Skilled Nursing Facilities (Nursing Home) - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

Skilled Nursing Facilities (Nursing Home)

Description:

Skilled Nursing Facilities (Nursing Home) Steven Tam, MD Assistant Clinical Professor UCI Internal Medicine/Geriatrics Speaker s notes: 1. These are examples of ... – PowerPoint PPT presentation

Number of Views:3717
Avg rating:3.0/5.0
Slides: 27
Provided by: tamh150
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Skilled Nursing Facilities (Nursing Home)


1
Skilled Nursing Facilities (Nursing Home)
  • Steven Tam, MD
  • Assistant Clinical Professor
  • UCI Internal Medicine/Geriatrics

2
Educational Objectives
  • Become familiar with Nursing Homes and other
    facilities
  • Understand who are candidates for Nursing Homes
    and other facilities
  • Define the services provided.
  • Identify important issues at Nursing Homes

3
The Stats!
  • Approximately 1.5 million Americans (4.2)gt65
    have spent time in a skilled nursing facility
    2004 National Nursing Home Survey
  • Jones AL, et al. 2009 Vital Health Stat
    1671-155.
  • Expected to be 3 million in 2030 if continues at
    this rate.
  • 50 of those 95 and older live in nursing homes.
  • 51 of nursing home residents require assistance
    with all ADLs

4
Skilled Nursing Facilities (Nursing Homes)
  • Skilled Nursing Facility part of a Nursing Home
    or Hospital that provides skilled nursing care.
  • Registered Nurses who provide skilled nursing
    care to people, along with interdisciplinary
    staff/team
  • Licensed practical and vocational nurses
  • Physical Therapy, Occupation Therapy
  • Speech Therapy
  • Social Worker/Case Manager
  • Skilled care usually a short period
  • Custodial Care may be required for longer period

5
Skilled Nursing Facilities (Nursing Homes)
  • A licensed physician supervises each patients
    care and a nurse or other medical professional is
    almost always on the premises.
  • gt80 of nursing homes use community physicians to
    provide care
  • Average family physician supervises 9.6 nursing
    home residents and conducts 2.3 nursing home
    visits per week
  • 2008 AAFP survey

6
Skilled Medical Care
  • Skilled Services
  • RN doing wound care or administering and
    monitoring IV antibiotics
  • A physical therapist working to improve strength
    and balance in a patient with difficulty walking
  • A speech therapist helping a patient speak and
    swallow after a stroke.
  • An occupational therapist helping a patient
    relearn dressing, grooming and eating.
  • Skilled care may also involve managing
    injections, ostomy management and tracheotomy
    care amongst other needs.

7
Custodial Care
  • Need assistance with ADLS
  • Bathing
  • Dressing
  • Eating
  • Grooming
  • Getting in and out of bed, or walking around
  • Toileting (incontinence care)
  • Often provided at a Nursing Home
  • May also be temporary

8
Who May Need a Nursing Home?
  • Skilled Nursing facility is for Patients who
  • Require a short stay for skilled services prior
    to returning to previous residence
  • Can no longer care for their own personal needs,
    such as feeding, bathing, toileting (custodial
    care) because of medical, physical, behavioral
    problems
  • Need more care than can be provided at home
  • Has extensive medical needs requiring daily
    attention, or monitoring

9
Who May Need a Nursing Home?
  • Special Needs in Skilled Nursing Facility
  • Dialysis, Dementia care, Respiratory Care,
    Parkinsons Care
  • Hospice care, Chronic Psychiatric Care

10
Nursing Home Costs
  • Medicare coverage for skilled care
  • Medicare Part A (Hospital Insurance)
  • Qualifying 3 day hospital stay 30 days prior to
    Nursing home admission
  • 100 day benefit period (renewable if not
    hospitalized, or in SNF for 60 consecutive days)
  • 1st 20 days, Medicare covers full cost
  • Between Day 21 and 100 there is a copay
  • After Day 100, Medicare covers nothing.

11
Nursing Home Costs
  • Medigap may cover deductibles/other charges
  • Medicaid for Custodial care, Long Term Care
    Insurance

12
Nursing Home Costs
  • 2004 MetLife Market Survey of Nursing Home and
    Home Care costs, 192/day, or 70,080 a year
    Private room
  • Shared room 169/day, or 61,685 a year.
  • Costs can vary with location
  • Alaska, highest rates for private room
    204,765/yr, or 561/day
  • Shreveport, Louisiana, lowest 36,135/yr, or
    99/day

13
Whats the Alternative?
  • Assisted Living facility
  • Subsidized senior housing
  • Board and care homes
  • Continuing care retirement communities
  • Program of All-Inclusive Care for the Elderly and
    the Social Managed Care Plan

14
Whats the alternative? ALF
  • In 2002, 1 million people lived in assisted
    living.
  • McCormick JC, et al. 2003 Health Care Finance Rev
    24143-150
  • Transition period?
  • Offers help with ADLS, but none or limited
    medical care.
  • gt80 require help with ADLS
  • 40 describe their health as poor

15
Whats the Alternative? ALF
  • Greater emphasis on personal privacy and
    autonomy.
  • No onsite RN
  • ALF provide only personal assistance that can be
    performed by someone with little or no medical
    training.
  • Patients may visit MD if onsite clinic
    available, at MD office, or if there is a
    Housecall MD.

