Overview of Long term care

Question 1

What percent of nursing home patients have an impairment in decision making?

Answer 1

81%

Question 2

What percent of nursing home patients need assistance with 3+ ADLs?

Answer 2

80%

Question 3

What percent of nursing home patients need assistance with 1-2 ADLs?

Answer 3

22%

Question 4

What percent of nursing home patients have dementia?

Answer 4

50-70%

Question 5

What percent of nursing home patients have orientation and/or memory problems?

Answer 5

66%

Question 6

What percent of nursing home patients have communication problems?

Answer 6

60%

Question 7

What percent of nursing home patients have bowel or bladder incontinence?

Answer 7

40-60%

Question 8

What percent of nursing home patients have visual impairment?

Answer 8

39%

Question 9

What percent of nursing home patients have hearing impairment?

Answer 9

36%

Question 10

What percent of nursing home patients have behavioral problems?

Answer 10

33%

Question 11

What percent of nursing home patients have depression?

Answer 11

20-25%

Question 12

What is the point where families move pts to nursing homes?

Answer 12

Toileting issues

Question 13

What fraction of patients in nursing homes are over 85 yo?

Answer 13

almost half

Question 14

What percent of nursing home pts are >65 yo?

Answer 14

91

Question 15

What percent of nursing home pts are female?

Answer 15

72%

Question 16

True or false: black americans 65-74 years old are more likely than white american to be admitted to a nursing home?

Answer 16

True

Question 17

What percent of nursing home pts are black?

Answer 17

12%

Question 18

Most nursing homes are for profit, non-profit, or government?

Answer 18

For profits

Government the least amount

Question 19

What is post acute care in nursing homes?

Answer 19

Dialysis
Orthopedic care
Ventilators
Post-op care
Rehab
Wound care

Question 20

What percent of nursing home stays are less than 90 days? Greater than 90 days? Greater than 3 years?

Answer 20

20%
80%
26%

Question 21

Where does most of the money come from for nursing homes?

Answer 21

medicaid

Question 22

What is the turnover rate of nursing homes?

Answer 22

> 50% per year for RNs, and directors, >70% for LPN

Question 23

High turnover rates in nursing homes are associated with what?

Answer 23

Increased rates of hospitalizations

Question 24

What are the two factors that correlate with quality of care in nursing homes?

Answer 24

RN hours and ratio

Question 25

Why is it beneficial for drs to work in nursing homes?

Answer 25

Enhanced communication with nurses

Question 26

Where are most nursing home pts referred from?

Answer 26

Admitted from an acute-care hospital

Question 27

What is the most common cause of hospitalization in nursing homes?

Answer 27

Infx

Question 28

What are the issues with transferring pts to hospitals from nursing homes?

Answer 28

Lack of documentation | no Advanced directives

Question 29

The omnibus budget reconciliation act (OBRA) had what three major impacts on nursing homes?

Answer 29

1. Limited use of restraints 2. Limited use of psychoactive meds 3. Document for all meds

Question 30

How do you define unnecessary drugs? (5)

Answer 30

1. in excessive doses 2. For excessive periods of time 3. W/o monitoring 4. w/o indications for use 5. in the presence of adverse consequences

Question 31

What is the minimum data set, set forth by the OBRA?

Answer 31

Periodic comprehensive clinical assessment of all residents

Question 32

Who are the non-vaccinated people in nursing homes?

Answer 32

Staff

Question 33

True or false: there is intense regulatory oversight in nursing homes?

Answer 33

True

Question 34

True or false: you need to hold discussions with pharmacists more often in nursing homes

Answer 34

True

Question 35

What are the responsibilities of a RN home Dr (non obvious ones)?

Answer 35

1. Periodic monitoring of chronic health problems 2. Prompt and thorough assessment of pts 3. periodic review of all meds 4. Determining each residents decision making capacity

Question 36

What are the three strategies for improving quality of care in nursing homes?

Answer 36

1. Specific consultation services 2. Interactive edu programs 3 Discussion with residents

Question 37

What characteristic about the patients in nursing homes makes it difficult to work there?

Answer 37

Heterogeneity

Question 38

Why is it more difficult to diagnose pts from histories in nursing homes? (2)

Answer 38

atypical presentations | Cognitive impairment

Question 39

True or false: most nursing homes have adequate access to biotechnology

Answer 39

False

Question 40

Who is relied upon most in nursing homes for overseeing care?

Answer 40

non-drs

Question 41

Why is it a hassle to work with dependent elderly pts?

Answer 41

Have to work with families

Question 42

What is the major ethical issue present at nursing homes that you have to deal with that you would not have to deal with elsewhere? (at least as much)

Answer 42

End of life care