Chapter 038 Long Term

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Chapter 38

Long-Term Care Chapter 38

Long-Term Care


Long-Term Care

Long-term care is defined by the American Nurses Association (ANA) as the provision of physical, psychologic, spiritual, social, and economic services to help people attain, maintain, and regain their optimum level of functioning.

Long-term care is provided in a variety of settings and offers a broad spectrum of services.


Setting for Long-Term Care The Home

Most older adults live in a home setting, with only a small percentage of those aged 65 or older residing in an institutional setting.

Care of the older adult at home may involve a great deal of participation from loved ones.

It costs approximately half as much to care for an older adult at home as it would cost in a long-term care facility.

Home patients may require only minimal assistance, or they might receive complex medical therapies.


Figure 38-1

Family is important in helping to maintain quality of life for the older adult.


Setting for Long-Term Care

Hospice Provides services to patients and families as

the end of life approaches. The philosophy of maintaining comfort as

death approaches is central to hospice care. Provide nursing interventions to meet basic

needs; ADLs; pain and symptom management; and spiritual and psychosocial support for the patient, family, and significant others.

Care providers include CNAs, HHAs, LPN/LVNs, and RNs.


Setting for Long-Term Care Adult Daycare

Community-based programs are designed to meet the needs of functionally or cognitively impaired adults through an individualized plan of care.

These structured, comprehensive programs provide a variety of services, including physical care, mental stimulation, socialization, assistance with health maintenance, and health referrals, during any part of the day but providing less than 24 hours’ care.

They are designed to serve adults who require supervision, social opportunities, or assistance due to a physical or cognitive impairment.


Figure 38-2

Available settings that provide long-term care services.



Residential Care Settings Primarily an older adult population, offering

a wide variety of services Assisted living

A type of residential care setting whereby the adult patient rents a small one-bedroom or studio-type apartment and can receive several personal care services

Continuing care retirement communities Offer a complete range of housing and health

care accommodations, from independent living to 24-hour skilled nursing care



Institutional Settings Subacute Unit

This type of institutional setting provides a less-expensive alternative to acute care when patients have high-acuity medical and nursing intervention needs.

Most are located in freestanding skilled nursing facilities; others are former hospital units that have been reclassified to provide subacute care.

They provide a stronger rehabilitative focus and shorter length of stay than a long-term care facility.



Institutional Settings Long-Term Care Facility

Most dominant setting for long-term care services

Commonly known as a nursing home or extended care facility

Provides services to primarily older adults Provides 24-hour care to individuals who do not

require inpatient hospital services but who do not have options for care at home or by other community agencies/services



Institutional Settings (continued) Long-Term Care Facility

Because the long-term care facility becomes a home for the older adult, the adults are referred to as residents rather than as patients.

Most residents have more than one health disorder when they are admitted, and more than half have three or more medical diagnoses.




The most common disorders on admission are as follows

Cardiovascular disease, including hypertension and cerebrovascular accident

Mental and cognitive disorders, including depression, anxiety, and dementia

Endocrine disorders, including type 2 diabetes mellitus and hypothyroidism




Two categories of residents Short-term: transferred from an acute care facility

to which he or she had been admitted for an acute illness or worsening of a chronic illness; admitted primarily for rehabilitation and expected to be discharged within 6 months

Long-term: usually stays in the facility until he or she dies or is transferred to an acute care facility. Most residents are long term.




Interdisciplinary setting Health care professionals work together as an

interdisciplinary team to meet the needs of the older adult.

Facility is managed by an administrator and has a director of nursing (DON).

These facilities are highly regulated by state and federal agencies to ensure quality services to a potentially vulnerable population.




Restorative nursing care Basic concepts of physical therapy for

maintenance of functional mobility and physical activity; care is provided by CNAs who have completed an educational program for restorative care

Omnibus Budget Reconciliation Act (OBRA) Defines requirements for the quality of care given

to residents of long-term care facilities




Medicare A federally funded national health insurance

program in the United States for people over age 65

Provide funding to long-term care facilities by adhering to the HCFA guidelines for reimbursement




Medicaid A federally funded, state-operated program of

medical assistance to people with low incomes A large source of revenue for the long-term care

facility




Several different types of nursing can be seen in this setting

Team nursing Functional nursing Total resident care Combination of the above


Setting for Long-Term CareI Institutional Settings (continued)

Long-Term Care Facility The interdisciplinary functional assessment of

the resident is the cornerstone of clinical practice.

Resident Assessment Instrument (RAI) OBRA-prescribed method of resident assessment

and care plan development Consists of three parts

Minimum Data Set (MDS) Resident Assessment Protocols (RAP) Utilization Guidelines




Documentation of the resident’s condition including vital signs and weights, is only required on a monthly basis.

The exception to this charting is a condition change, acute illness, or incident reporting, which must be documented at or soon after the time of occurrence.


Nursing Process

Nursing Diagnoses Aspiration, risk for Airway clearance, ineffective Gas exchange, impaired Cardiac output, decreased Nutrition: less than body requirements Fluid volume, risk for deficient Incontinence Thought process, disturbed Confusion, chronic


Key Points

Long term care services are provided after the acute stage of an illness has resolved but the patient continues to need services and maintain his or her current and changing physical and psychological status and functional abilities.

Settings that assist those caring for older adults in the home include adult daycare, hospice, home health agencies, and other community agencies and services.


Key Point

Residential care settings offer a wide variety of services of the older adult; two of the more popular types are assisted living facilities and continuing care retirement communities.

Institutional facilities include subacute units and long-term care facilities.

The majority of long-term care providers are regulated by federal and state guidelines or use them as minimum standards for health care systems.


Key Points

Ethical issues related to long-term care services include adherence to the Patient’s Bill of Rights, advance directives, DNR orders, power of attorney, guardianship, and responsible party designation.

In the long-term care facility, the resident’s plan of care is reviewed every 90 days for resolution of problems or revision of expected outcomes and interventions by the team.


References

Edited by B. Holmes MSN/Ed, RN


Nursing Process

Nursing Diagnoses (continued) Self-care deficit Injury, risk for Mobility, impaired physical Skin integrity, risk for impairment Self-esteem, chronic low Grieving Anxiety Social isolation

Chapter 038 Long Term

Economy & Finance

longterm care longterm

longterm care services

longterm care hospice

physical care

hospice care

hour care

subacute care

care providers