Long Term Care
Instructions: This test consists of both True/ False questions as well as multiple-choice questions. Each of these questions are worth one (1) point each and there is a short answer portion which is worth five (5) points with the total of the exam worth 100 points. Please note that the chapter wherein to locate the answers is provided on the exam. This is an open note/ open book exam.
Chapter 1
True/False:
1. The terms chronic care and long-term care are generally used interchangeably.
2. Long-term care consumers are usually defined by a single disease or condition.
3. Long-term care is defined as care provided in nursing homes.
4. Although we usually think of long-term care as being for the elderly, nearly half of the people using long-term care are non-elderly.
5. Aging in place is a form of single-site care availability.
Multiple Choice:
6. The current system of long-term care providers has developed largely in response to:
[1] need.
[2] demand.
[3] availability of reimbursement.
[4] all of the above.
7. Which of the following are not "informal caregivers?"
[1] family and friends
[2] religious organizations
[3] community groups
[4] government agencies
8. Baby boomers is a term used to describe people born:
[1] since 1990.
[2] between 1946 and 1964.
[3] before 1956.
[4] between 1964 and 1999.
9. "Multilevel facilities" refers to facilities that:
[1] provide multiple levels of care.
[2] are built on more than one floor.
[3] accept multiple levels of reimbursement for each type of care.
[4] all of the above.
10. Which of the following is not a weakness of the long-term care system?
[1] It is fragmented and uncoordinated.
[2] Services are distributed inequitably.
[3] There has been no innovation by providers.
[4] There are multiple entry points into the system.
Chapter 3
11. Which of the following is not a component of accessibility of long-term care services?
[1] financial eligibility
[2] location of services
[3] consumer choice
[4] complexity of the consumer's care needs
12. The term "consumer-driven" means that long-term care consumers are:
[1] capable of driving themselves to where services are provided.
[2] entitled to receive any services they wish.
[3] allowed to make decisions related to their care and financing as much as possible.
[4] driven from one provider to another by Medicaid staff if they cannot afford a car.
13. Public/private partnerships are efforts to reduce:
[1] the number of long-term care regulations.
[2] hostility between government agencies and private providers.
[3] purchases of private long-term care insurance.
[4] public funding of long-term care.
14. People who have to care for both their parents and their children are called:
[1] the "sandwich generation."
[2] the "lost generation."
[3] "generation X."
[4] none of the above.
15. The long-term care system is made up of providers who are organizationally:
[1] nonprofit.
[2] for-profit.
[3] government-owned.
[4] a mix of for-profit, nonprofit, and government-owned.
Chapter 4
True/False:
16. Nursing facilities are staffed with only licensed healthcare professionals.
17. About three-quarters of residents in nursing facilities are women.
18. OBRA does not require that the facility's medical director be full-time.
19. To qualify for Medicaid coverage, residents must require assistance with all five activities of daily living (ADLs).
20. Approximately one-third of all nursing facility residents show symptoms of depression.
Multiple Choice:
21. The term "nursing facility":
[1] came from OBRA legislation.
[2] came from OSHA legislation.
[3] refers to all long-term care facilities.
[4] refers only to facilities providing skilled nursing care.
22. The largest single source of financing for most nursing facilities today is:
[1] Medicare.
[2] Medicaid.
[3] private pay.
[4] long-term care insurance.
23. In long-term care, family members are:
[1] never involved.
[2] rarely involved.
[3] usually involved.
[4] always involved.
24. Special care units in nursing facilities may be created based on:
[1] disease or condition.
[2] age.
[3] either of the above.
[4] neither of the above.
25. Rising acuity levels in long-term care facilities refers to:
[1] caring for sicker patients/residents.
[2] caring for more patients/residents.
[3] denying eligibility for care to more patients/residents.
[4] none of the above.
Chapter 5
True/False:
26. Outcomes management ends at discharge.
27. The case manager may be "internal" (employed by the subacute unit) or "external" (employed by an MCO or other payer).
28. Managed care has been a major factor in the growth of subacute care.
29. Subacute care is generally more intensive than nursing facility care, but less than acute care.
30. Services provided in subacute care units vary depending on the nature of the specific population
Multiple Choice:
31. Subacute care is generally provided in:
[1] hospitals.
[2] nursing care facilities.
[3] either of the above.
