Week 5 Flashcards
What kind of clients will you see at Assisted Living?
- Most only require min A with basic ADLs and medication management
- Can still have independence in some areas
- They do NOT need skilled medical care
What kind of clients will you work with at a SNF?
- Clients are getting more intensive rehab (sub-acute rehab, bridges the gap between hospital and home)
- Lots of joint replacements
- Usually require some skilled nursing intervention like TPN, intravenous medication, wound care
What kind of clients will you work with at an Extended Care Facility?
- Those who cannot be home for medical reasons or don’t have outside support or place to stay
- Require 24 hour of care for unknown period of time
- May transfer from hospital, nursing home, or home
- Long term stay, you live there
- Person needs assistance with self-care
- “Functional recovery” may not be possible; lack financial resources or support at home
OTs role in Assisted Living
- Foster and enhance habits and routines, personal care skills and simple home care, leisure, activities with environmental supports (assistive tech)
- Can be consultative; assist with modifications and adaptations, programming and promoting safety throughout facility
- Can educate direct service staff regarding issues on aging, occupation, health promotion
- Direct services include safety, ADL assessments, IADL assessments and interventions, social activity
Housing and personalized support for those needing help with ADLs
Assited Living (AL)
- Allows for privacy
- Services available: linen service, meals, social activities, local transportation, laundry, housekeeping
How are Assisted Living places regulated?
-Regulated and licensed at a state level
How is Assisted Living funded?
- Private pay, state assistance, medicaid voucher
- Cost depends on number of services provided and type of living arrangement (2 bedrooms, suite, etc)
Require special, 24-hour care for either a short or extended time period
Skilled Nursing Facility (SNF). “Bridges the gap” with another level of care. Can be a unit in a hospital or in a free-standing nursing home
Where do clients come from and where do they go to after stay at SNF?
- Admitted from hospital
- Maybe sent for 2 weeks before able to tolerate lots of rehab
- After stay, can be sent home or back to acute rehab if need more/can tolerate more intensive and comprehensive therapy
OTs role in SNF:
- Similar to IRF but less intensive (less than 3 hours per day)
- ADL/IADL; teach approach, etc
How long will a patient stay at a SNF?
Short term stay: up to 100 days
Long term stay: as long as needed
OT role in Extended Care Facility (ECF) or Long-Term Care (LTC)
- Direct or consultative in nature
- Consultative: staff/nurse education, positioning
- Usually won’t hire full time
T/F: Cost at Extended Care Facility (ECF) or Long-Term Care (LTC) varies
True
Facility closest to classic “Nursing Home”
Extended Care Facility (ECF) or Long-Term Care (LTC)
How have nursing homes changed in the last couple decades?
- Publications in 80’s and 90’s have exposed the inefficiencies of nursing homes
- Nursing homes are now responsible for adhering to national and state guidelines
- Shifted from bare minimum to restoring function
- Before, nurses and docs spend little time with residents, used restraints, lack of meaningful occupation, dissatisfaction of care
- Federal and State regulations focus on residents rights, quality of care/life
- Implementation of Minimum Data Sat (MDS)-screens residents for potential problems, abilities, preferences
T/F: nursing homes have remained relatively static in their care implementation
False. Nursing homes have been constantly changing since 1965
Instrument that provides a comprehensive assessment of each resident’s functional capabilities and helps nursing home staff identify health problems
Minimum Data Set. Screens residents for potential problems, abilities, preferences
This legislative measure focussed on wellness and redefined the concept of long-term care
OBRA. OBRA-87 enhanced the regulation of nursing homes and included new requirements on quality of care, resident assessment, care planning, and the use of neuroleptic drugs and physical restraints. Lack of adherence to regulations created sanctions, such as fines.
What is the funding source for many residents of long term care and how does this affect standards of care at LTC facilities?
Madicare and Medicaid funds many residents, so must adhere to legislated standards of care to stay certified.
What are the 3 main categories of nursing home care?
- Skilled (ventilator care, high-level medicare care after a hospitalization)
- Rehabilitative (improvements expected with discharge to “less restrictive environment”). Stay from several weeks to several months
- True long term care
- Also residential alternatives e.g., adult day programs for less restrictive care
T/F: Today’s nursing home residents are sicker, cognitively impaired, physically dependent than in past
True. Almost half of residents are 85+, requiring more skilled services and medical attention
They held the view that older adults possess numerous capabilities and should be treated with dignity and respect
OBRA Legislation. Developed new standards of care and new survey and enforcement procedures
After OBRA paradigm shift, how did nursing home care improve?
- Decrease in physical and chemical restraints
- Improved resident rights and improved outcomes in dehydration, falls, pressure ulcers, malnutrition.
What is the primary concern for OTs in nursing home settings? Why is this problematic?
- Primary concern has been on functional problems, just like other rehab services e.g., measure assistance in grooming vs. altering social roles
- Very reductionistic view of OT; tx approach criticized as bottom up and not holistic, client centered occupational-centered practice
Why do OTs in nursing homes often treat specific impairments instead of working from a top-down approach?
- Reimbursement policies have forced therapists to treat specific impairments.
- OT is reimbursed by number of days and minutes resident is treated, but this tool pays for dependency, not independence.
- E.g., PPS: requires nursing staff to evaluate and implement
How is OT often viewed in nursing home settings?
