Nursing Home Care

Question 1

Purpose for a Skilled Nursing Facility

Answer 1

House persons requiring the care & supervision of a skilled nurse

Question 2

Skilled Nursing Facilities

Answer 2

Licensed & regulated by state agencies
Mostly staffed with nursing aides
Few licensed nurses are present to conduct assessments, distribute medications, supervise aides, communicate with providers, & administer treatment

Question 3

Assisted Living Facilities

Answer 3

Diverse facilities

Residents tend to be somewhat less impaired than nursing home residents

Question 4

Services Assisted Living Facilities Provide

Answer 4

Room & board

Assistance with ADLs & IADLs

Question 5

Long Term Care Residents Demographic

Answer 5

Mean ages: 78-85
Alzeimer's
Multi-infarct dementia
Severe chronic heart disease
Amputation
COPD Widows
No children
Low income

Question 6

Short Stay Care

Answer 6

Terminal care

Rehabilitation

Question 7

Long Stay Care

Answer 7

Medical problems

Dementia

Question 8

Payment for Nursing Homes

Answer 8

Medicare (60 days)
Medicaid
Private pay

Question 9

Who pays for assisted living centers?

Answer 9

Private pay

Question 10

Reasons for a Medical Director or Skilled Nursing Facilities

Answer 10

Ensures provider care addresses legal & medical needs
Quality improvement
Committees such as infection, control, pharmacy & utilization review
Reviews incident reports
Assists with development of policies & procedures for residents & staff
Oversees the health program for employees
Conducts educational programs for employees, residents & families
Acts as spokesperson for the facility in the community & with regulatory & other heath care agencies

Question 11

Function-Oriented Care

Answer 11

Maximize what each patient can do independently
Rehabilitative mind set
Assessment & care plan for functional status, establish prognosis, identify specific functional objectives & time frame to accomplish these
Monitor functional status improvement, preventing iatrogenic consequences
Plan a discharge date

Question 12

Types of Restraints

Answer 12

Vest
Wrist
Ankle
Chairs with locking lap trays
Waist restraints
Safety belts 
Bed rails

Question 13

Alternatives to Restraints

Answer 13

Increased involvement for residents in structured activities
Assisted daily ambulation, regular toiling
Active listening
Therapeutic touch
Behavior modification
Search for physiologic causes of agitation
Recliner chairs
Carpeted floors
Lower beds
Motion detectors & position monitors

Question 14

Two Parties Involved in Long Term Care Admissions

Answer 14

Family

Patient

Question 15

Function as Providers

Answer 15

Take time to meet with family
Anticipate future events & discuss in advance with family
Learn about family dynamics
Advanced directives
DNRs
End of life measures
Withholding treatments

Question 16

Common Problems in Long-Term Care Settings

Answer 16

Pneumonia
Urosepsis
Immobility
Falls & pressure sores
Nutrition, hydration, & maintenance of weight

Question 17

Cognitive Status of Falls & Pressure Sores

Answer 17

Risk assessment
Skin care
Frequent turning & positioning
Special beds & mattresses
Early treatment of pressure sores

Question 18

Causes of Constipation

Answer 18

Polypharmacy
Decreased physical activity
Immobility
Decreased oral intake
Decreased dietary fiber intake
Dehydration
Loss of functional status
Normal aging changes involving decreased gastric motility & peristalsis

Question 19

Meds that Cause Constipation

Answer 19

Antacids
Anticholinergics
TCAs
CCBs
NSAIDs
Benzodiazepines
Neuroleptics

Question 20

Treatment of Constipation

Answer 20

Exercise
Hydration
Stool softeners
Bulk laxatives
Drug changes

Question 21

Define Significant Weight Loss

Answer 21

Reduction of 5 pounds or more

Question 22

Reasons for Significant Weight Loss

Answer 22

Depression
Medications
Cancer
Swallowing disorders
Poor fitting or absent dentures
Advanced dementia

Question 23

Treatment of Nutrition, Hydration, & Maintenance of Weight

Answer 23

Monitor food & fluid intake
Weigh patients at least once a month
Look for reversible causes
Simple form diet: soft, puree

Question 24

Health Maintenance for Nursing Home Patients

Answer 24

TB screening
Flu vaccination
H&P
Labs based on H&P

Question 25

Overal Goal of Geriatric Medical Practice

Answer 25

Maintain older persons in the familiarity, comfort, & dignity of their own homes for as long as possible

Question 26

Reasons for Home Care

Answer 26

Aging of society Family caregivers provide 80% of care Pressure contain overall health care costs Alternative for hospitalization

Question 27

Technologies Available for Better Home Care

Answer 27

``` Infusion pumps Dialysis units Ventilators O2 concentrators Monitoring systems ```

Question 28

Criteria for Selecting Patients for Home Care

Answer 28

``` Clinical stability Caregiver support Appropriate environment Availability of professional services Financial support ```

Question 29

Provider Performs These Things at a House Call

Answer 29

``` H&P Counsel to patient & family Medication review Nutritional screening Assessment of environment Assessment of caregivers Home support devices (safety) Obtain specimens ```

Question 30

Benefits of Home Care

Answer 30

Improve desired outcomes of care | Medical-legal actions involved in home care visits are almost non-existent

Question 31

Basic Entry Criteria for Medicare Home Health Care

Answer 31

Must be homebound Leaving home must require assistance & considerable effort Must require intermittent skilled care: nurse visits, PT, ST, home health aide

Question 32

Home Medical Equipment

Answer 32

Wheelchairs Hospital beds Beside commodes Home nebulizer units