1. Chapter 1 NA The Nursing Assistant in Long-Term Care

2. Long-term care- LTC Long-term care facility- LTCF Length of stay Terminal illness- one in which they are expected to die Chronic- last a long period of time, even a lifetime… like dementia, stroke, heart disease

3. Residents- people who live in long-term care facilities, because these are their homes Diagnoses- medical conditions determined by the doctor

4. The job of the nursing assistant will vary- depends on each person’s symptoms, abilities and needs. Skilled care- medically necessary care given by a skilled nurse or therapist. Available 24 hours a day. Ordered by a doctor and involves a treatment plan.

5. Types of healthcare settings Long-term care- for people who needs 24- hour supervised skilled nursing care Home health care-provided in a person’s home for people chronically ill but able to stay at home. Assisted living- provide help with some daily care like showers and meals and medications, but do not need skilled, 24 hour care.

6. Adult Daycare- care given during daytime working hours Acute care- given in hospitals and ambulatory surgical centers. For people with immediate illnesses who need 24 hour skilled care for temporary periods. Subacute care- can be given in a hospital or in a LTCF. For people who have had an acute injury or illness or problem resulting from a disease. They need treatment that requires more than regular LTC but less than acute illnesses require.

7. Outpatient care- usually given for less than 24 hours. For people who have had treatments or surgery and needs short-term skilled care. Rehabilitation- is care given in facilities or homes by a specialist. PT, OT, ST restore or improve function Hospice care- given in facilities or home for people who have six months or less to live.

8. Adl’s -activities of daily living Culture change- individualized approaches to care, process of transforming services so they are based on the values and practices of the person receiving care. Respecting and working with the residents for choice, dignity, respect, self-determination, and purposeful living.

9. CMS- The Centers for Medicare & Medicaid Services (agency within US Department of Health and Human Services),… runs two national healthcare programs: – Medicare- for people 65 and over and with certain disabilities- Part A- for hospital, skilled nursing, home health or hospice Part B- for doctor, equipment Part D- for medications (only pays for care it determines to be medically necessary)

10. – Medicaid- medical assistance for low-income people Pays a fixed amount for services including long term care. Amount is determined based on the resident’s needs.

11. Role of the Nursing Assistant Perform assigned nursing tasks Provide personal care Promote independence and self-care Care for supplies and equipment Make beds Give backrubs Help with mouth care, toileting needs, dress Assist residents to move around safely Keep living areas neat and clean Observe and report changes Charting

12. Care plan Created to help the resident achieve his/her goals. Developed by the care team and the resident and their family. – Outlines the steps and tasks the care team must perform – States how often these tasks should be performed and how they should be carried out. – Must be followed

13. Characteristics Be professional Be positive, polite, cheerful Be compassionate Be honest Be tactful Be conscientious Be dependable Be respectful Be unprejudiced Be tolerant

14. If you make a mistake, report it promptly. Keep information confidential Do not accept gifts or tips Do not perform tasks outside your scope of practice Follow the care plan

15. OBRA also sets guidelines for minimum staff requirements OBRA regulates resident assessment requirements. OBRA surveys facilities/inspects OBRA requires a state registry of nursing assistants OBRA identified Resident Rights stating how residents must be treated.

16. OBRA identifies Resident Rights stating how residents must be treated. The right to: Quality of life Services and activities to maintain a high level of wellness Be informed regarding rights and services To participate in their own care To make independent choices

17. Privacy and confidentiality Dignity, respect, and freedom Security of possessions Complain Visits Social services During transfers and discharges.

18. Insurance portability Reviewlegal and ethical information regarding neglect, negligence, abuse, assault and battery, false imprisonment, involuntary seclusion. Reporting abuse is not an option- it is the law. Ombudsman- a legal advocate for residents. The Older Americans Act requires all states have an ombudsman program.

19. HIPAA- Health Insurance Portability and Accountability Act- one part of it is to keep health information private and secure. PHI- protected health information Review the guidelines p. 16 in text

20. Charting Document, if you don’t chart it, it did not legally happen. Guarantees clear and complete communication with the care team Legal record Do not record any care before it has been done. Write facts, not opinions

21. Use black ink. Never erase, draw one line through mistakes, correct it, put your initials and the date. Sign full name and title: Susan Smith, NAT Use military time Document as the care plan needs, with adl sheets

22. MDS- Minimum Data Set Is assessment Done within 5 days of admission, 14 days, 30 days, 60 days, 90 days and quarterly there after unless there is a significant change. Your reporting may ‘trigger’ a needed assessment if you notice a change Lists then what are identified as problems/needs and points to care plan.

23. Incident reports An incident is an accident or unexpected event during the course of care. Not routine – Error in care – Fall or injury – Complaint or accusation – You get injured or are exposed to blood or body fluids – They are confidential

24. Sentinel event- accident or injury that results in grave physical or psychological injury or death.