Chapters 7-9 Flashcards
Provide residents with around-the-clock care
Usually private or semi-private rooms along a common hallway
Often a communal bathing area
Common areas where residents gather to socialize
nursing homes
- intermediate care (long term)
- chronically ill
- ADL assistance
- increased focus on rehabilitation or restorative care
- skilled care (short term) or skilled rehabilitation care
- acute care for illness and injury
- some facilities provide both in separate areas of the facility
levels of nursing home care
Separate areas for special needs
- rehabilitation
- dementia care
- onocology
- ventilator-dependent
- pressure ulcers
- traumatic brain injury
special care units (SCUs)
Provide residents with limited assistance with
- personal care
- medication administration
- transportation
- meals
- housekeeping
- often live in small apartments with a kitchen, bathroom, living area, and a bedroom
- common area for socialization
assisted-living facilities
Provide a continuum of care by including facilities for: -independent living -assisted living -nursing home care on the same campus
continuing care retirement communities (CCRC)
As residents become less independent, they are able to stay within the ____ to obtain the care needed
-may also include restaurants, facilities for worship, and health centers
CCRC
Community supported facilities that provided shelter for those without means of supporting themselves
-early 1900s: homes for the aged, rest homes, convalescent homes
poorhouses
Retired or umemployed were entitled to receive a pension
Social Security Act of 1935
Nursing homes began as _____ that hired nurses
boarding homes
One that is owed by a company or organization that is operating the facility as a business with intentions on making a profit
for profit facility
Owned and operated by a service organization like a church or charitable group, its primary focus is to fulfill a community need
non-profit facility
Independently owned and operated
free standing facility
Owned and operated by a corporation that owns multiple facilities
chain facility
As a result of the Social Security Act, older people who were retired or unemployed were entitled to receive a ____, (regular cash payments) from the government
pension
1965: president Lyndon B. Johnson signed ____ and ___ programs into law
medicare and medicaid
Late ____ and ____, new for profit nursing homes were built
- smaller independent facilities were bought leading to chain facilities
- quality of care provided in many nursing homes were poor
- aides not required to receive formal training
1960s and 1970s
As a result of ___ and ___ programs, more people could afford long term care
medicare and medicaid
In the 1980s, ____ of ____ studied nursing home care
Institute of Medicine
- improved quality of life for residents in nursing homes
- care required to take into account residents physical, emotional, spiritual, and social needs
- sets standards for physical environment and training and evaluation of nursing assistants
Omnibus Budget Reconciliation Act 1987
____ standards increased cost to nursing homes
- hospitals discharged patients sooner and sicker
- less expensive to care for sicker people in nursing homes than in hospitals
- certification for skilled care sought by nursing homes
- sub-acute care facilities emerged
OBRA
In the ____s, president Clinton signed the Balanced Budget Act
- funding cut for Medicare program
- prospective payment system (PPS) for Medicare reimbursement
- assisted living facility as an alternative to nursing homes
- currently home care as an alternative
1990s
A $116.4 billion cut in funding for the Medicare program over 5 years time, largest cut in Medicare history
Balanced Budget Act
In 2000 developed several models for long term care, these models are known as _____
Pioneer Network
Pioneer Models for Culture Change
In this model, each residents personal history is used as the basis for an individualized plan of care
individualized care
This model fosters a sense of community within a facility among residents, staff, families, and volunteers
regenerative community
This model focuses on the idea of creating a neighborhood
resident directed care
This model also focuses on created a sense of community, the surroundings are designed in a way to support life and eliminate loneliness, helplessness, and boredom
The eden alternative
An ongoing process that focuses on changing attitudes, goals, and practices in order to improve the long term care environment and the way care is delivered
culture change
All types of _____ facilities must follow the requirements of:
- OSHA
- FDA
- Centers for Diseases and Control Prevention (CDC)
- OBRA
long term care
Federal OBRA laws apply only to _____
nursing homes
- make sure that facilities are following OBRA regulations and meeting government standards
- centers for medicare and medicaid services (CMS) responsible for monitoring nursing homes
- government payment for services depends on facilities meeting the standards
survey
Government agency responsible for monitoring nursing homes to make sure that they are following OBRA regulations and meeting the governments standards
Centers for Medicare and Medicaid Services (CMS)
- nursing homes must make their most recent survey results available
- CMS posts survey results on the internet
