Flashcards in Nursing Home Care/Home Care Deck (31):
Assisted Living Facility
All facilities provide
1. Room and board
2. Assistance with ADL’s and IADL’s
3. Including assistance with medications
Long term care residents
1. Mean age?
2. Associated conditions? 8
1. Mean age is 78-85
-Severe chronic heart disease
Nursing Home Care: Residents grouped into 4 categories?
1. for terminal care
1. primarily medical problems
Who pays for nursing homes
After Medicare runs out
Who pays for assisted living
1. 47% are Medicaid
2. 45% are private pay
1. Neither Medicare nor Medicaid pays for most assisted living
2. Ends up private pay
What are the types of restraints?
4. chairs with locking lap trays,
5. waist restraints,
6. safety belts,
7. bed rails
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
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.
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
Skilled Nursing Facility & Nursing Facility
All services PA is legally authorized to provide that would have been covered if provided personally by a physician.
___% of physician's fee schedule?
Common Problems in Long-term care settings
3. Falls and pressure sores
5. Nutrition, Hydration and Maintenance of Weight
6. Health Maintenance
What are associated risks with the following problems:
1. Infection? 2
2. Musculoskeletal? 2
3. Falls and pressure sores? 2
-Reduced mobility leads to both
What should we manage immbolization with?
Manage with mobilization and Acetaminophen
How can we prevent pressure sores?
1. Risk assessment
2. Skin care
3. Frequent turning and positioning
4. Special beds and mattresses
5. Early treatment of pressure sores
Early treatment of pressure sores includes?
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
Causes: Polypharmacy. Which meds?
4. Calcium channel blockers
Constipation non-medical causes? 7
1. Decreased physical activity
3. Decreased oral intake
4. Decreased dietary fiber intake
6. Loss of functional status
7. Normal aging changes involving the decrease gastric motility and peristalsis
3. Stool softeners
4. Bulk laxatives
5. Drug changes
1. Significant weight loss – a reduction of what?
2. What could this be from? 6
1. 5 pounds or more
-Poor fitting or absent dentures
Nutrition, Hydration and Maintenance of Weight
1. Monitor food and fluid intake
2. Weigh patients at least once a month
3. Look for reversible causes
4. Simple form of diet
Nutrition, Hydration and Maintenance of Weight
Simple form of diet. Such as?
1. Soft diet
2. Pureed diet
3. Adequate staff time to assist patient with eating
All new and prospective residents need to be screened for what?
First TB screen must involve what?
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“.
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”.
Reasons for Home Care
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
With families willing to help provide care, the following technologies are available for better home care?
1. Infusion pumps
2. Dialysis units
4. O2 concentrators
5. Monitoring systems
Criteria for selecting patients for home care?
1. Clinical stability
2. Caregiver support
3. Appropriate environment
4. Availability of professional services
5. Financial support
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
During the “house call” a provider performs:
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
Regulatory and coverage issues:
Basic entry criteria for Medicare home health care?
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
Patient must require intermittent skilled care ordered by the provider: Such as?
1. Nurse visits
2. Physical therapy
3. Speech therapy
4. Home Health aide