32 - Long-Term Care Flashcards
A nurse is discharging an older patient after a hospitalization for a hip fracture. The patient is a participant in a Program for All Inclusive Care for the Elderly (PACE). The nurse understands that a PACE program: (Select all that apply.)
a. ) provides services to older people who would otherwise need a nursing home level of care.
b. ) does not provide services to participants who reside in a nursing home.
c. ) is only available to individuals who have both Medicare and Medicaid.
d. ) provides medications, eyeglasses, and transportation to care.
e. ) provides urgent and preventive care.
a, d, e
a.) provides services to older people who would otherwise need a nursing home level of care.
d.) provides medications, eyeglasses, and transportation to care.
e.) provides urgent and preventive care.
This program is a Medicaid and Medicare program that provides community services to people age 55 or older who would otherwise need a nursing home level of care. Participants must meet the criteria for nursing home admission, prefer to remain in the community, and be eligible for Medicare and Medicaid. The majority of PACE participants reside in the community; however, the program will pay for nursing home care. If the individual has Medicaid, he or she will not have to pay a monthly premium for the long-term care portion of the PACE benefit. If the individual does not qualify for Medicaid but has Medicare, there will be a monthly premium to cover the long-term care portion of the PACE benefit and a premium for Part D Medicare drugs. PACE provides a comprehensive continuum of primary care, acute care, home care, adult day health care, nursing home care, and specialty care by an interdisciplinary team. PACE is a capitated system in which the team is provided with a monthly sum to provide all care to the enrollees, including medications, eyeglasses, and transportation to care as well as urgent and preventive care.
Which intervention addresses a right guaranteed a long-term care facility resident?
a. ) Ethnic foods are made available to culturally diverse residents who would like them.
b. ) Each resident has access to a telephone in his or her room.
c. ) Family members are welcome at any time.
d. ) A professional hairdresser is available 3 days a week.
c.) Family members are welcome at any time.
The Bill of Rights for Long-Term Care Residents includes the right to immediate visitation and access at any time for family, health care providers, and legal advisors and the right to reasonable visitation and access for others.
While generally provided, the remaining interventions are not directly related to the guaranteed rights.
An older adult is considering residential care/assisted living (RC/AL). The nurse knows that the older adult needs additional teaching when the older adult states which of the following?
a. ) I read a recent article that stated that almost half of older adults would move to an assisted living community if they could no longer care for themselves.”
b. ) “I am happy that Medicare pays for the cost of living in an RC/AL.”
c. ) “I will have to check with my long term care insurance company. I heard that it might pay for RC/AL.”
d. ) “RC/AL costs significantly less than nursing home care.”
b.) “I am happy that Medicare pays for the cost of living in an RC/AL.”
Medicare does not cover the cost of RC/AL.
All of the other statements are true.
Factors that are influencing the decrease in nursing home beds in the United States include: (Select all that apply.)
a. ) an increase in the use of residential care facilities.
b. ) a shortage of certified nursing assistants (CNAs).
c. ) increased Medicaid reimbursement for community-based care alternatives.
d. ) a shortage of Registered Nurses who are certified in gerontology.
e. ) the high cost of care in a nursing home.
a.) an increase in the use of residential care facilities.
c.) increased Medicaid reimbursement for community-based care alternatives.
The number of nursing home beds is decreasing in the United States as a result of the increased use of residential care facilities and more reimbursement by Medicaid programs for community-based care alternatives. However, in most areas of the country, the supply and use of nursing homes is still greater than those of other long-term care services options. While there is a shortage of certified nursing assistants as well as RNs who are certified in gerontology, this does not account for the decrease in nursing home beds in the United States. The cost of care in a nursing home is high; however, that is not the driving factor in the decrease in the number of nursing home beds in the United States.
Which statement made by the resident of a long-term care facility is evidence that the facility is providing care in accordance with the Bill of Rights for Long-Term Care Residents?
a. ) “It’s so nice to have my hometown newspaper available here.”
b. ) “Going out to the theater with the other residents is a nice social activity.”
c. ) “I was told that if I didn’t want to change rooms, I didn’t have to.”
d. ) “The whole place was decorated so beautifully for the holidays.”
c.) “I was told that if I didn’t want to change rooms, I didn’t have to.”
The Bill of Rights for Long-Term Care Residents assures the individual the right to be transferred only for appropriate reasons as indicated by the correct option.
While positive in nature, the remaining statements are not directly related to any of the guaranteed rights.
