Chapter 1 Working in Long-Term Care

Your focus is the resident—the person needing care. You must provide quality care and promote the person’s quality of life and independence. Independence means not relying on or requiring care from others.

LONG-TERM CARE CENTERS Long-term care centers provide health care to persons who cannot care for themselves at home but do not need hospital care. Board and care homes (residential care facilities) provide rooms, meals, and laundry to a few independent residents in a home-like setting. Assisted living facilities provide housing, personal care, support services, health care, and activities in a home-like setting.

Nursing center (nursing facility [NF], nursing home) provides health care and nursing care to persons who need regular or continuous care. Licensed nurses are required. Skilled nursing facilities (SNFs) provide health care and nursing care for residents who have many or severe health problems or who need rehabilitation. Purposes and goals include: Promoting physical and mental health Treating chronic illness Preventing communicable diseases Providing rehabilitation or restorative care

What do we call the people in these facilities?? RESIDENTS

Nursing Center Organization Nursing centers are owned by an individual, a corporation, or county health departments. Each center has an administrator. Department directors report to the administrator. By law, nursing centers must have a medical director. Page 4….Chain of Command

Typical Organizational Chart

Nursing Service The director of nursing (DON) is responsible for the entire nursing staff. Nurse managers (usually RNs) assist the DON. Staff RNs report to the charge nurse. LPNs/LVNs report to staff RNs or to the charge nurse. You (nursing assistant) report to the nurse supervising your work.

THE NURSING TEAM The nursing team involves those who provide nursing care. RNs, LPNs/LVNs, and nursing assistants

THE INTERDISCIPLINARY HEALTH CARE TEAM Involves the many health care workers whose skills and knowledge focus on the person’s total care The overall goal is quality resident care. Coordinated care is needed. An RN leads the team.

PAYING FOR HEALTH CARE Private insurance is bought by individuals and families. Group insurance is bought by groups or organizations for individuals. Medicare is a federal health insurance program for persons 65 years of age or older. Part A Part B Medicaid is a health care payment program sponsored by the federal government and operated by the states.

THE OMNIBUS BUDGET RECONCILIATION ACT OF 1987 (OBRA) OBRA is a federal law that applies to all 50 states. Purpose is to improve quality of life for residents. Resident rights are a major part of OBRA. Page 9-10

OBRA REQUIREMENTS for nursing assistants MUST complete a training and competency evaluation program 75 hours of instruction (minimum) 16 hours of clinical (minimum) Written & Skills test At least 3 attempts if necessary Nursing assistant registry

RESIDENT RIGHTS Residents have rights: As United States citizens Relating to their everyday lives and care in a nursing center Nursing centers must inform residents of their rights: Orally and in writing Before or during admission to the center In the language the person uses and understands

Residents have the right to: Information Refuse treatment Privacy and confidentiality Personal choice Voice disputes and grievances Not work or work Take part in resident and family groups Care and security of personal items Freedom from abuse, mistreatment, and neglect Freedom from restraint Quality of life

Nursing centers must care for residents in a manner that: Promotes dignity and self-esteem Promotes physical, psychological, and mental well-being Nursing centers must provide activity programs that: Allow personal choice Promote physical, intellectual, social, spiritual, and emotional well-being The center’s environment must: Promote quality of life Be clean, safe, comfortable, and as home-like as possible

OMBUDSMAN PROGRAM An ombudsman is someone who supports or promotes the needs and interests of another person. Long-term care ombudsmen: Are employed by a state agency Act on behalf of nursing center and assisted living residents Protect the health, safety, welfare, and rights of residents “The middle man”

MEETING STANDARDS Standards for nursing centers are set by: The federal and state governments Accrediting agencies A center must meet standards for: Licensure (issued by the state) Certification (req to receive Medicare/Medicaid funds) Accreditation (voluntary, signifies quality and excellence)

The Survey Process Surveys are done to see if the center meets set standards. You must: Provide quality care Protect the person’s rights Provide for the person’s and your own safety Help keep the center clean and safe Conduct yourself in a professional manner Have good work ethics Follow center policies and procedures Answer questions honestly and completely

Roles & responsibilities Scope of practice You are an assistant No nursing diagnoses or plans Report observations May be given some delegated tasks

Delegation To authorize another person to perform a nursing task in a certain situation. Delegating nurse is legally accountable for the nursing task. Nursing assistants CANNOT delegate tasks. You can accept or you can refuse a task. Refuse if….page 16-17 Can’t refuse just because you don’t want to do it…..

QUALITY OF LIFE Nursing center care is always focused on the resident.