Anemia in Long-Term Care

Long-term care refers to a heterogeneous spectrum of facilities and health-related services that range from home nursing services to residential care and skilled nursing facilities, so-called nursing homes. Although the services eligible for Medicare coverage are defined by CMS, the clinical and demographic mix in facilities, even of the same level of care, is highly variable. The shifting health care environment has led to a shift towards increasing acuity in skilled facilities and rising levels of dependency in nonskilled assisted and supported living facilities and housing. In general, nursing homes provide two kinds of reimbursable Medicare service: subacute rehabilitation and skilled nursing. In both instances, admission to a nursing facility must have occurred within 30 days of hospitalization. It represents both the absence of adequate home supports and an illness-related decline in functional status. The goal is to return the patients to their previous level of function. However some proportions are never able to return to unsupported living. Increasingly, nursing homes have become the site of terminal care for patients without the resources for home hospice. Patients who are not Medicare eligible or have stayed beyond the 90 period must have another payor, usually it is Medicaid, some are self-pay.