Chapter 038 Long Term


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  • Give an example of services which might be provided. Give an example of settings in which long-term care is provided.
  • Give an example of two situations in which a person would require minimal versus complex assistance in the home.
  • Give an example of a patient who would require hospice.
  • Give an example of a patient who would benefit from adult daycare. How does this service help the patient’s family?
  • What type of services would be available for the person living in an assisted living environment? Why would an older adult choose a facility that offers both independent living and 24-hour skilled care?
  • What is the benefit to the patient and the facility to offer such a unit?
  • Give an example of a patient who would require long-term care.
  • Why is there a higher incidence of these disorders upon admission?
  • Give an example of a short-term and long-term resident.
  • What types of disciplines are offered in long-term care facilities? Why are these agencies monitored so closely by the state and federal agencies?
  • What is the CNA’s role in this environment? Describe OBRA.
  • Give an example of who might require both Medicare and Medicaid benefits.
  • What is team nursing? What is functional nursing? Who would provide total resident care?
  • Who would conduct the RAI? What other disciplines would be involved?
  • Why would vital signs and weights only be required on a monthly basis?
  • Provide nursing interventions that would apply to these nursing diagnoses.
  • Provide nursing interventions that would apply to these nursing diagnoses.
  • Chapter 038 Long Term

    1. 1. Chapter 38 Long-Term Care
    2. 2. Long-Term Care <ul><li>Long-term care is defined by the American Nurses Association (ANA) as the provision of physical, psychologic, spiritual, social, and economic services to help people attain, maintain, and regain their optimum level of functioning. </li></ul><ul><li>Long-term care is provided in a variety of settings and offers a broad spectrum of services. </li></ul>
    3. 3. Setting for Long-Term Care <ul><li>The Home </li></ul><ul><ul><li>Most older adults live in a home setting, with only a small percentage of those aged 65 or older residing in an institutional setting. </li></ul></ul><ul><ul><li>Care of the older adult at home may involve a great deal of participation from loved ones. </li></ul></ul><ul><ul><li>It costs approximately half as much to care for an older adult at home as it would cost in a long-term care facility. </li></ul></ul><ul><ul><li>Home patients may require only minimal assistance, or they might receive complex medical therapies. </li></ul></ul>
    4. 4. Figure 38-1 Family is important in helping to maintain quality of life for the older adult.
    5. 5. Setting for Long-Term Care <ul><li>Hospice </li></ul><ul><ul><li>Provides services to patients and families as the end of life approaches. </li></ul></ul><ul><ul><li>The philosophy of maintaining comfort as death approaches is central to hospice care. </li></ul></ul><ul><ul><li>Provide nursing interventions to meet basic needs; ADLs; pain and symptom management; and spiritual and psychosocial support for the patient, family, and significant others. </li></ul></ul><ul><ul><li>Care providers include CNAs, HHAs, LPN/LVNs, and RNs. </li></ul></ul>
    6. 6. Setting for Long-Term Care <ul><li>Adult Daycare </li></ul><ul><ul><li>Community-based programs are designed to meet the needs of functionally or cognitively impaired adults through an individualized plan of care. </li></ul></ul><ul><ul><li>These structured, comprehensive programs provide a variety of services, including physical care, mental stimulation, socialization, assistance with health maintenance, and health referrals, during any part of the day but providing less than 24 hours’ care. </li></ul></ul><ul><ul><li>They are designed to serve adults who require supervision, social opportunities, or assistance due to a physical or cognitive impairment. </li></ul></ul>
    7. 7. Figure 38-2 Available settings that provide long-term care services.
