AS A MEMBER OF MASS SENIOR ACTION I HAVE BEEN INVOLVED IN MANY SENIOR ISSUES.
RIGHT NOW MASS SENIOR ACTION IS INVOLVED IN FINDING THE BEST ALTERNATIVE FOR CARING FOR OUR AGING POPULATION
ONE OF THE MAIN ISSUES IS DEALING WITH THE "HOUSE OF HORRORS" KNOWN AS NURSING HOMES AND GETTING MORE HUMANE WAYS OF DELIVERING HEALTH CARE THAT THE MAJORITY OF ELDERLY THE FAMILIES AND CARE GIVERS VOTE FOR HOME CARE IN FAMILIAR NEIGHBORHOODS
IN MALDEN WE HAVE FOUND AN "OASIS" TO THE NURSING HOME PROBLEM FOR SATISFACTORY HUMANE AND ADEQUATE
CARE IN A CITY OWNED FACILITY FOR CRITICALLY ILL CLIENTS WHERE A HOME CARE ENVIRONMENT IS PRACTICED
KEEP MCFADDEN MANOR OPEN
Tuesday, March 11, 2008
Monday, March 10, 2008
Nursing Home Problems
If Nursing Home Problems Occur
Understanding how the nursing home system works, how to solve problems, where to go for help, and the residents' rights are important in getting good care in a nursing home.
Communication Is Key
There are many reasons why nursing home care is not always good. At the first sign of a problem, it is best to discuss it with the nursing home staff. Friendly, open communication and relationships with nursing assistants, charge nurses, the director of nursing, the social workers, the administrator and other staff help keep small problems from becoming big. When a problem comes up or is ongoing, chances are that other families (and residents) are also concerned.
Communication among the families of residents is so important that Medicare and Medicaid nursing homes are required to allow families to form family councils. These councils can meet privately in the facility. Ideally, the council is a place for families to talk freely among themselves. They can present concerns or complaints to staff. Find out if there is an established family council already meeting. If not, start one. Communication is always the best step to avoiding or solving problems.
Periodically, nursing homes must hold care planning meetings. During these, residents' needs and any changes the nursing home should make in their care are discussed. It's important that residents and their families participate in these meetings. The meeting should involve a team of staff members, not just nurses. Ask about the next care planning conference. Ask who will be attending and feel free to request that other staff attend as well (including nursing assistants). The long-term care ombudsman, a member of the clergy or a close friend could also come to the meeting to provide support.
How to Solve Problems
Often families fear that if they complain, someone will take it out on their loved one. Sometimes, out of fear, residents ask family members not to speak up. This is the primary reason families hesitate to complain about poor nursing home care. Nursing home workers themselves say that families who call attention to problems get results. Try the following suggestions to confront problems:
Use the care planning conference to discuss problems with staff. This meeting creates a natural setting to address concerns without raising them to the level of a complaint.
When making a complaint about a staff member to a supervisor, share any concerns about retaliation.
Work with the family council to address problems in the nursing home.
Solving problems can be more affective when working in a group.
If the nursing home is poorly staffed or poorly managed, it may not give good care until residents or their families take the concern to a higher level. If working with the nursing home is not getting the problem solved, never hesitate to take a complaint outside the facility The purpose of your complaint should be to get better care for a loved one and the other residents. It should not be to hurt the facility or its employees. A written record can be very helpful when filing a complaint. Keep track of when the problems(s) occurred and who was involved. These are some places to go for advice or investigation of complaints dealing with nursing homes:
Long-term care ombudsman
Citizen advocacy groups
Legal services
State licensing and certification agency
When the Nursing Home System Fails
If nothing you try improves the care a loved one is receiving, join a citizen advocacy group. If none exists, form one. Ask the family council group for help, and check with the local AAA or ombudsman program about how to get an advocacy group started in your area.
Protecting Rights and Dignity
Too often people lose even the simplest rights when they become nursing home residents:
Privacy when they sleep, bathe, and dress
Freedom to go wherever and whenever they want to visit with friends and relatives
Choice of what they eat or wear
Control of their money
The right to choose their own doctor or make decisions about medical treatment
The Nursing Home Residents' Bill of Rights helps people can keep their privacy and dignity. It protects rights as basic as whether or not staff knock on the door before entering a resident's room. These rights apply to all residents who live in Medicare or Medicaid certified nursing homes.
Neglect and Abuse
Good care is everyone's basic right in a nursing home. Poor care is usually from the nursing homes' failure to have enough qualified licensed nurses and nursing assistants. It is understandable to sympathize with overworked nursing staff, but expectations for good care should not be lowered. Nursing homes must keep an adequate number of qualified staff.