[4] neither of the above.
32. The four generally agreed-upon categories of subacute care are transitional, general, chronic, and:
[1] general transitional.
[2] long-term chronic.
[3] long-term transitional.
[4] general chronic.
33. Care planning begins with:
[1] application by the patient for admission to the unit.
[2] onset of the illness or condition requiring admission.
[3] admission.
[4] a detailed assessment.
34. Case management is primarily concerned with:
[1] the type and quality of care received.
[2] the cost-effectiveness of care received.
[3] initial assessment of the patient.
[4] discharge planning.
35. The largest source of reimbursement for subacute care is:
[1] Medicare.
[2] Medicaid.
[3] private insurance.
[4] self-pay.
Chapter 6
True/False:
36. All assisted living facilities provide the same services.
37. The average age of residents in assisted living facilities is 70.
38. Assisted living developed from both boarding homes and independent living facilities.
39. Location relative to family members is not an important consideration in choosing an assisted living facility.
40. Less than half of the residents in assisted living facilities need assistance with one or more activities of daily living (ADLs).
Multiple Choice:
41. An assisted living facility is staffed with:
[1] the same number of nurses as a nursing facility of the same size.
[2] fewer nurses than a nursing facility of the same size.
[3] more nurses than a nursing facility of the same size.
[4] only registered nurses.
42. The most common source of admissions to assisted living is from:
[1] home.
[2] nursing facilities.
[3] other assisted living facilities.
[4] hospitals.
43. The most common destination for people leaving assisted living is:
[1] home.
[2] nursing facilities.
[3] other assisted living facilities.
[4] hospitals.
44. The largest source of financing for assisted living facilities is:
[1] Medicare.
[2] Medicaid.
[3] private insurance.
[4] self-pay.
45. Assisted living is:
[1] highly regulated.
[2] unregulated.
[3] largely unregulated and likely to remain that way.
[4] largely unregulated, but likely to become more regulated.
Chapter 7
True/False:
46. Age-restricted retirement communities are oriented toward an active lifestyle, or "younger-thinking" seniors.
47. Cohousing is age-restricted.
48. Continuing care retirement communities offer several levels of assistance, usually including independent living, assisted living, and nursing home care commonly all on one campus or site.
49. Many seniors enter into a CCRC contract while they are healthy and active.
50. Managers of senior housing must be licensed.
Multiple Choice:
51. One of the major advantages of a continuing care retirement community is:
[1] the option to move between housing environments.
[2] not having to choose among services offered.
[3] the low cost.
[4] Medicare coverage.
52. Monthly costs for congregate housing can range from $500 to over:
[1] $1,000.
[2] $2,000.
[3] $3,000.
[4] $4,000.
53. The most common type of ownership of independent living communities is:
[1] nonprofit.
[2] government-owned.
[3] for-profit.
[4] none of the above.
54. Occupancy rates in senior housing are currently:
[1] around 50%.
[2] around 70%.
[3] over 90%.
[4] unknown.
55. Independent living is for:
[1] fragile elderly.
[2] relatively healthy, active seniors.
[3] nursing facility residents.
[4] homebound seniors.
Chapter 8
True/False:
56. Hospice care is provided both at home and in healthcare facilities.
57. Home health care is based on the concept of taking the services to the consumer.
58. All home care services must be ordered by a physician.
59. Most hospice organizations are nonprofit.
60. Managed care is not an important factor in the growth of adult day care.
Multiple Choice:
61. Which of the following is not a Medicare-covered home care service?
[1] skilled nursing
[2] speech pathology
[3] MealsonWheels
[4] medical social services
62. Physician services for hospice patients are provided by:
[1] a physician employed by the hospice.
[2] the patient's own physician.
[3] either of the above.
[4] neither of the above.
63. Adult day care developed from the concept of:
[1] home care.
[2] hospice.
[3] respite.
[4] welfare.
64. When is home health care more cost-effective than nursing facility care?
[1] never
[2] when used intermittently
[3] when used exclusively
[4] always
65. Medicare pays hospice providers on the basis of:
[1] reimbursement of costs incurred.
[2] a per diem rate.
[3] DRGs.
[4] capitation.
Chapter 10
True/False:
66. A "gatekeeper" is a person or agency that determines how much and what type of care is received by an individual.
67. The primary role of state government in regulating long-term care quality is as the designated agency administering federal programs.
