Ch 34: Long-Term Care

Question 1

Development of LTC Institutional Care before the 20th century

Answer 1

No differentiation in the care of developmentally disabled, mentally ill, orphaned, poor, aged, and criminals
Any type of inpatient care limited  private help or family care
Almshouses
Poor rules and routines led to residents being inactive, erosion of identifies, and maladaptive behaviors

Question 2

development of LTC during the 20th century

Answer 2

LTCs were fashioned like prisons or hospitals
1935: small facilities developed with enactment of Social Security
1946: government contributed to nursing home growth
1960s: enactment of Medicare/Medicaid provided reimbursement for nursing homes
1987: Omnibus Budget Reconciliation Act set stringent nursing home regs; required the use of standardized assessment tool (MDS), timely development of a care plan, reduction in the use of restraints, protection of staff rights, and training for nursing assistants

Question 3

nursing homes today

Answer 3

Regs set minimal standards a nursing home must meet for reimbursement
Are minimums to comply with the law to be licensed and certified
States can add to federal regs
Joint Commission offers accreditation
Residents have several rights
5% of older adults live in a nursing home
Are for people who are functionally dependent on a long-term basis from physical/mental impairment
Admission due to functional status
Crisis can cause triggers for placement

Question 4

factors to consider when selecting a nursing home

Answer 4

Cost (daily rate, health insurance, out-of-pocket costs, costs for daily rate, policy when reimbursement limits are reached)
Philosophy of care (custodial vs. rehabilitative, promotion of independence and choice, active participant in care)
Administration (organizational structure, ownership, accessibility of administration, regular meetings)
Special services (available of therapies, cost for services, transfers to hospital)
Meals (meal schedule, type of food served, assistance with meals, snacks between meals, substitutions, cultural/ethnic influences, special diets, dietician)
Staff (number of caregivers on shift, ratios, number of supervisory staff, in-service education, quality of interactions, courtesy of staff)
Residents (cleanliness, grooming, type of clothing worn, activity level, interactions)
Physical facility (cleanliness, smell, lighting, noise control, safety, proximity of areas to nursing station, home-like appearance, outdoor areas)
Activities (activity schedule, range and frequency of activities, bedside activities, activities off grounds, resident council, visitors participation in activities)
Care (basic daily care, contact with staff, management of special problems, increased mobility and function, dignity/privacy, management of emergencies, evaluations by regulatory agencies, frequency of complications in facility)
Family involvement (preadmission prep to families, orientation, ongoing support, family conferences, visitation policies)
Spiritual needs (religious affiliation, chapel/synagogue, visitations from clergy, ways for residents to meet spiritual needs)

Question 5

helping families with nursing home admission before admission

Answer 5

Encourage the family to visit and review basic info
Ask for info about the resident
Create an opportunity to express concerns and feelings and discuss when/how residents adjusts
Describe rights and responsibilities

Question 6

helping families with nursing home admission at admission

Answer 6

Admission process should include someone that initially met the family
Arrange for staff to introduce themselves
Arrange for the family to meet another resident’s family
Advise family of sequence of events for the resident and care planning meetings

Question 7

helping families with nursing home admission during visitation

Answer 7

Encourage active involvement in care planning
Suggest activities that the family can do with the resident
Offer respect and privacy during visits

Question 8

helping Families with nursing home admission in general

Answer 8

Be courteous and patient
Call family for a change in status or incident
Listen and investigate complaints
Promote discussion of problems and concerns
Invite participation in care planning

Question 9

administrative nursing roles and responsibilities

Answer 9

Staff education
Role modeling
Coaching
Performance evaluation
Correction of performance problems
Staff development director
Director of nursing
Supervisor/unit nurse coordinator
Geropsychiatric nurse specialist
Quality assurance coordinator
Resident Assessment Coordinators

Question 10

clinical nursing roles and responsibilities

Answer 10

Good supervision of staff
Direct care providers
Completion of MDS assessment tool (Resident Assessment Coordinators)
Development of care plans
Charge RN
Function independently due to lack of providers on-site
Measures to protect against COVID-19

Question 11

uses of assisted living communities

Answer 11

• For people who need
  assistance with ADLs
  but aren’t complex
  to need 24/7 help
• Number of beds have
  increased for
  assisted living
• Mostly private pay
• Nurses must ensure
  the standards of care
  are developed and
  practiced in this
  setting

Question 12

use of community-based and home care

Answer 12

• People want services
  in their home
• Must be 65,
  homebound, and in
  need of skilled
  services that a family
  member can’t do in
  order to qualify for
  Medicare/Medicaid
  reimbursement
• Many organizations

Question 13

hierarchy of resident’s needs

Answer 13

Helps nurses meet the needs of residents
Hygiene
-Most basic needs for survival
Holism
-Psychological, social, and spiritual needs
Healing
-Establishment of a meaningful and purposeful life
Assumptions