- OT still seen as “rehab” vs health promoting
- Restorative nursing programs are supposed to carry out restorative programs and OT can play huge role in this, but OT remains consultative in nature (consultative is cheaper for facility)
T/F: Regulations state that OT is required in a LTC setting to aid in functioning and activitities
They should but false. OBRA mandates that facility provides activities to meet well being of individual, but don’t name OT as specific provider. They say that different types of personal are equally capable. Can be recreational specialist, activity director, has special training, OR OT. Long term care administrators will hire least expensive for cost-effectiveness.
We need to utilize best practice and evidence to prove that promoting health and well being is cost effective
A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.
PPS. OT is reimbursed by number of days and minutes resident treated. Requires nursing staff to evaluate and implement restorative programming for long-term care residents. Role of rehab staff is consultative in nature-not a collab approach with multiple disciplines so reinforced learned skill
Risk factors for entering nursing home include:
- Above 65+
- Low income
- Low levels of social activity
- Functional/mental difficulties
- Poor family support
Ability to carry out activities of daily living; client, context, and activity interact for sake of activity completion and satisfaction; leads to engagement in occupations or meaningful activity
Occupational Performance
Events or tasks designed to provide incentive and opportunity to engage in continuing life experiences and hence, to satisfy interests and meet general activity needs (focus on enjoyment, stimulation and repetition of present skills)
General Activities Program. Fcous on enjoyment, stimulation, and repetition of skills
T/F: Currently, there are no guidelines set in nursing homes that emphasize a match between activities and the interests of residents’ ages, gender, and levels of cognitive functioning
False! In June of 2006, CMS revised guidelines so there is an emphasis on the match between activities and the interests of residents and their ages, genders, and levels of cognitive functions
T/F: Nursing staff members generally feel valued and content with pay
False. Overworked, not enough experience, cannot make decisions, feel undervalued, stressed, not payed enough
T/F: Generally, nursing home patients feel disempowered, not independent, bored, and/or depressed
True. Also often losing function, lack meaningful activities
T/F: In nursing homes, there is often strong communication between disciplines
FALSE. There is fragmented communication among disciplines, leading to misunderstandings and increased stress. Gaps between expectations and responsibilities in each discipline. Many staff members feel unheard, frustrated, and angry
Philosophy that encourages a more homelike environment and allows direct-care workers to be more involved in decision making
The Eden alternative, est. 1992. Led to The Green House Project. Uses animals, plants, children to make enjoyable environment. Resident is central focus
Provide alternative to typical nursing homes via specialty design houses for elderly and empowerment of direct care workers. Runs like SNF/Nursing home
The Green House Project
Encourages nursing homes to work together to teach staff best practices and move from typical nursing home culture of control
Wellspring Model. Designed for residents with memory loss. Normally physician may be the leader-may not be best practice anymore
This initiative altered how nursing home work force was viewed and treated by management
LEAP initiative
Offers a list of respective services for older adults e.g., plumber that doesn’t take advantage of people
Village to Village. Like Angie’s List for older adults!
Promotes cultural change model that allows person centered focus of care and steers away from strictly medical model.
Pioneer network. Members are researchers, practitioners, educators
An individual’s feelings or perception of his/her contribution to workplace
Psychological empowerment
- Meaningfulness of work
- Perceived competency or self-efficacy
- One’s self-determination
- Perceived impact on outcome
These all are important requirements to feeling…?
Psychological empowered!
This gives frontline staff responsibilities for making decisions related to their practice without going to someone higher
Shared Governance
This model is based on professional values and principles of autonomy, shared decision-making, and engaged participation
Shared Governance
Shared governance is a decision-making model that is based on principles of what 3 things?
- Accountability
- Equity
- Ownership
In nursing facilities, who is in the best position to make informed decisions?
RNs and CNAs because they have first hand knowledge of the residents
Shared Governance results in all of the following except?
A. Provides a way to implement change
B. Provides patient outcomes
C. Improves patient care
D. Increases staff morale
E. Increases staff income
F. Increases job satisfaction (retention of staff)
G. Facilitates personal and professional growth and development
H. Leads to patient satisfaction
I. Increases staff autonomy and decision-making
J. Improves communication between interdisciplinary teams
E. Shared governance does not directly lead to an increase in income. But when staff is happy, patients are happy and report overall more satisfaction and quality of care. If workers feel appreciated, they tend to go above and beyond to take better care of patients. Everyone works together and feels empowered!
This profession is one of the lowest ranked on the medical hierarchy and is paid minimally
CNA (Certified Nursing Assistant). Physically exacting, risk of infection, emotionally demanding, get yelled at, clean up after pts
Which of the following factors does not influence decision making of nursing staff? A. Race of CNA B. Age of CNA C. Emotional exhaustion D. Supervisor support E. Positive attitudes F. Gender of CNA G. One's perceived work
B. Age of CNA
Personal characteristics that have been reported to affect a CNA’s structural decision-making include gender, positive attitudes, emotional exhaustion and one’s perceived work
Opportunities for OTs in nursing homes:
- Empower residents
- Empower staff
- Educate family and caregivers
- Teach independence
- Change culture to support meaningful activities
- Provide meaningful activities to residents
- Life balance (work, rest, play)
- Equipment and modifications
- Help residents and staff feel valued
- Help people become HAPPY!
