9. Long Term Care Flashcards
in elders will spend some part of their lives in institutions
1 in 4
Majority of nursing facility reimburstment in the US comes from
medicaid (then self pay then medicare)
The number of institutionalized people will increase by … during your career
200-300%
Characteristics of chronic disease are
- Long term
- Course is uncertain
- Involves discomfort, pain, disability, and restricted activity
- Multiply themselves
Staffing at nursing homes is mostly made up of (percentage)
Nurses aides (90%)
What percent of workers in nursing homes don’t provide any care
32%
What is the most common reason for referral to a nursing home
poor physical health
What is the most common reason for application to nursing home
excessive burden on family
Also are
- New health problem
- Wrosening of existing health problem
- Gradual deterioration
- Urging by physician
Effects of nursing home confinement
- Deindividuation
- Disculturalation
- Emotional, social, physical damage
- Estrangement
- Isolation
- Stimulus deprivation
For patients in NH who are fully edentulous what % of them
- Have a prosthesis that needs repairing
- Are without a prosthesis
- Have a prosthesis that needs repairing 40%
- Are without a prosthesis 30%
For patients in NH who are fully edentulous what % of them
- Have poor OH
- Have advanced perio
- Have an urgent need
- Have Caries
- Have poor OH= 77%
- Have advanced perio = 70%
- Have an urgent need = 77%
- Have Caries= 84%
What federal regulation are in place for NH for patient access to dental care
- Routine and 24 hr emergency care access
- Assist in making appointments
- Arrange transportation
- Refer residents with lost/damaged dentures to a dentist
T/F in NYS NHs must contract with a dentist
t
In NYS is dental care a part of a resident’s care plan
yes
Know this
the decision to defer treatment of identified dental conditions should be documented based on physical or mental contraindications for care or the resident’s informed choice
What are the reason’s many resident decline dental treatment
- If it doesn’t hurt there isn’t a problem
- Leave me alone I feel bad
- why should I care
- Cynical interpretation of dentist’s motives
- Frugal
NH must have a written policy stating what about dental care
- How oral hygiene is part of the “care plan”
- The who and how of OH
- How emergencies are dealt with
- How all decisions on treatment or no treatment will be made
T/F People that work at NH must provide daily oral hygiene
t
What can be used to mark a patient’s denture with their name
Identure (Geri)
An oral exam conducted by a dentist or hygienist must occur within _ (days/weeks/months) of patient admission
30 days
How frequent (at minimum) must residents receive oral exams
yearly
If after an oral exam- it is determined the patient needs treatment the treatment must begin before when
before 30 days after the exam
The NH patient records must be kept where
at the NH facility
What are the elements of informed consent
- Dx (if known)
- Nature and purpose of proposed tx
- Risk and benefits
- Alternatives (regardless of cost and insurance)
- Risks and benefits of alternatives
- Risk and benefits of not receiving treatment
If a pateint doesn’t have the capacity to consent who can speak for them
power of attourney (POA) or health care proxy
Who can verify if a patient is capable of consenting
MD (NOT the court)
Different sources of bringing patients into your office are
- Word of mouth
- Advertising
- Provided by employer/senior dentist
- Arranged via caregivers/advocates
- Referals from (social wrokers, MDs, Nurses, etc.)
Fewer dentists compete for what types of patients
- NH patients
- Frail elderly
- Mentally retarded
- Other developmentally disabled
- Homebound elderly
Sources of facilities (in other words ways you can obtain space to do dental work without owning your own office)
- Rent
- Buy
- Share space with another dentist
- Work for another dentist or a hospital
- Work for a facilitiy when you can use your own portable equipment