An older patient with dementia is referred for adult day services (ADS). The patient’s daughter asks the nurse about the benefits of ADS. The nurse considers which of the following in formulating a response? (Select all that apply.)
a. ) ADS are designed to provide social and some health services for older adults.
b. ) ADS are covered under Medicare Part B.
c. ) ADS offer respite services for caregivers from the responsibilities of caregiving.
d. ) ADS often provide educational programs and support groups for caregivers.
e. ) ADS are all staffed with registered nurses.
a, c, d
a.) ADS are designed to provide social and some health services for older adults.
c.) ADS offer respite services for caregivers from the responsibilities of caregiving.
d.) ADS often provide educational programs and support groups for caregivers.
Adult day services are community-based group programs designed to provide social and some health services to adults who need supervised care in a safe setting during the day. They also offer caregivers respite from the responsibilities of caregiving, and most provide educational programs, support groups, and individual counseling for caregivers. Some ADS are private pay, and others are funded through Medicaid home and community-based waiver programs, state and local funding, and the Veterans Administration. While most ADS do have professional nursing staff, there is no mandate that they do.
An older married couple is considering selling their home and moving into a continuing care retirement community (CCRC). The major benefit of a CCRC is:
a. ) they provide affordable living for older adults.
b. ) they have all levels of care in one location, allowing community members to easily transition between levels.
c. ) they are paid for by Medicare.
d. ) they allow the older adult’s family to retain ownership of the property after the owner dies.
b.) they have all levels of care in one location, allowing community members to easily transition between levels.
A major benefit of a CCRC is that it has all levels of care in one location, which allows community members to make the transition between levels without life-disrupting moves. Costs of a CCRC can range greatly from an affordable rate to a very large amount of money. The cost of a CCRC is not covered by Medicare. In the majority of the CCRCs, the property reverts back to the community after the death of the owner.
Differences between subacute care and long term care include which of the following? (Select all that apply.)
a. ) Subacute care is more costly than long term care.
b. ) Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay.
c. ) Medicare covers the costs of both subacute and long term care.
d. ) Subacute patients tend to be younger and more cognitively intact.
e. ) Subacute care is usually delivered in a hospital setting and long term care in a nursing home setting.
a, b, d
a.) Subacute care is more costly than long term care.
b.) Patients who receive subacute care have a usual length of stay of 1 month; long term care patients have an indefinite length of stay.
d.) Subacute patients tend to be younger and more cognitively intact.
Subacute care is more intensive than traditional nursing home care and several times more costly. For subacute patients, the expectation is that the patient will be discharged home or to a less intensive setting, and the length of stay is usually 1 month or less. Subacute care is largely reimbursed by Medicare. Patients in subacute units are usually younger and less likely to be cognitively impaired than those in traditional nursing home care. Both subacute and long term care are delivered in a nursing home setting.
Which statement made by a nurse regarding a resident of a long-term care facility requires followup by the nurse manager?
a. ) “If he doesn’t take his medication, he’ll get no dessert tonight.”
b. ) “She can’t take a walk outdoors today; it’s much too cold and snowy.”
c. ) “The grandchildren have colds so they should not visit this week.”
d. ) “I don’t understand why, but she wants a different doctor to see her.”
a.) “If he doesn’t take his medication, he’ll get no dessert tonight.”
The Bill of Rights for Long-Term Care Residents assures the individual the right to be free of any form of abuse. Using a threat to gain the resident’s cooperation is a form of verbal/emotional abuse and must be addressed by the nurse manager. The client may indeed request a change in medicine providers, even if the staff is unaware of the reasoning behind the request.
The remaining statements related to resident safety, not the denial of their guaranteed rights.
Which nursing evaluation supports the fact that the goals of long-term client care have been achieved? (Select all that apply.)
a. ) Resident has participated in bath with minimal assistance from the staff.
b. ) Resident has experienced no falls since admission 3 months ago.
c. ) Resident continues to show loss of strength in upper extremities.
d. ) Resident is not required to dress or feed self since assistance is always available.
e. ) Resident demonstrates improved weight bearing on affected leg; discharge to be considered.
a, b, e
a.) Resident has participated in bath with minimal assistance from the staff.
b.) Resident has experienced no falls since admission 3 months ago.
e.) Resident demonstrates improved weight bearing on affected leg; discharge to be considered.
Goals of long-term care include providing a safe and supportive environment for chronically ill and functionally dependent people; restoring and maintaining the highest practicable level of functional independence; and providing coordinated interdisciplinary care to residents who plan to return to home.
The remaining options show loss of function that is likely preventable and an environment that does not support autonomy and independence.
