Nursing Home Care/Home Care

Question 1

Assisted Living Facility
All facilities provide
3

Answer 1

1. Room and board
2. Assistance with ADL’s and IADL’s
3. Including assistance with medications

Question 2

Long term care residents

1. Mean age?
2. Associated conditions? 8

Answer 2

1. Mean age is 78-85
2. • Alzheimer’s
   • Multi-infarct dementia
   • Severe chronic heart disease
   • Amputation
   • COPD
   • Widows
   • No children
   • Low income

Question 3

Nursing Home Care: Residents grouped into 4 categories?

Answer 3

Short stay

1. for terminal care
2. rehabilitation

Long stay

1. primarily medical problems
2. dementia

Question 4

Who pays for nursing homes
After Medicare runs out
2

Who pays for assisted living
2

Answer 4

1. 47% are Medicaid
2. 45% are private pay
3. Neither Medicare nor Medicaid pays for most assisted living
4. Ends up private pay

Question 5

What are the types of restraints?

7

Answer 5

1. Vest,
2. wrist,
3. ankle,
4. chairs with locking lap trays,
5. waist restraints,
6. safety belts,
7. bed rails

Question 6

Restraints
Alternatives?
10

Answer 6

1. Increased involvement for residents in structured activities
2. Assisted daily ambulation, regular toileting
3. Active listening
4. Therapeutic touch
5. Behavior modification
6. Search for physiologic causes of agitation–Pain, constipation, infection
7. Recliner chairs
8. Carpeted floors
9. Lower beds
10. Motion detectors and position monitors

Question 7

To some extent, long-term care residents are a medically underserved population
Lack personal relationships and individualized attention that characterize the best primary medical care.
WHY? 4

Answer 7

1. Logistics of traveling to a long-term care facility
2. Decisions are made via telephone
3. Medicare and Medicaid reimbursements are low
4. High resident and staff turnover

Question 8

Skilled Nursing Facility & Nursing Facility
All services PA is legally authorized to provide that would have been covered if provided personally by a physician.

REIMBURSEMENT RATE
___% of physician’s fee schedule?

Answer 8

85

Question 9

Common Problems in Long-term care settings

6

Answer 9

1. Infection
2. Musculoskeletal
3. Falls and pressure sores
4. Constipation
5. Nutrition, Hydration and Maintenance of Weight
6. Health Maintenance

Question 10

What are associated risks with the following problems:

1. Infection? 2
2. Musculoskeletal? 2
3. Falls and pressure sores? 2

Answer 10

1. • Pneumonia
   • Urosepsis
2. • Immobility
   • Arthritis
3. • Reduced mobility leads to both
   • Cognitive status

Question 11

What should we manage immbolization with?

Answer 11

Manage with mobilization and Acetaminophen

Question 12

How can we prevent pressure sores?

5

Answer 12

1. Risk assessment
2. Skin care
3. Frequent turning and positioning
4. Special beds and mattresses
5. Early treatment of pressure sores

Question 13

Early treatment of pressure sores includes?

5

Answer 13

1. Protection from further pressure, shear and friction
2. Debridement of necrotic tissue
3. Maintenance of a moist wound environment
4. Protection from secondary infection
5. Adequate nutrition

Question 14

Constipation
Causes: Polypharmacy. Which meds?
7

Answer 14

Polypharmacy

1. Antacids
2. Anticholinergics
3. TCA’s
4. Calcium channel blockers
5. NSAID’s
6. Benzodiazapines
7. Neuroleptics

Question 15

Constipation non-medical causes? 7

Answer 15

1. Decreased physical activity
2. Immobility
3. Decreased oral intake
4. Decreased dietary fiber intake
5. Dehydration
6. Loss of functional status
7. Normal aging changes involving the decrease gastric motility and peristalsis

Question 16

Constipation treatment?

5

Answer 16

1. Exercise
2. Hydration
3. Stool softeners
4. Bulk laxatives
5. Drug changes

Question 17

1. Significant weight loss – a reduction of what?

2. What could this be from? 6

Answer 17

1. 5 pounds or more
2. • Depression
   • Medications
   • Cancer
   • Swallowing disorders
   • Poor fitting or absent dentures
   • Advanced dementia

Question 18

Nutrition, Hydration and Maintenance of Weight
Treatment?
4

Answer 18

1. Monitor food and fluid intake
2. Weigh patients at least once a month
3. Look for reversible causes
4. Simple form of diet

Question 19

Nutrition, Hydration and Maintenance of Weight
Treatment:
Simple form of diet. Such as?

Answer 19

1. Soft diet
2. Pureed diet
3. Adequate staff time to assist patient with eating

Question 20

Health Maintenance

All new and prospective residents need to be screened for what?

Answer 20

TB

Question 21

First TB screen must involve what?

Answer 21

booster testing

Question 22

What does Two-step TB testing involve?

Answer 22

a person getting re-tested one week after the initial tuberculosis test. If both TB tests are negative, the person is unlikely to have TB. Furthermore, if a future TB test is positive, it can be concluded that the TB infection is new and not due to the TB “booster phenomenon“.

Question 23

What is the TB booster phenomenon?

Answer 23

The TB “Booster Phenomenon” in Purified Protein Derivative (PPD) TB testing occurs when a person’s immune system has “forgotten” about an infection by Mycobacterium tuberculosis until years later when the person is tested again for TB; the PPD TB test “reminds” the immune system about the infection.

Although the initial PPD TB test was negative, a second PPD TB test, performed years later, may “boost” the immune system’s ability to react to the tuberculin.

Therefore, there is no way of knowing if the positive TB test result was due to a recent TB infection or due to the TB “Booster Phenomenon”.

Question 24

Reasons for Home Care

5

Answer 24

1. Aging of society
2. Family caregivers provide 80% of care
3. Pressure to contain overall health care costs
4. DRG’s- Shortening the period of an inpatient convalescence
5. Managed care and health maintenance organizations have encouraged the use of home care as an alternative to hospitalization

Question 25

With families willing to help provide care, the following technologies are available for better home care? 5

Answer 25

1. Infusion pumps 2. Dialysis units 3. Ventilators 4. O2 concentrators 5. Monitoring systems

Question 26

Criteria for selecting patients for home care? | 5

Answer 26

1. Clinical stability 2. Caregiver support 3. Appropriate environment 4. Availability of professional services 5. Financial support

Question 27

What needs to be estimated before estimating home care?

Answer 27

Self pay costs need to be estimated before initiating home care --Poorly covered at present by Medicare and other insurers

Question 28

During the “house call” a provider performs: | 8

Answer 28

1. History and physical 2. Counsel to patient and family 3. Medication review 4. Nutritional screening 5. Assessment of environment 6. Assessment of caregivers 7. Home support devices (safety) 8. Obtain specimens

Question 29

Regulatory and coverage issues: Basic entry criteria for Medicare home health care? 3

Answer 29

1. Patient must be homebound 2. Leaving home must require assistance and considerable effort 3. Patient must require intermittent skilled care ordered by the provider

Question 30

Patient must require intermittent skilled care ordered by the provider: Such as? 4

Answer 30

1. Nurse visits 2. Physical therapy 3. Speech therapy 4. Home Health aide

Question 31

Both Medicare and Medicaid pay for certain types of home medical equipment Homebound status is not required for these, but there must be signed physician order that specifies the nature of the clinical problem that requires the device. Such as? 4

Answer 31

1. Wheelchairs 2. Hospital beds 3. Beside commodes 4. Home nebulizer units