Overview of Long term care Flashcards
What percent of nursing home patients have an impairment in decision making?
81%
What percent of nursing home patients need assistance with 3+ ADLs?
80%
What percent of nursing home patients need assistance with 1-2 ADLs?
22%
What percent of nursing home patients have dementia?
50-70%
What percent of nursing home patients have orientation and/or memory problems?
66%
What percent of nursing home patients have communication problems?
60%
What percent of nursing home patients have bowel or bladder incontinence?
40-60%
What percent of nursing home patients have visual impairment?
39%
What percent of nursing home patients have hearing impairment?
36%
What percent of nursing home patients have behavioral problems?
33%
What percent of nursing home patients have depression?
20-25%
What is the point where families move pts to nursing homes?
Toileting issues
What fraction of patients in nursing homes are over 85 yo?
almost half
What percent of nursing home pts are >65 yo?
91
What percent of nursing home pts are female?
72%
True or false: black americans 65-74 years old are more likely than white american to be admitted to a nursing home?
True
What percent of nursing home pts are black?
12%
Most nursing homes are for profit, non-profit, or government?
For profits
Government the least amount
What is post acute care in nursing homes?
Dialysis Orthopedic care Ventilators Post-op care Rehab Wound care
What percent of nursing home stays are less than 90 days? Greater than 90 days? Greater than 3 years?
20%
80%
26%
Where does most of the money come from for nursing homes?
medicaid
What is the turnover rate of nursing homes?
> 50% per year for RNs, and directors, >70% for LPN
High turnover rates in nursing homes are associated with what?
Increased rates of hospitalizations
What are the two factors that correlate with quality of care in nursing homes?
RN hours and ratio
Why is it beneficial for drs to work in nursing homes?
Enhanced communication with nurses
Where are most nursing home pts referred from?
Admitted from an acute-care hospital
What is the most common cause of hospitalization in nursing homes?
Infx
What are the issues with transferring pts to hospitals from nursing homes?
Lack of documentation
no Advanced directives
The omnibus budget reconciliation act (OBRA) had what three major impacts on nursing homes?
- Limited use of restraints
- Limited use of psychoactive meds
- Document for all meds
How do you define unnecessary drugs? (5)
- in excessive doses
- For excessive periods of time
- W/o monitoring
- w/o indications for use
- in the presence of adverse consequences
What is the minimum data set, set forth by the OBRA?
Periodic comprehensive clinical assessment of all residents
Who are the non-vaccinated people in nursing homes?
Staff
True or false: there is intense regulatory oversight in nursing homes?
True
True or false: you need to hold discussions with pharmacists more often in nursing homes
True
What are the responsibilities of a RN home Dr (non obvious ones)?
- Periodic monitoring of chronic health problems
- Prompt and thorough assessment of pts
- periodic review of all meds
- Determining each residents decision making capacity
What are the three strategies for improving quality of care in nursing homes?
- Specific consultation services
- Interactive edu programs
3 Discussion with residents
What characteristic about the patients in nursing homes makes it difficult to work there?
Heterogeneity
Why is it more difficult to diagnose pts from histories in nursing homes? (2)
atypical presentations
Cognitive impairment
True or false: most nursing homes have adequate access to biotechnology
False
Who is relied upon most in nursing homes for overseeing care?
non-drs
Why is it a hassle to work with dependent elderly pts?
Have to work with families
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)
End of life care
