long term care Flashcards
1
Q
describe the nursing hope population
A
- Impairment in decision making = 81%
- need assistance with 3+ ADLs = 80%
- need assistance with 1-2 ADLs = 22%
- Dementia = 50-70%
- orientation and or memory problems = 66%
- communication problems = 60%
- bowel or bladder incontinence = 40-60%
- visual impairment = 39%
- hearing impairment = 36%
- depression 20-25%
- behavioral problems = 33%+
2
Q
what are the demographics of nursing homes
A
- almost half are over 85%
- the majority are women, widowed, with limited social supports
- percentage of black residents approaches the percentage in general pop.
- black Americans 65-74 years old are more likely than white Americans to be admitted to a nursing home
- Hispanic Americans, Asian Americans, and native Americans are underrepresented despite higher disability rates
3
Q
postacute care in nursing homes
A
- response to declining length of hospital stays and higher care needs of older adults
- integrates features of acute medical care, long term care nursing, and rehabilitation
4
Q
factors associated with nursing-home placement
A
- increasing age
- low income and low social activity
- poor family supports (especially lack of spouse and children)
- accepting attitude toward nursing homes
- cognitive and functional impairment
5
Q
describe the interface of acute and long term care
A
- most nursing home residents are admitted from an acute-care hospital
- nursing home residents have high rates of hospitalization, most commonly due to infection
- NPs and PAs working in concert with a primary care physician as a team:
- -> often reduce hospitalization rate while maintaining cost of neutrality
6
Q
OBRA (omnibus budget reconciliation act
A
- bolstered residents rights to
- -> limited use of restraints
- -> limited use of psychoactive medications
- initiated the minimum data sets (MDS)
- requries documentation of the need for all medications, particularly psychoactive agents
- OBRA requires monthly evaluation of medications by pharmacist
- medications must be reviewed at regular intervals and include no unnecessary drugs
7
Q
Unnecessary drugs
A
- in excessive doses
- excessive periods of time
- without adequate monitoring
- without adequate indications for use
- in presence of adverse consequences indicating the need for dose reduction or discontinuation.
8
Q
describe minimum data set (MDS
A
- periodic comprehensive clinical assessment of all residents
- used to compile nursing facility quality measures such as pain, pressure ulcers, weight loss, depression, rates of vaccination and restraint use
- identification of current or potential problem triggers review of diagnostic and therapeutic protocols
9
Q
challenges in nursing home medical care
A
- heterogeneity of residents, necessitating individualized approaches to care
- atypical and subtle presentation of illness
- limited access to biotechnology
- dependence on non physicians for patient evaluation
- high prevalence of cognitive impairment
- the need to involve families in care plans and provide educational and psychosocial support for families
- ethical and legal concerns, such as end of life care, feeding, hydration and resident rights
- intense regulatory oversight
10
Q
physician responsibilites
A
- comprehensie admission assessment (including history and physical, and review of available medical records)
- development of care plan (concert with other team members)
- periodic monitoring of chronic health problems
- prompt and thorough assessment of acute medical problems or change in function
- communication with interdisciplinary team members, the resident and the family
- physical attendance to each resident
11
Q
What are strategies for enhancing quality of care
A
- specific consultation services (efforts to reduce falls)
- interactive educational programs for physicians and nursing staff
- discussion with residents about their preferences for care