- nursing assistants role important to ensure positive survey results
federal OBRA laws
Grants accreditation to CCRCs, as well as to some other types of organizations that provide long term care services
Continuing Care Accreditation Commission (CCAC)
Assisted living facilities and nursing homes are regulated by the ____
state
Licensure for long term care, facilities must undergo an ____
inspection
Begins when the person is hospitalized and ends when the person has not received any skilled health care services, either in hospital or nursing home
benefit period
- needed for participation in the medicare and medicaid programs
- inspections
- federal and state regulations
certification
Compliance with any regulations that the local government has established for long term care facilities
city or county health departments
- continuing care accreditation commission (CCAC)
- grants accreditation to CCRCs
- only accrediting organization specifically for CCRCs
Joint Commission
Requirements for ___ payment
- skilled health care provided by nurses or other health care professionals
- care must follow hospital stay
- care must be provided in a nursing facility licensed to provide skilled care
- benefit period
- ending medicare coverage
medicare
- eases the financial burden for the person receiving care
- increases the financial burden for nursing facility
- cost of care versus medicaid payments
- state must accommodate medicaid costs within its budget
medicaid
- purchased to pay for long term care in the future
- expensive and risky
- premiums increase with age
- does not pay for all nursing home cost
- deductible
long term care insurance
- cost approximately half of the cost of nursing home care
- primarily private pay
- long term care insurance may cover some expenses
assisted living care
Most residents of nursing homes are ____ years or older
65
_____ in medical care allows for recovery from conditions that people used to die from
advances
A condition that is ongoing and often needs to be controlled through continuous medication or treatment
chronic illness
A condition that gets progressively worse over time
degenerative condition
- lingering effects of an acute illness
- need for continuous monitoring and treatment for one or more chronic conditions
- need for help meeting physical needs because of a degenerative condition
- no longer safe to live alone
Are some reasons for _____
long term care admission
Routine task of daily life
activities of daily living (ADLs)
More complex task that a person must be able to do in order to continue to live independently such as:
- telephone
- groceries
- meals
- handling money
instrumental activities of daily living (IADLs)
- related to early hospital discharge
- receive care until able to go home
- saves health care costs
short term stay
- physical or mental disabilities
- ADLs
- IADLs
- co-existing medical condition
- cognitive impairment
extended stay admission
More than one medical condition at the same time
co-exiting medical condition
Problem processing learning, or remembering information, especially with physical problems
cognitive impairment
- placement not planned
- coping with multiple losses
- fear and anxiety
- loss of independence
Are some feelings a ____ may feel
resident
The first step in helping a resident make the transition into a nursing home is to understand what the resident and family may be feeling, this is part of a ____ job
nursing assistants
As a nursing assistant you can help family members adjust by helping them to feel ____ and ____ in the ongoing care of their loved one
included and involved
- effects how others perceive the resident
- long term medication usage
- lifestyle changes
- battle for pain relief
Are effects of a ____ on a resident
chronic condition
- physical disability
- traumatic injuries
- developmental disabilities
Are a reason for a ____ person to be admitted to long term care
young
Adjustment process in a _____ in long term care
- longer to adjust
- acting out to gain control
- methods to assist the young resident to cope
- sexuality and intimacy
young person
____ protects the quality of life
- hobbies
- special events
- interacting with residents
- allow residents to assist
OBRA
The permanent and progressive loss of the ability to think and remember, caused by damage to the brain tissue
dementia
A person with _____ experiences:
- problems with memory, especially short term memory
- difficulty putting thoughts together and understanding concepts
- problems with judgement
- disorientation
- inability to manage activities of daily living
dementia
Temporary state of confusion, symptom of an underlying disorder such as an infection
- once the disorder is treated, it goes away
- if the cause of it is not treated, the person may die
delirium
- begins to experience memory loss
- person is aware of memory changes, becomes fearful, anxious, or depressed
- may become angry at other people
Are the ____ stages of dementia
early
- difficult communicating
- difficulty recognizing familiar people and things
- difficulty remembering steps necessary to complete familiar tasks
- personality changes, behaving differently
- incontinence
Are the ____ stage of dementia
middle
- loses ability to walk and sit independently
- becomes bedridden
- no longer able to speak, swallow, or smile
