Long Term Care
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Why is financing of health care services important for nurses to know about?
It demonstrates the importance of an active role for nursing in developing new health services and clearly defining nursing services that contribute to high-quality care. Nursing leadership was lacking as nursing homes grew and as non-nurses determined nursing's fucntion, role and staffing requirements. The results speak for themselves.
What is health care reform?
Has to do with more stringent enforcement provisions and living conditions provided by the facilities. If conditions are not met by LTC facilities then termination of Medicare/Medicaid reimbursement would happen. As a result new regulations and strict enforcement of them have improved
How can nurses play a role in healthcare reform?
Important to have an active role in developing new health services and clearly defining nursing services that contribute to high quality care
What is involved in the growth of LTC facilities
there were few institutions in the US until the 19th century. Pressure grew to create facitlities that could house clients w/o financial assistance for LTC. Early facilities relied on charities for funding. The enactment of SS helped an informal LTC system grow. In 1965 Medicare and medicaid were developed to ensure a minimum level of healthcare for aged and poor. In 1987 OBRA
How did "nursing homes" get this name/label attached to them?
Many of the LTC homes that were rented by older adults who needed personal care assistance were operated by nurses which gave the term "nursing home" to the facilities
What are the protections for residents via regulatory requirements
Requires 24 hr licensed nursing coverage, provisions for special deits and other good standards of practice. When that failed the OBRA act of 1987 produced reforms in nursing home care. Protections afforded to residents are on the website National citizen's coalition for nursing home reform. Provisions are more stringent
Who are the residents of LTC facilities
Mostly older adults that have impairments that limit independent self-care. Many have alzheimer's disease, cardio disease, arthritis or combo of illnesses. Most need assistance with ADLs. Many spend time in facility to recover from illness or disease, they do recover and return to community
Who are the staff of LTC facilities
Most are unlicensed professionals, regulatory standards are basic and require that only 1 RN be on duty at least 8 hrs a day 7 days a week. A full-time DON must be on staff if the facility has more than 60 beds. The proportion of other staff is not stated. It is required that the facility have 24 hr nursing services yet most direct nursing care is provided by NAs.
What are the nursing responsibilities in the LTC arena
- Care planning
what is an assessment at a LTC
MDS, data collected on each resident. Must assess residents w/in first 5 days and again at 14 days, then 30, 60, 90. MDS is a minimum assessment. Quality care relies on nurse's assessment of resident with every contact. Age-related changes can cause atypical manifestations. Timely recognition of manifestations can help prvent complications
What is care planning
Regulations that a care plan be written for each resident w/in 7 days after completions of the assessment. It is interdisciplinary, resident and family should participate in plan of care. It is a working tool to guide nursing actions. Goals and actions need to be implemented and observed
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