    8. 8. Setting for Long-Term Care <ul><li>Residential Care Settings </li></ul><ul><ul><li>Primarily an older adult population, offering a wide variety of services </li></ul></ul><ul><ul><li>Assisted living </li></ul></ul><ul><ul><ul><li>A type of residential care setting whereby the adult patient rents a small one-bedroom or studio-type apartment and can receive several personal care services </li></ul></ul></ul><ul><ul><li>Continuing care retirement communities </li></ul></ul><ul><ul><ul><li>Offer a complete range of housing and health care accommodations, from independent living to 24-hour skilled nursing care </li></ul></ul></ul>
    9. 9. Setting for Long-Term Care <ul><li>Institutional Settings </li></ul><ul><ul><li>Subacute Unit </li></ul></ul><ul><ul><ul><li>This type of institutional setting provides a less-expensive alternative to acute care when patients have high-acuity medical and nursing intervention needs. </li></ul></ul></ul><ul><ul><ul><li>Most are located in freestanding skilled nursing facilities; others are former hospital units that have been reclassified to provide subacute care. </li></ul></ul></ul><ul><ul><ul><li>They provide a stronger rehabilitative focus and shorter length of stay than a long-term care facility. </li></ul></ul></ul>
    10. 10. Setting for Long-Term Care <ul><li>Institutional Settings </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Most dominant setting for long-term care services </li></ul></ul></ul><ul><ul><ul><li>Commonly known as a nursing home or extended care facility </li></ul></ul></ul><ul><ul><ul><li>Provides services to primarily older adults </li></ul></ul></ul><ul><ul><ul><li>Provides 24-hour care to individuals who do not require inpatient hospital services but who do not have options for care at home or by other community agencies/services </li></ul></ul></ul>
    11. 11. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Because the long-term care facility becomes a home for the older adult, the adults are referred to as residents rather than as patients. </li></ul></ul></ul><ul><ul><ul><li>Most residents have more than one health disorder when they are admitted, and more than half have three or more medical diagnoses. </li></ul></ul></ul>
    12. 12. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>The most common disorders on admission are as follows </li></ul></ul></ul><ul><ul><ul><ul><li>Cardiovascular disease, including hypertension and cerebrovascular accident </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mental and cognitive disorders, including depression, anxiety, and dementia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Endocrine disorders, including type 2 diabetes mellitus and hypothyroidism </li></ul></ul></ul></ul>
    13. 13. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Two categories of residents </li></ul></ul></ul><ul><ul><ul><ul><li>Short-term: transferred from an acute care facility to which he or she had been admitted for an acute illness or worsening of a chronic illness; admitted primarily for rehabilitation and expected to be discharged within 6 months </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Long-term: usually stays in the facility until he or she dies or is transferred to an acute care facility. Most residents are long term. </li></ul></ul></ul></ul>
    14. 14. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Interdisciplinary setting </li></ul></ul></ul><ul><ul><ul><ul><li>Health care professionals work together as an interdisciplinary team to meet the needs of the older adult. </li></ul></ul></ul></ul><ul><ul><ul><li>Facility is managed by an administrator and has a director of nursing (DON). </li></ul></ul></ul><ul><ul><ul><li>These facilities are highly regulated by state and federal agencies to ensure quality services to a potentially vulnerable population. </li></ul></ul></ul>
    15. 15. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Restorative nursing care </li></ul></ul></ul><ul><ul><ul><ul><li>Basic concepts of physical therapy for maintenance of functional mobility and physical activity; care is provided by CNAs who have completed an educational program for restorative care </li></ul></ul></ul></ul><ul><ul><ul><li>Omnibus Budget Reconciliation Act (OBRA) </li></ul></ul></ul><ul><ul><ul><ul><li>Defines requirements for the quality of care given to residents of long-term care facilities </li></ul></ul></ul></ul>