16
Whats the Alternative? Continuing Care
Retirement Communities
  • Continuing Care Retirement Communities provides
    independent living, housing-with-services, and
    Nursing home care in one location
  • Enables seniors to remain in a familiar setting
    as they grow older
  • Many enter while they are healthy and active,
    knowing they will be able to stay in the same
    community
  • May be able to move within the different levels
    of care.

17
Important Issues in Skilled Nursing Facilities
  • Transitions of Care
  • To and From Acute Care settings
  • To Home and or other Long Term Care options
  • End of Life Care
  • 1/3 rd of nursing home residents die within one
    year of admission
  • Estimated by 2020, 40 of all deaths will occur
    in nursing homes.
  • Oliver DP, et al. 2004 J Am Med Dir Assoc 5(3)
    147-155
  • End of life care similar to that in the community
    setting, and hospice and palliative care can be
    provided in the skilled nursing facility

18
Important Issues in Skilled Nursing Facilities
  • Infections
  • Similar nosocomial infection rates to acute care
    hospitals?
  • MRSA 10-30 prevalent in nursing homes.
  • Pacio GA, et al. 2003 Infect Control Hosp Epid
    24(4) 246-250
  • C. Difficile Colitis
  • Scabies
  • Influenza, Tuberculosis
  • Infection control programs

19
Important Issues in Skilled Nursing Facilities
  • Abuse and Neglect
  • Surveys of nursing home residents suggest abuse,
    neglect common?
  • Frailty
  • Fatigue
  • Inactivity
  • Slowness
  • Weakness
  • Weight loss

20
Important Issues in Skilled Nursing Facilities
  • Nutrition and weight loss
  • Various strategies
  • Liberating diet
  • Frequent meals
  • Supplements between meals
  • Resistance strength training
  • Family presence and socialization
  • Assess feeding disability and need for assistance
  • Appetite stimulants?
  • Artificial Nutrition (maybe a limited role).

21
Important Issues in Skilled Nursing Facilities
  • Pain Management
  • Est. 45-80 of nursing home residents with
    chronic pain
  • Unwin BK, et al. 2010 American Family Physician
    81(10) 1229-1237
  • Pressure Ulcers can be common in Nursing homes
  • management principles usually similar to the
    community.

22
Important Issues in Skilled Nursing Facilities
  • Urine Incontinence and Retention
  • 55 of nursing home residents
  • Unwin BK, et al. 2010 American Family Physician
    81(10) 1229-1237
  • Treatment strategies (evaluation, review meds,
    toileting programs, pharmacologic therapy)
  • Catheters must require a valid reason!

23
Important Issues in Skilled Nursing Facilities
  • Falls
  • 20 of deaths from falls are amongst nursing home
    residents.
  • www.cdc.gov/ncipc/factsheets/nursing.htm
  • Causes maybe multifactorial
  • Restraints
  • Careful and thorough review, used only when no
    safer alternative.
  • Adverse Drug Events
  • Common in nursing homes 40-50 considered
    preventable.
  • Gurwitz JH, et al. 2000 Am J Med 109(2) 87-94

24
Important Issues in Skilled Nursing Facilities
  • Dementia
  • 67-78 of nursing home residents
  • Behaviors can be a serious problem
  • Nonpharmacologic treatment (identify triggers,
    activities, environment modification, staff and
    family education).
  • Pharmacologic treatment higher risk of
    morbidity/mortality?

25
Important Issues in Skilled Nursing Facilities
  • Delirium up to 60 of nursing home residents
  • Depression estimated that 12-16 percent of older
    adults in nursing homes have major depression
  • Unwin BK, et al. 2010 American Family Physician
    81(10) 1229-1237

26
Conclusions
  • A Nursing Home is a facility where an
    interdisciplinary team provides care for the
    patient
  • Including nursing services, physical and
    occupational therapy
  • There are alternatives to the Nursing Home.
  • Those requiring a Nursing Home may do so for a
    variety of reasons
About PowerShow.com