Adult Family Homes: Viable LTC Options for People with TBI

Transcription

1 Adult Family Homes: Viable LTC Options for People with TBI Vicki Anensen-McNealley, PhD, MN, RN Executive Director Washington State Residential Care Council 523 Pear Street SE, Olympia WA * [email protected]

2 Objectives Define AFH Compare, contrast AFHs from other LTC settings Identify ways AFHs can address the needs of TBI Discuss opportunities for expansion

3 What is an AFH? Licensed by DSHS 2 6 residents Residential home Specialties: geriatric, dementia, mental illness, developmental disabilities Private pay, Medicaid, VA, some LTC insurance Care for higher acuity clients

4 Where are the AFHs? 2,770 homes, 15,301 licensed beds Majority of homes in King (1,036) Snohomish (413) 1,922 Clark (299) Pierce (274) Fewest homes in Grays Harbor (3) Wahkiakum (1) Garfield (0) Skamania (0)

5 The Medicaid Issues 2,394 AFHs have Medicaid contracts 7,000 Medicaid clients (45% total) Medicaid rates between $47 -$163/day, depending on care needs Behaviors without clinical complexity do not balance out AFHs lack economy of scale to adjust for even one low payer

6 Compare and Contrast Assisted Living Facility 536; 29,418 licensed beds 326 with Medicaid contracts 6,700 Medicaid clients (23%) Most cater to loweracuity 50 with 10 or < beds Terry Home (Pacific, Auburn) Nursing Home 241; 22,661 licensed beds Most with Medicaid contracts 10,000 Medicaid clients (44%) Most geared towards rehab Delta Rehab (Snohomish)

7 Reality: TBI & LTC Relatively new for those higher functioning Benefits of structured days Allow to remain in familiar community Access to larger community Difficult population mix for larger facilities Activities Food Interaction Expectations of resident AND staff

8 What Would YOU Want? When I get older, I want to live in a nursing home. FACT: Most of us don t plan for LTC If we do, it s just HOW WE WILL PAY FOR IT FACT: Most LTC placements are urgent

9 Adult Family Homes: Benefits Small, home atmosphere Set up for aging in place Niche homes Home with nursing services if needed, reasonable accommodation, coordination of care and service, medication management, health treatments, assessment of needs, care plans, monitoring

10 Adult Family Homes: Benefits No federal oversight = less restrictive Wide array of care levels Many younger residents work outside the home Intense needs can be met through nursing care, PT/OT visits, and coordination of services Opportunities for niche homes Younger population 100% brain-injury clientele Age in place with enhanced services

11 Adult Family Homes: Environment Minimize multiple noises Comfortable surroundings Fewer distractions, interruptions, surprises Soothing home and natural light Structure to the day Organization a high possibility

12 Adult Family Homes: Staff Staff-resident ratio Individualized approaches, responses Lower turnover = consistency Specialty training Nurse oversight if needed by resident Nurse delegation if needed by resident

13 Adult Family Homes: Concerns Eyes on the residents Remote; fewer visitors Family-run business Mandatory reporting issues Small home = hard to get away from it all Transportation TBI education for owner, staff Public funding

14 Past Look at AFHs Seattle Times articles Poor preparation Loose regulatory oversight Too many too fast

15 Current Look at AFHs Improved prep for new homeowners Enhanced business + caregiving standards Administrator training Caregiver training Increased oversight, enforcement Fines Licensing fees Change of ownership costs Qualified owners opening homes

16 Future Look at AFHs SB 5630 Enhanced training preparation TBI specialty homes Niche homes Unique care and service Dedicated populations Enhanced rates for behavioral, supervisory needs

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18 Thank You Vicki Anensen-McNealley, PhD, MN, RN Executive Director Washington State Residential Care Council 523 Pear Street SE, Olympia WA * [email protected]