    16. 16. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Medicare </li></ul></ul></ul><ul><ul><ul><ul><li>A federally funded national health insurance program in the United States for people over age 65 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Provide funding to long-term care facilities by adhering to the HCFA guidelines for reimbursement </li></ul></ul></ul></ul>
    17. 17. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Medicaid </li></ul></ul></ul><ul><ul><ul><ul><li>A federally funded, state-operated program of medical assistance to people with low incomes </li></ul></ul></ul></ul><ul><ul><ul><ul><li>A large source of revenue for the long-term care facility </li></ul></ul></ul></ul>
    18. 18. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Several different types of nursing can be seen in this setting </li></ul></ul></ul><ul><ul><ul><ul><li>Team nursing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Functional nursing </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Total resident care </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Combination of the above </li></ul></ul></ul></ul>
    19. 19. Setting for Long-Term Care <ul><li>I </li></ul><ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>The interdisciplinary functional assessment of the resident is the cornerstone of clinical practice. </li></ul></ul></ul><ul><ul><ul><li>Resident Assessment Instrument (RAI) </li></ul></ul></ul><ul><ul><ul><ul><li>OBRA-prescribed method of resident assessment and care plan development </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Consists of three parts </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Minimum Data Set (MDS) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Resident Assessment Protocols (RAP) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Utilization Guidelines </li></ul></ul></ul></ul></ul>
    20. 20. Setting for Long-Term Care <ul><li>Institutional Settings (continued) </li></ul><ul><ul><li>Long-Term Care Facility </li></ul></ul><ul><ul><ul><li>Documentation of the resident’s condition including vital signs and weights, is only required on a monthly basis. </li></ul></ul></ul><ul><ul><ul><li>The exception to this charting is a condition change, acute illness, or incident reporting, which must be documented at or soon after the time of occurrence. </li></ul></ul></ul>
    21. 21. Nursing Process <ul><li>Nursing Diagnoses </li></ul><ul><ul><li>Aspiration, risk for </li></ul></ul><ul><ul><li>Airway clearance, ineffective </li></ul></ul><ul><ul><li>Gas exchange, impaired </li></ul></ul><ul><ul><li>Cardiac output, decreased </li></ul></ul><ul><ul><li>Nutrition: less than body requirements </li></ul></ul><ul><ul><li>Fluid volume, risk for deficient </li></ul></ul><ul><ul><li>Incontinence </li></ul></ul><ul><ul><li>Thought process, disturbed </li></ul></ul><ul><ul><li>Confusion, chronic </li></ul></ul>
    22. 22. Key Points <ul><li>Long term care services are provided after the acute stage of an illness has resolved but the patient continues to need services and maintain his or her current and changing physical and psychological status and functional abilities. </li></ul><ul><li>Settings that assist those caring for older adults in the home include adult daycare, hospice, home health agencies, and other community agencies and services. </li></ul>
    23. 23. Key Point <ul><li>Residential care settings offer a wide variety of services of the older adult; two of the more popular types are assisted living facilities and continuing care retirement communities. </li></ul><ul><li>Institutional facilities include subacute units and long-term care facilities. </li></ul><ul><li>The majority of long-term care providers are regulated by federal and state guidelines or use them as minimum standards for health care systems. </li></ul>
    24. 24. Key Points <ul><li>Ethical issues related to long-term care services include adherence to the Patient’s Bill of Rights, advance directives, DNR orders, power of attorney, guardianship, and responsible party designation. </li></ul><ul><li>In the long-term care facility, the resident’s plan of care is reviewed every 90 days for resolution of problems or revision of expected outcomes and interventions by the team. </li></ul>
    25. 25. References <ul><li>Edited by B. Holmes MSN/Ed, RN </li></ul>
    26. 26. Nursing Process <ul><li>Nursing Diagnoses (continued) </li></ul><ul><ul><li>Self-care deficit </li></ul></ul><ul><ul><li>Injury, risk for </li></ul></ul><ul><ul><li>Mobility, impaired physical </li></ul></ul><ul><ul><li>Skin integrity, risk for impairment </li></ul></ul><ul><ul><li>Self-esteem, chronic low </li></ul></ul><ul><ul><li>Grieving </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Social isolation </li></ul></ul>