Exam #2: Nursing-Home Population Flashcards Preview

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Flashcards in Exam #2: Nursing-Home Population Deck (18):
1

What are the most common reasons that patients are in a nursing home setting?

- Impairments in decision making/ dementia
- Need assistance with ADLs
- Communication problems
- Bowel/bladder incontinence

2

What is the common "breaking point" for families that leads to placement of a loved on in a nursing home?

Bowel/bladder incontinence

3

What are the typical demographics of patients in a nursing home?

- Over half are > 85 years-old
- Majority are women
- Majority are African American

4

What is post-acute care?

Care for patient's that have recently been admitted to the hospital or undergone surgery

5

Why is post-acute care increasing in nursing homes?

Declining length of stay in hospital setting

6

What is the average length of stay in a nursing home?

>90 days

7

What are the medicare rules for payment for nursing-home care?

1) Requires 3-day hospitalization
2) First 20 days= pays in full
3) 21- 100 require co-payment

8

What is the high rate of nursing staff turnover in the LTC facility associated with?

Increased rates of hospitalized for nursing home residents

9

Why is nursing-home care viewed negatively from the perspective of clinicians?

1) Excessive regulations & paperwork
2) Limited reimbursement
3) Undesirability of long-term care environment

10

What was shown to improve the quality of drug use in nursing homes?

- Enhanced nurse-doctor communication
- Interdisciplinary team discussions

11

What are the factors associated with nursing home placement?

- Increased age
- Financial status
- Poor family support
- Attitude of acceptance of nursing home
- Cognitive & functional impairment

12

How are most residents admitted to a nursing-home?

From acute-care setting

13

Where do most of the problems occur in nursing care?

Suboptimal information during transfer

14

What is the Omnibus Budget Reconciliation Act (ORBA)? What did it require?

ORBA was an act passed in 1987, which:
- Stated guidelines on minimum staffing requirements
- Limited due of chemical & physical restraints
- Required documentation for the need of all medications
- Required minimum data sets

15

What are minimum data sets?

- Periodic comprehensive clinical assessment of all residents

*****Information is used to compile nursing facility quality information

16

What are the challenges to nursing-home medical care?

- Heterogeneity of residents
- Atypical & subtle presentation
- Limited access to biotech.
- Dependence on non-physicians for patient evaluation
- Cognitive impairment
- Ethical & legal concerns
- Regulatory oversight

17

What is a major way to enhance satisfaction with nursing-home practice?

Frequent discussion with the facility's consultant pharmacist

18

What are the physician's responsibilities in the nursing-home facility?

1) Comprehensive admission assessment
2) Develop care plan
3) Periodic monitoring of chronic problems
4) Address acute problems
5) Interdisciplinary communication
6) Periodic review of all meds.
7) Optimize quality of life
8) Determine resident's decision-making capacity
9) Physical attendance to each resident