- totally incontinent of urine and feces
- death
____ stage of dementia
late
Four most common types of ____ are:
- Alzheimers
- vascular (multi-infarct) dementia
- Lewy body dementia
- frontotemporal dementia
dementia
Most common type of dementia, accounting for more than 60% of cases
- more than 5 million people in the US have this disease
- if no cure is found, it is estimated that 11 to 16 million people will have it by 2050
- exact cause is unknown
Alzheimers
Researchers have identified a number of risk factors for ____ such as:
- age
- family history
- serious head trauma
- heart disease
- high blood cholesterol
- diabetes
Alzheimers
Abnormal deposits of protein, especially in parts of the brain that functions in memory, these deposits are called ____ and ____
plaques and tangles
Damage to the blood vessels that supply the brain can affect the delivery of oxygen to the brain tissue
-mental functions are lost because multiple areas of the brain tissue die due to lack of adequate oxygen and nutrients
Vascular (multi-infarct) dementia
Death of tissue due to lack of oxygen and nutrients
infarction
- thought to be the cause of dementia in approximately 20% to 25% of people, can coexist with other types of dementia
- most often affects people between the ages of 55 and 75, most commonly in 70 year olds
- is more common in MEN
vascular dementia
Conditions that put a person at risk for _____:
- history of myocardial infarction (heart attack)
- hypertention
- diabetes mellitus
- peripheral vascular disease
- transient ischemic attacks (TIAs)
- obesity
- smoking
- high blood cholesterol levels
vascular dementia
- symptoms may appear suddenly and they may vary from person to person depending on which area of the brain are affected
- like Alzhemiers, it is irreversible and incurable
- keeping blood pressure, blood glucose, and blood cholesterol levels within normal limits can help to slow progression
vascular dementia
Caused by the build up of abnormal protein deposits, in areas in areas of the brain that are responsible for thinking and movement
- develop problems controlling body movements, a shuffling gait, slow movements and tremors similar to those with Parkinsons disease
- tend to have visual hallucinations and changes in mental alterness
Lewy body dementia
Caused by damage to the frontal lobe and temporal lobes of the brain
- frontal lobe– personality and behavior
- temporal lobe– language
frontotemporal dementia
- person may show extreme changes in personality and behavior, have difficulty with language, or both
- challenging because the disease may cause the person to say or do things that are socially inappropriate
- some people may become bored and listless, no longer care about anything, lack of motivation and energy
- accounts for only 5% of all cases of dementia and occurs at younger age (40-65)
- memory is often spared until later in disease process
frontotemporal dementia
- amnesia
- aphasia
- agnosia
- apraxia
Are the 4 As of _____
dementia
- difficulty remembering
- short term memory in early stages: provide lots of reminders, introduce self each time, structured routine
- long term memory in later stages: living in the pass, easy to embarrass and upset
- validation therapy
amnesia
- difficulty speaking
- expressive
- receptive
- source of stress and frustration
aphasia
- difficulty recognizing information obtained through the five senses
- unable to recognize objects, danger, people
agnosia
- difficulty coordinating steps needed to complete task
- ADLs
- eating
Allow person to do what they can
- coaching
- hand over hand cueing
- never rush person
apraxia
Types of behavior with ____:
- wandering
- pacing—person may have to go to bathroom or is hungry
- repetition (perseveration)—doing something over and over
- rummaging—go through drawers or closets
- delusions or hallucinations
- agitation
- catastrophic reactions
- sundowning
- inappropriate sexual behaviors
demetia
A false belief
-person may think they are someone else
delusion
Seeing, hearing, tasting, or smelling something that is not really there
hallucination
An over-react to something that would cause a healthy person minimal or no stress
catastrophic reaction
Worsening of a persons behavioral symptoms in the late afternoon and evening, as the sun goes down
-exact cause unknown—may be brought on because person can not see aswell at night
sundowning
Years ago the technique of ___ was used with people with dementia
- based the importance of bringing the person back to the here and now
- not an effective technique
reality orientation
Stresses the importance of acknowledging the persons reality
-pay attention to the words, phrases, and body language of the person to better understand what they are trying to communicate
validation therapy
When helping a person with dementia with their ___:
- speak clearly
- remind person at each step what they need to do next
- use hand gestures
- plan for procedure in advance
- keep to a regular schedule
ADLs
To reminisce means remember
-in ____ the person is encouraged to remember and share experience from their past
reminiscence therapy
The ____ stage of dementia:
- unable to walk—pressure ulcers, contractures, pneumonia
- unable to swallow—feeding tubes
- comfort care—O2 therapy
- care for someone who is dying
- care for the family
late