68. HIPAA prohibits sharing clinical data about a consumer with other providers without the consumer's written permission.
69. Certified nursing assistants (CNAs) are not licensed.
70. Private certification standards measure minimal acceptable levels of performance.
Multiple Choice:
71. Nursing facility administrators are licensed by:
[1] the federal government.
[2] state governments.
[3] the Joint Commission on Accreditation of Health Care Organizations.
[4] none of the above.
72. Which of the following is not a reason why long-term care is so heavily regulated?
[1] Consumers of long-term care often have no other recourse.
[2] Consumers of long-term care are politically powerful.
[3] Consumers of long-term care are vulnerable.
[4] Consumers of long-term care are often unable to judge quality for themselves.
73. Which of the following must be licensed?
[1] hospital administrators
[2] nursing facility administrators
[3] home health care administrators
[4] all of the above
74. Which of the following is not an accrediting agency?
[1] JCAHO
[2] NCQA
[3] CARF
[4] HCFA
75. Most accreditation agencies measure performance against standards that are:
[1] based on government regulatory standards.
[2] the same as licensure requirements.
[3] less stringent than licensure requirements.
[4] set higher than licensure requirements.
Chapter 2
True/False:
76. The Affordable Care Act passed with a mix of Republican and Democrats votes.
77. The ACA requires individuals to have insurance coverage and businesses to provide coverage or pay fines.
78. The United States Supreme Court ruled that the individual mandate was, in fact, a tax.
79. The "No Wrong Door" system portion of the ACA mandates that long-term care consumers can access any provider's services.
80. "Pay-for-performance" provides financial incentives to healthcare providers to achieve optimal outcomes for patients.
Multiple Choice:
81. Which of these is not part of the stated aim of the ACA?
[1] to increase the affordability of health insurance coverage for Americans
[2] to reduce the costs of health care for individuals
[3] to be implemented within two years
[4] to reduce the costs of health care for the government
82. The ACA makes cuts in Medicare to finance part of the new spending, including:
[1] reduction in funding for Medicare Advantage policies.
[2] reduction in Medicare home healthcare payments.
[3]reduction in certain Medicare hospital payments.
[4] all of the above.
83. The Medicare hospital readmissions reduction program (HRRP):
[1] assesses penalties on hospitals with high readmission rates for patients with certain medical conditions.
[2] assesses penalties on nursing homes with high readmission rates from hospitals.
[3] has little impact on long-term care providers.
[4] requires that long-term care providers have contracts with hospitals.
84. The Community Living Assistance Services and Supports (CLASS) Act:
[1] was designed to establish a national long-term care insurance program.
[2] was delayed for three years.
[3] is not considered particularly important.
[4] none of the above.
85. The ACA's employer mandate:
[1] has no impact on long-term care providers.
[2] affects all long-term care providers.
[3] affects only larger long-term care providers.
[4] none of the above.
Chapter 9
True/False:
86. Long-term care today is a competition-driven system.
87. Competition in long-term care comes both from other LTC organizations and from other types of organizations.
88. The difference between cooperation and integration is largely a matter of degree and structure.
89. Horizontal integration involves an alliance of two or more organizations providing similar services.
90. An ownership-based IHS usually consists of a mix of nonprofit and for-profit subsidiaries.
Multiple Choice:
91. Which of the following is not a reason for joining an integrated health system?
[1] economies of scale
[2] protection against competitors
[3] increased market share
[4] reduced regulation
92. History has shown that increasing the availability of services usually results in:
[1] no change in usage of services.
[2] a decrease in usage of services.
[3] an increase in usage of services.
[4] creation of new services.
93. The influence of managed care on the competitiveness of long-term care:
[1] is great.
[2] has not been felt yet.
[3] has been great, but is diminishing.
[4] is insignificant.
94. Integrated clinical information systems typically address four specific areas: patient management, clinical guidelines, quality improvement, and:
[1] patient education.
[2] financial management.
[3] regulatory reporting.
[4] clinical outcomes.
95. To date, most integrated health systems have been built around:
[1] nursing facility chains.
[2] hospitals.
[3] government agencies.
[4] non-healthcare businesses.
Discuss what you have learned about Long Term Care thus-far, that you did not know before. How has this effected what you think about your future.