Nursing Home Care Flashcards
Purpose for a Skilled Nursing Facility
House persons requiring the care & supervision of a skilled nurse
Skilled Nursing Facilities
Licensed & regulated by state agencies
Mostly staffed with nursing aides
Few licensed nurses are present to conduct assessments, distribute medications, supervise aides, communicate with providers, & administer treatment
Assisted Living Facilities
Diverse facilities
Residents tend to be somewhat less impaired than nursing home residents
Services Assisted Living Facilities Provide
Room & board
Assistance with ADLs & IADLs
Long Term Care Residents Demographic
Mean ages: 78-85 Alzeimer's Multi-infarct dementia Severe chronic heart disease Amputation COPD Widows No children Low income
Short Stay Care
Terminal care
Rehabilitation
Long Stay Care
Medical problems
Dementia
Payment for Nursing Homes
Medicare (60 days)
Medicaid
Private pay
Who pays for assisted living centers?
Private pay
Reasons for a Medical Director or Skilled Nursing Facilities
Ensures provider care addresses legal & medical needs
Quality improvement
Committees such as infection, control, pharmacy & utilization review
Reviews incident reports
Assists with development of policies & procedures for residents & staff
Oversees the health program for employees
Conducts educational programs for employees, residents & families
Acts as spokesperson for the facility in the community & with regulatory & other heath care agencies
Function-Oriented Care
Maximize what each patient can do independently
Rehabilitative mind set
Assessment & care plan for functional status, establish prognosis, identify specific functional objectives & time frame to accomplish these
Monitor functional status improvement, preventing iatrogenic consequences
Plan a discharge date
Types of Restraints
Vest Wrist Ankle Chairs with locking lap trays Waist restraints Safety belts Bed rails
Alternatives to Restraints
Increased involvement for residents in structured activities
Assisted daily ambulation, regular toiling
Active listening
Therapeutic touch
Behavior modification
Search for physiologic causes of agitation
Recliner chairs
Carpeted floors
Lower beds
Motion detectors & position monitors
Two Parties Involved in Long Term Care Admissions
Family
Patient
Function as Providers
Take time to meet with family Anticipate future events & discuss in advance with family Learn about family dynamics Advanced directives DNRs End of life measures Withholding treatments
Common Problems in Long-Term Care Settings
Pneumonia Urosepsis Immobility Falls & pressure sores Nutrition, hydration, & maintenance of weight
Cognitive Status of Falls & Pressure Sores
Risk assessment Skin care Frequent turning & positioning Special beds & mattresses Early treatment of pressure sores
Causes of Constipation
Polypharmacy Decreased physical activity Immobility Decreased oral intake Decreased dietary fiber intake Dehydration Loss of functional status Normal aging changes involving decreased gastric motility & peristalsis
Meds that Cause Constipation
Antacids Anticholinergics TCAs CCBs NSAIDs Benzodiazepines Neuroleptics
Treatment of Constipation
Exercise Hydration Stool softeners Bulk laxatives Drug changes
Define Significant Weight Loss
Reduction of 5 pounds or more
Reasons for Significant Weight Loss
Depression Medications Cancer Swallowing disorders Poor fitting or absent dentures Advanced dementia
Treatment of Nutrition, Hydration, & Maintenance of Weight
Monitor food & fluid intake
Weigh patients at least once a month
Look for reversible causes
Simple form diet: soft, puree
Health Maintenance for Nursing Home Patients
TB screening
Flu vaccination
H&P
Labs based on H&P
Overal Goal of Geriatric Medical Practice
Maintain older persons in the familiarity, comfort, & dignity of their own homes for as long as possible
Reasons for Home Care
Aging of society
Family caregivers provide 80% of care
Pressure contain overall health care costs
Alternative for hospitalization
Technologies Available for Better Home Care
Infusion pumps Dialysis units Ventilators O2 concentrators Monitoring systems
Criteria for Selecting Patients for Home Care
Clinical stability Caregiver support Appropriate environment Availability of professional services Financial support
Provider Performs These Things at a House Call
H&P Counsel to patient & family Medication review Nutritional screening Assessment of environment Assessment of caregivers Home support devices (safety) Obtain specimens
Benefits of Home Care
Improve desired outcomes of care
Medical-legal actions involved in home care visits are almost non-existent
Basic Entry Criteria for Medicare Home Health Care
Must be homebound
Leaving home must require assistance & considerable effort
Must require intermittent skilled care: nurse visits, PT, ST, home health aide
Home Medical Equipment
Wheelchairs
Hospital beds
Beside commodes
Home nebulizer units
