Nursing Home

A nursing home or '''skilled nursing facility''' ('''SNF''') is a place of residence for people who require constant Nursing care and have significant Activity of Daily Living (ADL) deficiencies. Residents include the elderly and younger adults with physical disabilities. Adults 18 or older can stay in a skilled nursing facility to receive physical, occupational, and other rehabilitative therapies following an accident or illness. In the US, nursing homes are required to have a Licensed Nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse . In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002. Some states have nursing homes that are considered '''NF''' or nursing facility......these homes do not have beds certified for Medicare patients, but can only treat patients whose payments source is Private Pay or Medicaid .

SIMILAR FACILITIES

What is a nursing home not? A Hospital is not a residence, but is a place where people require constant Nursing care. A Retirement Home is a residence, but individuals residing there require only intermittent Nursing care. An Assisted Living facility does have some similarities to a nursing home; however, a nursing home's patients need more intensive care than residents in an assisted living facility. A long term care facility (LTCF) is a generic term for long-term residences wherein the occupants require some form of assistance with medical needs or activities of daily living. LTCF is commonly used within a medical context.

People in nursing homes generally, but not always, live in double occupancy rooms. There is usually a nursing station in each hallway of a nursing home for the nurses ( Licensed Practical Nurse s, with a minority of Registered Nurse s, generally in a supervisory role) who monitor resident health and administer medications. Nursing Assistants (Health Care Assistants in the UK) play a key role maintaining residents' hygiene, assiting residents with activities of daily living, and performing other basic nursing skills. A housekeeping staff in a nursing home is responsible for ensuring that the rooms, beds, towels, bathrooms, and other facilities are kept sanitary. Physical Therapist s and Occupational Therapist s attempt to help the residence regain certain abilities. Assistive Technology such as Wheelchairs , Standing Frames , and pateint lifts are often used. Social Worker s help with personal issues such as billing and transitions back to the home environment.

In the US, Medicare reimburses an elderly person for nursing home stays for skilled nursing care and rehabilitation purposes after the elderly person has been in the hospital for three or more days (technically 3 midnight stays). Medicare pays 100 percent of the cost for the first 20 days of stay. From day 21 through day 100 there is a copayment for each day. Medicare does not pay after the 100th day. Also, if during the 100 days the person has gotten as well as the nursing home staff believes she will get, Medicare no longer reimburses.

Medicare never reimburses for purely custodial care. Medicaid does reimburse for custodial and Long-term Care but a person may only qualify for Medicaid if she has extremely limited income and assets.

In the US, nursing home costs can run to $350 and up daily. Charges are usually determined by how much assistance the nursing home resident needs with the Activities Of Daily Living (ADLs).

GOVERNMENT/REGULATORY OVERSIGHT

For United States homes, the Centers For Medicare And Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see Nursing Home Compare in the link below). Homes in England are regulated by the Commission for Social Care Inspection .

All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors, or most commonly: state surveyors.

In Texas, nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).

ASSOCIATIONS/ORGANIZATIONS

American Health Care Association , based in Washington, D.C. publishes a magazine, (Provider) for individuals employed in the field of Long Term Care.

CONSUMER CHOICES

Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private Nursing Agencies may be able to provide live-in nurses to stay and work with patients in their own homes.

When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and Assisted Living facilities as well as Retirement Home s, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an Adult Daycare Center .

New trends

Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small sets of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Pioneer Network, the Eden Alternative, and the Green House Project. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry.

QUALITY OF LIFE

Resident- Oriented Care

Resident oriented care is where nurses are assigned to particular patients and they have the ability to develop relationships with the patient. Patients are treated more as family as, oppose to random patients. Using resident oriented care nurses are able to become familiar with each patient and cater more to their specific needs, rather they be emotional or medical.

Scientific Findings

According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows for them to dispel many feeling of loneliness and discontent.

“ Resident assignment” refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident.

In coming to this conclusion three guidelines must be assessed: structure, process and outcome. Structure is the assessment of the instrumentalities of care and their organization; Process being the quality of the way in which care is given; Outcome being the usually specified in terms of health, wellbeing, patient satisfaction, etc. Using these three criteria find that are strengthened when residents experience resident oriented care.

Communication is also heightened when residents feel comfortable discussing various issues with someone who is experienced with their particular case. In this particular situation nurses are also better able to do longitudinal follow up, which insures the implementation of more lasting results.

Task -Oriented Care

Task oriented care is where nurses are assigned specific task to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of task, nurses are declined the ability to develop more in dept relations with any particular resident.

Scientific Findings

Various finding suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result decide not to share information at all.

Patients usually complain of loneliness and feelings of displacement.

“Resident assignment” is allocated to numerous nurses as oppose to one person carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable identify with gradual emotional and physical changes experienced by one particular resident. Resident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deals with one resident.

EXTERNAL LINKS

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Nursing Home