1. Chapter 39 Nursing in Long-Term Care Facilities

2. Factors Contributing to Emerging Dynamic Long-Term Care Settings Increasing complex resident population Improved standards Ability to develop long-term relationships with residents –Allowing nurses to use healing arts

3. Development of Institutional Care End of the 17 th century: European institutions cared for the disabled, aged, orphaned, and poor. End of 19 th century: Almshouses became the primary source of institutional care in the U.S. 1900s: Public and charitable institutions began to replace almshouses. 1946: The Hill-Burton Hospital Survey and Construction Act provided funds for the construction of nursing homes. 1987: Omnibus Budget Reconciliation Act of 1987 (OBRA ’87) was enacted.

4. Omnibus Budget Reconciliation Act of 1987 (OBRA ’87) Provisions Use of Minimum Data Set (MDA) Timely development of a written care plan Reduction in the use of restraints and psychotropic drugs Increase in staffing Protection of residents’ rights Training for nursing assistants

5. Lessons for Gerontological Nurses Learned from History A vision and a clear model are important foundations. 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 be that nurses are part of the problem. Entrepreneurial thinking can benefit nursing and patients.

6. Facility Residents Most have dependencies in their ADLs. Most are incontinent. Many are cognitively impaired. The average age is 8. For most people, nursing home placement was not the first or most desirable choice.

7. Factors to Consider in Selecting a Nursing Facility Cost Philosophy of care Administration Special services Staff Residents Physical facility

8. Factors to Consider in Selecting a Nursing Facility (cont.) Meals Activities Care Family involvement Spiritual needs

9. Regulations Related to Nursing Facilities Resident rights Admission, transfer, and discharge rights Resident behavior and facility practices Quality of life Nursing services Dietary services Physician services

10. Regulations Related to Nursing Facilities (cont.) Specialized rehabilitation services Dental and pharmacy services Infection control Physical environment Administration

11. New Model of Long-Term Care Hygiene Holism Healing

12. Assumptions Woven into Model of Holism and Healing Psychological, social, and spiritual well-being are of equal and sometimes greater importance than physical well- being. Medical supervision and treatment are only one component of the overall needs of residents. Many of the needs resulting from chronic conditions can be effectively and safely met with the use of alternative and complementary therapies.

13. Assumptions Woven into Model of Holism and Healing (cont.) Caregivers’ presence and interactions affect health, healing, and the quality of nursing facility life. The physical environment can be used as a therapeutic tool. The nursing facility is an integral and active member of the community at large.

14. Role of Gerontological Nurses in Long- Term Facilities Administrative and management roles –Director of nursing –Supervisor –Unit nurse coordinator –Charge nurse

15. Role of Gerontological Nurses in Long- Term Facilities (cont.) Specialized roles –Staff development director –Quality assurance coordinator –Infection control coordinator –Geropsychiatric nurse specialist –Rehabilitative nurse Direct care providers to residents

16. Responsibilities of Gerontological Nurses in Long-Term Facilities Assist in selection of and adjustment to facility. Develop individualized care plan. Monitor health status. Recommend and facilitate rehabilitation as needed. Evaluate care. Identify and act upon changes in resident condition.

17. Responsibilities of Gerontological Nurses in Long-Term Facilities (cont.) Coordinate with interdisciplinary team. Advocate for patient rights. Promote high quality of life for residents. Ensure and promote competency of staff.

18. Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).