Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Independence means not relying on or requiring care from others. Slide 2 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

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 residences (ALRs) provide housing, personal care, support services, health care, and activities in a home-like setting. Slide 3 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

 Nursing centers (nursing facility [NF], nursing home) provide 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 Promoting physical and mental health Treating chronic illness Treating chronic illness Preventing communicable diseases Preventing communicable diseases Providing rehabilitation or restorative care Providing rehabilitation or restorative care Slide 4 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

 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. Department directors report to the administrator.  By law, nursing centers must have a medical director. Slide 5 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

 Nursing service  The director of nursing (DON) is responsible for the entire nursing staff.  Nurse managers (usually registered nurses [RNs]) assist the DON.  Staff RNs report to the charge nurse.  Licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) report to staff RNs or to the charge nurse.  You report to the nurse supervising your work.  Nursing education staff (staff development) is part of nursing science. Slide 6 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

The Nursing Team  The nursing team involves those who provide nursing care.  RNs, LPNs/LVNs, and nursing assistants Slide 7 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Nursing Care Patterns  The pattern used depends on:  How many persons need care  The staff  The cost  Functional nursing focuses on tasks and jobs.  Team nursing involves a team of nursing staff led by an RN.  Primary nursing involves total care. Slide 8 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

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. Slide 9 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

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. Slide 10 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

 Prospective payment systems  Diagnosis-related groups (DRGs) are for hospital costs.  Resource utilization groups (RUGs) are for SNF payments.  Case mix groups (CMGs) are used for rehabilitation centers.  Managed care limits: The choice of where to go for health care The choice of where to go for health care The care that doctors provide The care that doctors provide Slide 11 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

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  Accreditation Slide 12 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

 The survey process  Surveys are done to see if the center meets set standards.  You must: Provide quality care Provide quality care Protect the person’s rights Protect the person’s rights Provide for the person’s and your own safety Provide for the person’s and your own safety Help keep the center clean and safe Help keep the center clean and safe Conduct yourself in a professional manner Conduct yourself in a professional manner Have good work ethics Have good work ethics Follow center policies and procedures Follow center policies and procedures Answer questions honestly and completely Answer questions honestly and completely Slide 13 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.

Quality of Life  Nursing center care is always focused on the resident.  Resident should be allowed to do as much for themselves as safely possible. Slide 14 Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.