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Geriatrics > Nursing Home Care/Home Care > Flashcards

Flashcards in Nursing Home Care/Home Care Deck (31):
1

Assisted Living Facility
All facilities provide
3

1. Room and board
2. Assistance with ADL’s and IADL’s
3. Including assistance with medications

2

Long term care residents
1. Mean age?
2. Associated conditions? 8

1. Mean age is 78-85

2.
-Alzheimer’s
-Multi-infarct dementia
-Severe chronic heart disease
-Amputation
-COPD
-Widows
-No children
-Low income

3

Nursing Home Care: Residents grouped into 4 categories?

Short stay
1. for terminal care
2. rehabilitation

Long stay
1. primarily medical problems
2. dementia

4

Who pays for nursing homes
After Medicare runs out
2

Who pays for assisted living
2

1. 47% are Medicaid
2. 45% are private pay

1. Neither Medicare nor Medicaid pays for most assisted living
2. Ends up private pay

5

What are the types of restraints?
7

1. Vest,
2. wrist,
3. ankle,
4. chairs with locking lap trays,
5. waist restraints,
6. safety belts,
7. bed rails

6

Restraints
Alternatives?
10

1. Increased involvement for residents in structured activities

2. Assisted daily ambulation, regular toileting

3. Active listening

4. Therapeutic touch

5. Behavior modification

6. Search for physiologic causes of agitation--Pain, constipation, infection

7. Recliner chairs

8. Carpeted floors

9. Lower beds

10. Motion detectors and position monitors

7

To some extent, long-term care residents are a medically underserved population
Lack personal relationships and individualized attention that characterize the best primary medical care.
WHY? 4

1. Logistics of traveling to a long-term care facility
2. Decisions are made via telephone
3. Medicare and Medicaid reimbursements are low
4. High resident and staff turnover

8

Skilled Nursing Facility & Nursing Facility
All services PA is legally authorized to provide that would have been covered if provided personally by a physician.

REIMBURSEMENT RATE
___% of physician's fee schedule?



85

9

Common Problems in Long-term care settings
6

1. Infection
2. Musculoskeletal
3. Falls and pressure sores
4. Constipation
5. Nutrition, Hydration and Maintenance of Weight
6. Health Maintenance

10

What are associated risks with the following problems:
1. Infection? 2
2. Musculoskeletal? 2
3. Falls and pressure sores? 2

1.
-Pneumonia
-Urosepsis

2.
-Immobility
-Arthritis

3.
-Reduced mobility leads to both
-Cognitive status

11

What should we manage immbolization with?

Manage with mobilization and Acetaminophen

12

How can we prevent pressure sores?
5

1. Risk assessment
2. Skin care
3. Frequent turning and positioning
4. Special beds and mattresses
5. Early treatment of pressure sores

13

Early treatment of pressure sores includes?
5

1. Protection from further pressure, shear and friction
2. Debridement of necrotic tissue
3. Maintenance of a moist wound environment
4. Protection from secondary infection
5. Adequate nutrition

14

Constipation
Causes: Polypharmacy. Which meds?
7

Polypharmacy
1. Antacids
2. Anticholinergics
3. TCA’s
4. Calcium channel blockers
5. NSAID’s
6. Benzodiazapines
7. Neuroleptics

15

Constipation non-medical causes? 7

1. Decreased physical activity
2. Immobility
3. Decreased oral intake
4. Decreased dietary fiber intake
5. Dehydration
6. Loss of functional status
7. Normal aging changes involving the decrease gastric motility and peristalsis

16

Constipation treatment?
5

1. Exercise
2. Hydration
3. Stool softeners
4. Bulk laxatives
5. Drug changes

17

1. Significant weight loss – a reduction of what?

2. What could this be from? 6

1. 5 pounds or more

2.
-Depression
-Medications
-Cancer
-Swallowing disorders
-Poor fitting or absent dentures
-Advanced dementia

18

Nutrition, Hydration and Maintenance of Weight
Treatment?
4

1. Monitor food and fluid intake
2. Weigh patients at least once a month
3. Look for reversible causes
4. Simple form of diet

19

Nutrition, Hydration and Maintenance of Weight
Treatment:
Simple form of diet. Such as?

1. Soft diet
2. Pureed diet
3. Adequate staff time to assist patient with eating

20

Health Maintenance
All new and prospective residents need to be screened for what?

TB

21

First TB screen must involve what?

booster testing

22

What does Two-step TB testing involve?

a person getting re-tested one week after the initial tuberculosis test. If both TB tests are negative, the person is unlikely to have TB. Furthermore, if a future TB test is positive, it can be concluded that the TB infection is new and not due to the TB "booster phenomenon“.

23

What is the TB booster phenomenon?

The TB “Booster Phenomenon” in Purified Protein Derivative (PPD) TB testing occurs when a person's immune system has "forgotten" about an infection by Mycobacterium tuberculosis until years later when the person is tested again for TB; the PPD TB test "reminds" the immune system about the infection.

Although the initial PPD TB test was negative, a second PPD TB test, performed years later, may "boost" the immune system's ability to react to the tuberculin.

Therefore, there is no way of knowing if the positive TB test result was due to a recent TB infection or due to the TB “Booster Phenomenon”.

24

Reasons for Home Care
5

1. Aging of society

2. Family caregivers provide 80% of care

3. Pressure to contain overall health care costs

4. DRG’s- Shortening the period of an inpatient convalescence

5. Managed care and health maintenance organizations have encouraged the use of home care as an alternative to hospitalization

25

With families willing to help provide care, the following technologies are available for better home care?
5

1. Infusion pumps
2. Dialysis units
3. Ventilators
4. O2 concentrators
5. Monitoring systems

26

Criteria for selecting patients for home care?
5

1. Clinical stability
2. Caregiver support
3. Appropriate environment
4. Availability of professional services
5. Financial support

27

What needs to be estimated before estimating home care?

Self pay costs need to be estimated before initiating home care
--Poorly covered at present by Medicare and other insurers

28

During the “house call” a provider performs:
8

1. History and physical
2. Counsel to patient and family
3. Medication review
4. Nutritional screening
5. Assessment of environment
6. Assessment of caregivers
7. Home support devices (safety)
8. Obtain specimens

29

Regulatory and coverage issues:
Basic entry criteria for Medicare home health care?
3

1. Patient must be homebound
2. Leaving home must require assistance and considerable effort
3. Patient must require intermittent skilled care ordered by the provider

30

Patient must require intermittent skilled care ordered by the provider: Such as?
4

1. Nurse visits
2. Physical therapy
3. Speech therapy
4. Home Health aide

31

Both Medicare and Medicaid pay for certain types of home medical equipment

Homebound status is not required for these, but there must be signed physician order that specifies the nature of the clinical problem that requires the device. Such as?
4

1. Wheelchairs
2. Hospital beds
3. Beside commodes
4. Home nebulizer units