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Flashcards in Overview of Long term care Deck (42):
1

What percent of nursing home patients have an impairment in decision making?

81%

2

What percent of nursing home patients need assistance with 3+ ADLs?

80%

3

What percent of nursing home patients need assistance with 1-2 ADLs?

22%

4

What percent of nursing home patients have dementia?

50-70%

5

What percent of nursing home patients have orientation and/or memory problems?

66%

6

What percent of nursing home patients have communication problems?

60%

7

What percent of nursing home patients have bowel or bladder incontinence?

40-60%

8

What percent of nursing home patients have visual impairment?

39%

9

What percent of nursing home patients have hearing impairment?

36%

10

What percent of nursing home patients have behavioral problems?

33%

11

What percent of nursing home patients have depression?

20-25%

12

What is the point where families move pts to nursing homes?

Toileting issues

13

What fraction of patients in nursing homes are over 85 yo?

almost half

14

What percent of nursing home pts are >65 yo?

91

15

What percent of nursing home pts are female?

72%

16

True or false: black americans 65-74 years old are more likely than white american to be admitted to a nursing home?

True

17

What percent of nursing home pts are black?

12%

18

Most nursing homes are for profit, non-profit, or government?

For profits

Government the least amount

19

What is post acute care in nursing homes?

Dialysis
Orthopedic care
Ventilators
Post-op care
Rehab
Wound care

20

What percent of nursing home stays are less than 90 days? Greater than 90 days? Greater than 3 years?

20%
80%
26%

21

Where does most of the money come from for nursing homes?

medicaid

22

What is the turnover rate of nursing homes?

>50% per year for RNs, and directors, >70% for LPN

23

High turnover rates in nursing homes are associated with what?

Increased rates of hospitalizations

24

What are the two factors that correlate with quality of care in nursing homes?

RN hours and ratio

25

Why is it beneficial for drs to work in nursing homes?

Enhanced communication with nurses

26

Where are most nursing home pts referred from?

Admitted from an acute-care hospital

27

What is the most common cause of hospitalization in nursing homes?

Infx

28

What are the issues with transferring pts to hospitals from nursing homes?

Lack of documentation
no Advanced directives

29

The omnibus budget reconciliation act (OBRA) had what three major impacts on nursing homes?

1. Limited use of restraints
2. Limited use of psychoactive meds
3. Document for all meds

30

How do you define unnecessary drugs? (5)

1. in excessive doses
2. For excessive periods of time
3. W/o monitoring
4. w/o indications for use
5. in the presence of adverse consequences

31

What is the minimum data set, set forth by the OBRA?

Periodic comprehensive clinical assessment of all residents

32

Who are the non-vaccinated people in nursing homes?

Staff

33

True or false: there is intense regulatory oversight in nursing homes?

True

34

True or false: you need to hold discussions with pharmacists more often in nursing homes

True

35

What are the responsibilities of a RN home Dr (non obvious ones)?

1. Periodic monitoring of chronic health problems
2. Prompt and thorough assessment of pts
3. periodic review of all meds
4. Determining each residents decision making capacity

36

What are the three strategies for improving quality of care in nursing homes?

1. Specific consultation services
2. Interactive edu programs
3 Discussion with residents

37

What characteristic about the patients in nursing homes makes it difficult to work there?

Heterogeneity

38

Why is it more difficult to diagnose pts from histories in nursing homes? (2)

atypical presentations
Cognitive impairment

39

True or false: most nursing homes have adequate access to biotechnology

False

40

Who is relied upon most in nursing homes for overseeing care?

non-drs

41

Why is it a hassle to work with dependent elderly pts?

Have to work with families

42

What is the major ethical issue present at nursing homes that you have to deal with that you would not have to deal with elsewhere? (at least as much)

End of life care