (from the
Oregon Hospice Association)
Nursing Facilities
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Nursing facilities are licensed by the Department of Human
Services, Seniors and People with Disabilities and are required
to meet both federal and state regulations.
Services offered in nursing facilities
 Nursing care on a 24-hour basis
 On-site physical rehabilitation (Skilled Care)
 Recuperation after hospitalization for serious illness or
surgery (Skilled Care)
 Restorative services
 End-of-life care
Nursing Facilities
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Nursing facilities are most appropriate for people
who need 24-hour medical oversight and a
protective/structured setting. Residents may have
medical and behavioral needs that cannot be met in
other care settings.
Most residents must share their room. Space is
limited, but residents are allowed to bring personal
items to encourage a more home-like atmosphere.
Future trends in Long Term Care
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Cost efficiency and Innovative Ideas (read this September
2010 report on Long Term Care in Oregon)
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The Role of Nurses in Long Term Care (Module 4)
Culture Change (Module 4)
The PACE model (including a program in Oregon) in
this article from seniorjournal.com
Respite Care and Adult Day Services:
 Great
idea that isn’t currently working
 Great need, but no reimbursement currently
 Transportation is one of the problem issues