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 – Highlights of a leader in the 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.
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1990 Oregon’s first ALF is licensed.
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1990 – present Expansion of Residential Care and Adult Foster Home Programs.
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Mid 1990’s Standardization of dementia care through Best Friends approach.
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2003 – 2006 Better Jobs, Better Care Demonstration Project Person-Directed Care
Measurement Tool developed.
2004 Making Oregon Vital for Elders coalition formed
The History of LTC in Oregon
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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.
 2/3
receive informal care only.
 9% receive only formal 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.
31% have provided care for 5 years or more (average is 4.6 years), usually to
a relative (86%).
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).
About ½ of care recipients live in their own homes, 29% live with the caregiver.
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.
The annual national spending for formal home health care and formal nursing
home care, totals about $158 billion.
Family caregiving continues for those receiving formal in-home services and for
those living in LTC facilities.
Assistance for home dwelling older
adult and caregivers
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Adult day services
Respite care services
“Respite care gives families and other caregivers
temporary relief from providing care for frail adults.
Companionship, light assistance, recreational activities and
security are provided in the resident's home, out of home in
a group setting, or overnight in a residential setting. Respite
care allows for a healthier and better quality of life for
both the caregiver and care receiver.”
Oregon Department of Human Services
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
In Home Care
If a licensed Home Care Agency provides home care
services, the person pays privately and the care is
subject to Oregon Administrative Rule (see below)
Oregon In-Home Care Agency Administrative Rules
The person needing help may be eligible for services
from the Department of Human Services, Seniors
and People with Disabilities. They offer home care
worker assistance, and other programs including
Independent Choices, Oregon Project Independence,
and Spousal Pay. Click on this link to learn more.
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.
Are not required to have licensed registered nurses on
staff 24-hours-a-day. The role of the nurse is emerging.
ALFs and RCFs
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Duties and qualifications of direct caregivers vary
among facilities. Staff to resident ratio will typically
be lower than what is required for nursing homes.
Caregivers are not required to be certified,
although training prior to providing services to
residents is mandatory.
Oregon Residential Care and Assisted Living
Facilities Administrative Rules
In their own words…
Hannah and Brad share the experience of a typical day
working in an Assisted Living Facility.
Please note: Allowing the YouTube clips to fully load in your browser window may result
in better video quality.
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Hannah Perry, BSN, RN talks about a typical day at
work.
Brad Finley, RN talks about starting his morning at work
and the variety of skills that he uses each day
Adult Foster Homes
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Adult foster homes offer personal and health care to
individuals in private residences.
Care and supervision are provided to maintain a
safe and secure setting.
Adult foster homes are licensed, inspected and
monitored by the Department of Human Services,
Seniors and People with Disabilities and Area
Agency on Aging offices.
Adult Foster Homes
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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
Oregon Department of Human Services
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.
Memory Care Community Requirements
Structural requirements in an endorsed setting
 A secure building that alerts staff if a resident has exited
 A secure outdoor area that provides outdoor freedom safely
 Interior finishes that are non-glare and well lit
 Visual contrasts between floors, walls and doorways
Program Requirements
 In addition to providing the services required in our other licensed settings, memory
care communities must also have programs, which include:
 Gross motor activities
 Self care activities
 Social activities
 Crafts
 Sensory enhancement activities
 Outdoor activities
Oregon Department of Human Services
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.
 Requires a Doctor/Nurse Practitioner order
 Is time limited and usually paid for by insurance
 Provides a team approach to care
 Oregon Home Health Agency Administrative Rules
Professional Support Services
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Hospice
 Provides
palliative and end-of-life support
 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.
In her own words…
Polly describes a typical day working in an Nursing
Facility
Please note: Allowing the YouTube clip to fully load in your browser window may result
in better video quality.
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Polly Youngren, RN, MN talks about the fact that
there is no typical day in her position as Director of
Nursing
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
In their own words..
Other nurses describe the administrative and
regulation work that they do.
Please note: Allowing the YouTube clips to fully load in your browser window may result
in better video quality.
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Leslie Joy Boyer, RN, an administrator, describes her
many roles as Director of Nursing Services.
Joan Morris, RN, an Assisted Living regulator, talks
about the variety in her work.