Presentation on theme: " Long-term-care facilities are becoming more complex: -Complex Patients -Subacute care units involving higher l level of care, such as, ventilator care,"— Presentation transcript:
Long-term-care facilities are becoming more complex: -Complex Patients -Subacute care units involving higher l level of care, such as, ventilator care, hyperalimentation or other services that would confine a patient to the hospital
Nurses who are frustrated with abbreviated hospital stays, fragmented care, staffing shortages may enjoy working in a long-term-care facility. Nurses have the opportunity to get to know their patients and establish relationships with them.
Historically, long-term-care has a negative image. Media highlights of abuse and substandard conditions. Reimbursement policies that limit the ability to provide high-quality care.
Before the 20 th century institutions were used to care for the mentally ill, developmentally disabled, aged, orphaned, poor, or those suffering from a contagious disease. Common in Europe by the end of the 17 th century. Limited funds and low public interest led to custodial care.
In the US acute or long-term-care was scarce until the 19 th century. Family was expected to care for family members.
Erving Goffman, sociologist labeled these facilities “total institutions”, he characterized them as follows: All activities conducted in the same manner, in the same place. All individuals treated in the same manner and required to comply with the same acticities and schedules.
Strict, inflexable schedule of activities and schedules. Numerous and heavy enforced rules. Activities that furthered the aims of the institution more than serving the needs of its residents. This approach to care led patients to institutionalized behaviors.
By the 1900’s, public and charitable institutions began to replace almshouses. Funding scarce, poor care. LTC was used as a dreaded last resort.
1935, enactment of Social Security. Provided a means of of private funds to purchase care. 1946 Hill-Burton Act-assists with the construction of hospitals and LTC facilities. Hilton-Burton act stimulated growth, Medicare & Medicaid was made available for reimbursement.
number of nursing homes doubled and number of residents tripled. Operated by business-oriented people instead of medical professionals. Federal standards were minimal, leading to the stigma of poor conditions of LTC facilities.
1987 Omnibus Budget Reconciliation Act, (OBRA ‘87) was developed: This legislation was the beginning of more stringent nursing home regulations: -use of a standardized assessment tool, Minimum Data Set (MDS) - timely development of a written care plan -reduction in the use of restraints and psychotropic drugs
-increase in staffing -protection of resident’s rights -training for nursing assistants OBRA brought about the most profound changes in nursing home care ever witnessed, if standards weren’t followed Medicare and Medicaid reimbursement was terminated.
A vision and clear model for nursing care is necessary When nursing fails to exercise leadership, non- nurses will determine nursing practice When nursing does not attempt to correct problems in the health care system, others will, and public perception will see nurses as part of the problem
Nursing homes referred to as long-term- care facilities Licensed staff must be on duty around the clock Nursing assistants must complete a certification process Documentation has improved Continue to be problems
People who are functionally dependent as a result of physical or mental impairment Functional ability determines the need for care Oftentimes family caregiving cannot meet the needs of the individual before long-term care becomes an option A crisis situation triggers the need for an alternative to home care
Increased demands and complexities of long-term care facilities necessitate that highly competent nurses be employed in this setting Unlicensed staffing imposes a greater demand on licensed professionals Staff education and evaluation Performance evaluation Clinical and administrative duties
Admission assessments and completion of MDS tool Identify Problems Direct Care and planning activity Evaluation of effectiveness of care Independent nursing practice Ability to develop long-term relationships
Care for people with less complex needs Less stringent regulations Fewer licensed nurses available Increasing number of beds Private pay Challenges for gerontological nurses