Notes: 70% of for-profit NHs are group or chain affiliated NH occupancy rate is 86% (2008-9) Go to: www.medicare.gov/NHCompare to obtain NH-specific information: number of beds, Medicare/Medicaid status; resident characteristics (e.g., % with pressure ulcer, UTI), last inspection/survey findings; number of RNs, LPN/LVNs, CNAs
Notes: African-American residents: 9%; increasing slowly Mobility assistance needed: 65% Toileting assistance (includes transfer, hygiene) needed: 80% Long-term memory loss, disorientation: &gt;50% Depression most common among 65-84 y/o Socially inappropriate behavior: 13% (e.g., sexual acting out; disrobing; smearing food) Younger NH residents tend to be in hospital-based NHs & VA facilities Go To: www.medicare.gov/NHCompare to obtain NH-specific information: number of beds, Medicare/Medicaid status; resident characteristics (e.g., % with pressure ulcer, UTI), last inspection/survey findings; number of RNs, LPN/LVNs, CNAs
Notes: Issues in Dementia SCUs: inadequate staff training and numbers; outcomes regarding effectiveness are mixed Sub-acute Care Units more common in larger and not-for-profit NHs Many states regulate Sub-acute Care Units as to: admission and discharge criteria, specially trained staff, special programs, resident and family education, process to evaluate care. Many assisted living communities (ALCs) provide special dementia care services or units. Some ALCs are dementia-care only; variety of names, eg, memory enhancement.
Notes: The licensed nurse requirement can be waived if a NH shows, in good faith, inability to hire a licensed nurse to meet this requirement; there must, however, be a licensed nurse on call. Most NH staff are full-time employees Advanced practice nurses typically not employees of the NH NH physicians can be in a group practice; private practice; full or part-time employee of the NH. SW, Activities, Nutritionist: number varies with bed size of facility
Notes Podiatric, ophthalmology, dental, pharmacy etc services can be on site or resident is transported to provider’s office. All reasonable consultative services must be provided/arranged, eg, neuro, ortho Rehabilitation services (PT, OT, ST): service can be skilled (Medicare reimbursed), or maintenance (not Medicare reimbursed) 75% of nursing homes use certified hospice agency for consultation or as full provider of end of life care. Psychiatry consultant required but not necessarily on staff; very few gero-psychiatric nurses Ethics Committee or rounds: not required. Family Councils are not mandated. 50% have them.
Notes: State Health Departments conduct un-announced Quality of Care and Quality of Life inspection (i.e., survey) every 12-15 months on behalf of CMS State surveys can last up to 5 days. Survey team: predominantly nurses; likely to include environmentalist, nutritionist, social worker Quality of care problems or “deficiencies” are classified by “scope” (number of residents potentially or actually affected) and “severity” (extent of possible harm). Most frequently cited deficiency: comprehensive care planning followed by food sanitation, pressure sores, dignity, accidents.
Notes: Some NH provider associations and clinicians question the validity of some aspects of the 5-Star rating system Changes (positive and negative) in the NH can affect quality within a time period; it is important to look at other factors that can influence quality and at consistency of ratings from period to period. For implications of a NH’s rating on selection as a clinical site, see Modules 4.
Notes: Health Inspection Domain NH rating based on scope and severity of care deficiencies.
Notes: MDS: MDS (2.0) collects data on: cognition, memory, communication, hearing, vision, mood, behavior, ADL, physical functioning, continence, disease and health conditions, skin condition, oral and nutritional status, activity interests and pursuits, treatments, medications, and discharge potential. Data is collected at specific intervals: within 14 days after admission; quarterly; when there is a “significant” change of condition (positive or negative); annually MDS is part of medical record or can be maintained in separate file Many NHs have an “MDS Coordinator” – usually an RN MDS 3.0 (Oct 2010) will have improved reliability, accuracy and usefulness, require less time to complete, and will include resident interview as part of assessment process regarding quality of life Some researchers question the validity and reliability of MDS data
30%* of NH resident care is reimbursed by Medicare only. 70% of NH resident care is reimbursed by Medicaid 28% of residents are private pay The Medicare daily rate is generally higher than Medicaid rate, but less than private pay rate. Note: These numbers are not mutually exclusive. Many post-acute care NH residents start on Medicare and then revert to private pay and/or Medicaid when Medicare coverage stops. Other residents start as private pay and then revert to Medicaid when they no longer have sufficient assets.
Module 1. Nursing Homes, the Basics
Nursing Homes: The Basics
Sarah Greene Burger, RN-C, MPH, FAAN
Ethel Mitty, EdD, RN
Mathy Mezey, EdD, RN, FAAN
Hartford Institute for Geriatric Nursing,
New York University College of Nursing
Module 1 of Nursing Homes as Clinical Placement Sites for Nursing Students Series