Nursing Home

From Anvita Health Wiki

Contents 1 Introduction 2 Complications 3 More General Terms 4 Additional Terms 5 References

Introduction

• Nursing home care
  

• types of facility

• 20,00 nursing home facilities in USA (2001)
• 75% are for profit
• most are small, < 100 beds
• 2 key people, administrator & director of nurses ( DON)

• nursing home residents

• 4.4% of older persons (> 65 years)

• < 2% 65-74 years
• 4.4% 75-84 years
• 15.4% >= 85 years

• 30% lifetime risk of being in a nursing home
• 40% are > 85 years of age
• women > men; > 80% women if > 85 years [7]
• single, widowed > married
• dependent in ADL*s, incontinence, especially bowel
• socially isolated
• women living in nursing homes need more assistance with ADLs than men [7]
• white residents have lowest rates of dependence among different races [7]

• key predictors of institutionalization

• age
• living alone without a spouse
• cognitive impairment - dementia &/or depression
• functional impairment

• sources of nursing home admissions

• from home, precipitated by

• weakening/failure of support systems
• behavioral problems

• wandering
• nighttime agitation

• incontinence

• acute care hospital
• readmission after hospitalization

• infection, dehydration, CAD, GI bleed, fracture

• goals of nursing home care

• provide a safe & supportive environment
• maximize functional independence & quality of life
• preserve autonomy
• comfort & dignity for terminally ill
• optimized management of chronic conditions
• prevent acute & iatrogenic illnesses
• recognize & rapidly treat acute conditions

• length of stay

• average length of stay is 19 months
• 45% stay < 3 months
• 2/3 of patients die in nursing home

• staffing patterns in nursing homes

• nursing assistants provide hands-on-care
• RN (10% of staff)
• physician: 10% spend 2 hours/week in nursing home
• nurse practitioners ( NP) & physician assistants ( PA)
• laboratory, EKG, X-ray, respiratory services are available at the nursing home by outside vendors

• physician visits

• initial, H&P within 72 hours of admission
• subsequent visits every 30 days for the 1st 3 months, then every 60 days if medically stable
• telephone management

• reimbursement/payment

• 50% Medicaid - Medical in Calif
• 32% out of pocket
• 12% Medicare

• Medicare - Title XVIII

• persons > 65 years who have worked for 11 years
• persons < 65 years who received disability insurance for 2 years
• persons of any age with end-stage renal disease
• two parts

• A ( hospital) - automatic
• B ( outpatient services) - co-pay

• limitations in nursing home

• need 3 day acute hospital stay - 3 midnights
• medicare pays fully for the 1st 20 days

• if still elgible, can get up to 100 days with a copayment

• 80% Medicare
• 20% supplemental insurance after the 1st 20 days

• subacute care = transitional care = skilled nursing home ( SNF)

• usually younger than the average nursing home resident
• admitted from acute care hospital
• 65-75% is paid by Medicare
• services that qualify

• Admission to nursing home

• number of admissions has increase since 1994 because more facilities offer short-term services & rehabilitation after hospitalization [7]
• see physician evaluation at nursing home admission
• see minimum data set for nursing home residents
  

• * ADL = activities of daily living
• * H&P = history & physical

Complications

• high prevalence of both multidrug-resistent gram-negative bacteria & MRSA on colonizing residents & environmental surfaces [6]

More General Terms

• geriatrics

Additional Terms

• annual physician review of long term nursing home residents
• assisted living; includes: rest home; domiciliary; retirement home
• health maintenance in nursing home patients
• health requirements for nursing home admission
• medical progress notes on nursing home residents
• Medicare reimbursed services at skilled nursing facility (SNF) level
• minimum data set (MDS) for nursing home residents
• physician evaluation at nursing home admission
• qualtity of care in nursing homes
• role of medical director of nursing home

References

1. Eslami, M., UCLA School of medicine, 2001
2. Ouslander J, JAMA 262:2582, 1989
3. Ouslander & Ouslander, Ann Intern Med, 20:584, 1994
4. Ouslander et al: in: Medical Care in Nursing Home, McGraw Hill, NY, 1991
5. Ouslander, JG: In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
6. O'Fallon E et al Multidrug-resistant gram-negative bacteria at a long-term care facility: Assessment of residents, healthcare workers, and inanimate surfaces. Infect Control Hosp Epidemiol 2009 Dec; 30:1172. PMID: [1]
7. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010

nursing home