Nursing home

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A nursing home is one specific type of care of residents.

Contents

A nursing home or skilled nursing facility (SNF) is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness. In the US, nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse. In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002. Some states have nursing homes that are called nursing facilities (NF), which do not have beds certified for Medicare patients, but can only treat patients whose payments source is Private Pay or Medicaid.

[edit] Difference between a SNF and a nursing home

A SNF is an institution or a distinct part of an institution, which is primarily engaged in providing skilled nursing care or rehabilitation services that will enable rehabilitation of injured, disabled, or sick persons. Hospitals often have arrangements with SNFs to provide follow up care after a patient no longer needs the level of services that an acute hospital provides. The patient is sent to a SNF to get skilled care / rehabilitation until they are able to return home (or are at a state where further improvement is no longer possible).

A nursing home is residence facility that provides a room, meals, and help with activities of daily living and recreation. Generally, nursing home residents have physical or mental problems that keep them from living on their own. They usually require daily assistance.

In general, SNF care is covered under health insurance plans and Medicare, where nursing home care is not. Many patients who live in nursing homes often exhaust their personal finances at some point, and in the U.S.A., once that happens, they are eligible for Medicaid (care for the poor) which will pay the nursing home for the care they provide. However, many nursing homes would argue that the amount Medicaid pays does not cover the cost they face in providing that care.

[edit] Government/Regulatory Oversight

For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see Nursing Home Compare in the link below). Homes in England are regulated by the Commission for Social Care Inspection.

All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors, or most commonly: state surveyors.

The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.

In Texas, nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).

[edit] Associations/Organizations

[edit] Consumer choices

Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.

When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an Adult Daycare Center.

Beginning in 2002, Medicare began hosting an online resource known as Nursing Home Compare (see the "External Links" section at the bottom of the page). The program is intended to foster quality improving competition between nursing homes. Informed consumer choice has long been missing from decisions regarding the placement of the elderly in need.

[edit] New trends

Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small sets of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Pioneer Network, the Eden Alternative, and the Green House Project. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry.

[edit] Quality of Life

[edit] Resident-Oriented Care

Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patients. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical.

[edit] Scientific Findings

According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows for them to dispel many feelings of loneliness and discontent.

“ Resident assignment” refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this system can cause difficulties for the nurse or care-giver should their one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are caring for.

In coming to this conclusion three guidelines must be assessed: structure, process and outcome. Structure is the assessment of the instrumentalities of care and their organization; Process being the quality of the way in which care is given; Outcome being the usually specified in terms of health, wellbeing, patient satisfaction, etc. Using these three criteria find that are strengthened when residents experience resident oriented care.

Communication is also heightened when residents feel comfortable discussing various issues with someone who is experienced with their particular case. In this particular situation nurses are also better able to do longitudinal follow up, which insures the implementation of more lasting results.

Various finding suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result decide not to share information at all.

Patients usually complain of loneliness and feelings of displacement.

“Resident assignment” is allocated to numerous nurses as oppose to one person carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable identify with gradual emotional and physical changes experienced by one particular resident. Resident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deals with one resident. citations needed

[edit] Task-Oriented Care

Task oriented care is where nurses are assigned specific task to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of task, nurses are declined the ability to develop more in depth relations with any particular resident.

[edit] References

  • Illustrated History of Long Term Care.[1]


[edit] External links

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