Exam #2: Nursing-Home Population

Question 1

What are the most common reasons that patients are in a nursing home setting?

Answer 1

• Impairments in decision making/ dementia
• Need assistance with ADLs
• Communication problems
• Bowel/bladder incontinence

Question 2

What is the common “breaking point” for families that leads to placement of a loved on in a nursing home?

Answer 2

Bowel/bladder incontinence

Question 3

What are the typical demographics of patients in a nursing home?

Answer 3

• Over half are > 85 years-old
• Majority are women
• Majority are African American

Question 4

What is post-acute care?

Answer 4

Care for patient’s that have recently been admitted to the hospital or undergone surgery

Question 5

Why is post-acute care increasing in nursing homes?

Answer 5

Declining length of stay in hospital setting

Question 6

What is the average length of stay in a nursing home?

Answer 6

> 90 days

Question 7

What are the medicare rules for payment for nursing-home care?

Answer 7

1) Requires 3-day hospitalization
2) First 20 days= pays in full
3) 21- 100 require co-payment

Question 8

What is the high rate of nursing staff turnover in the LTC facility associated with?

Answer 8

Increased rates of hospitalized for nursing home residents

Question 9

Why is nursing-home care viewed negatively from the perspective of clinicians?

Answer 9

1) Excessive regulations & paperwork
2) Limited reimbursement
3) Undesirability of long-term care environment

Question 10

What was shown to improve the quality of drug use in nursing homes?

Answer 10

• Enhanced nurse-doctor communication

- Interdisciplinary team discussions

Question 11

What are the factors associated with nursing home placement?

Answer 11

• Increased age
• Financial status
• Poor family support
• Attitude of acceptance of nursing home
• Cognitive & functional impairment

Question 12

How are most residents admitted to a nursing-home?

Answer 12

From acute-care setting

Question 13

Where do most of the problems occur in nursing care?

Answer 13

Suboptimal information during transfer

Question 14

What is the Omnibus Budget Reconciliation Act (ORBA)? What did it require?

Answer 14

ORBA was an act passed in 1987, which:

• Stated guidelines on minimum staffing requirements
• Limited due of chemical & physical restraints
• Required documentation for the need of all medications
• Required minimum data sets

Question 15

What are minimum data sets?

Answer 15

• Periodic comprehensive clinical assessment of all residents

*****Information is used to compile nursing facility quality information

Question 16

What are the challenges to nursing-home medical care?

Answer 16

• Heterogeneity of residents
• Atypical & subtle presentation
• Limited access to biotech.
• Dependence on non-physicians for patient evaluation
• Cognitive impairment
• Ethical & legal concerns
• Regulatory oversight

Question 17

What is a major way to enhance satisfaction with nursing-home practice?

Answer 17

Frequent discussion with the facility’s consultant pharmacist

Question 18

What are the physician’s responsibilities in the nursing-home facility?

Answer 18

1) Comprehensive admission assessment
2) Develop care plan
3) Periodic monitoring of chronic problems
4) Address acute problems
5) Interdisciplinary communication
6) Periodic review of all meds.
7) Optimize quality of life
8) Determine resident’s decision-making capacity
9) Physical attendance to each resident