Providing poor quality food, not keeping residents clean and dry, and ignoring a change in a resident's condition are all signs of neglect. Sometimes poor care and neglect may result in dangerous medical conditions. Some signs to watch for are:
Dehydration
Malnutrition
Bedsores (or pressure sores)
Physical restraints
Chemical restraints (Drugs used to control a resident's behavior)
Contractures (Muscles that are becoming too stiff to move easily)
Abuse sometimes happens in nursing homes. Sometimes residents are hurt physically or psychologically. Do not accept behavior toward a loved one that is abusive, including rough treatment or unkind words during or in between care. If supervisory staff do not act immediately to fix a problem, contact one or more of the following authorities:
The long-term care ombudsman
The local adult protective services agency
The police
Nursing homes should be a place where loved ones get the care they need. Working together, families can make nursing homes better.
AARP Resources
Understanding how the nursing home system works, how to solve problems, where to go for help, and the residents' rights are important in getting good care in a nursing home.
Communication Is Key
There are many reasons why nursing home care is not always good. At the first sign of a problem, it is best to discuss it with the nursing home staff. Friendly, open communication and relationships with nursing assistants, charge nurses, the director of nursing, the social workers, the administrator and other staff help keep small problems from becoming big. When a problem comes up or is ongoing, chances are that other families (and residents) are also concerned.
Communication among the families of residents is so important that Medicare and Medicaid nursing homes are required to allow families to form family councils. These councils can meet privately in the facility. Ideally, the council is a place for families to talk freely among themselves. They can present concerns or complaints to staff. Find out if there is an established family council already meeting. If not, start one. Communication is always the best step to avoiding or solving problems.
Periodically, nursing homes must hold care planning meetings. During these, residents' needs and any changes the nursing home should make in their care are discussed. It's important that residents and their families participate in these meetings. The meeting should involve a team of staff members, not just nurses. Ask about the next care planning conference. Ask who will be attending and feel free to request that other staff attend as well (including nursing assistants). The long-term care ombudsman, a member of the clergy or a close friend could also come to the meeting to provide support.
How to Solve Problems
Often families fear that if they complain, someone will take it out on their loved one. Sometimes, out of fear, residents ask family members not to speak up. This is the primary reason families hesitate to complain about poor nursing home care. Nursing home workers themselves say that families who call attention to problems get results. Try the following suggestions to confront problems:
Use the care planning conference to discuss problems with staff. This meeting creates a natural setting to address concerns without raising them to the level of a complaint.
When making a complaint about a staff member to a supervisor, share any concerns about retaliation.
Work with the family council to address problems in the nursing home.
Solving problems can be more affective when working in a group.
If the nursing home is poorly staffed or poorly managed, it may not give good care until residents or their families take the concern to a higher level. If working with the nursing home is not getting the problem solved, never hesitate to take a complaint outside the facility The purpose of your complaint should be to get better care for a loved one and the other residents. It should not be to hurt the facility or its employees. A written record can be very helpful when filing a complaint. Keep track of when the problems(s) occurred and who was involved. These are some places to go for advice or investigation of complaints dealing with nursing homes:
Long-term care ombudsman
Citizen advocacy groups
Legal services
State licensing and certification agency
When the Nursing Home System Fails
If nothing you try improves the care a loved one is receiving, join a citizen advocacy group. If none exists, form one. Ask the family council group for help, and check with the local AAA or ombudsman program about how to get an advocacy group started in your area.
Protecting Rights and Dignity
Too often people lose even the simplest rights when they become nursing home residents:
Privacy when they sleep, bathe, and dress
Freedom to go wherever and whenever they want to visit with friends and relatives
Choice of what they eat or wear
Control of their money
The right to choose their own doctor or make decisions about medical treatment
The Nursing Home Residents' Bill of Rights helps people can keep their privacy and dignity. It protects rights as basic as whether or not staff knock on the door before entering a resident's room. These rights apply to all residents who live in Medicare or Medicaid certified nursing homes.
Neglect and Abuse
Good care is everyone's basic right in a nursing home. Poor care is usually from the nursing homes' failure to have enough qualified licensed nurses and nursing assistants. It is understandable to sympathize with overworked nursing staff, but expectations for good care should not be lowered. Nursing homes must keep an adequate number of qualified staff.
Providing poor quality food, not keeping residents clean and dry, and ignoring a change in a resident's condition are all signs of neglect. Sometimes poor care and neglect may result in dangerous medical conditions. Some signs to watch for are:
Dehydration
Malnutrition
Bedsores (or pressure sores)
Physical restraints
Chemical restraints (Drugs used to control a resident's behavior)
Contractures (Muscles that are becoming too stiff to move easily)
Abuse sometimes happens in nursing homes. Sometimes residents are hurt physically or psychologically. Do not accept behavior toward a loved one that is abusive, including rough treatment or unkind words during or in between care. If supervisory staff do not act immediately to fix a problem, contact one or more of the following authorities:
The long-term care ombudsman
The local adult protective services agency
The police
Nursing homes should be a place where loved ones get the care they need. Working together, families can make nursing homes better.
AARP Resources
United States Nursing Homes
In the United States, nursing homes are required to have a licensed nurse on duty 24 hours a day, and during at least one shift each day, one of those nurses must be a Registered Nurse. In April, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 in December, 2002. Some states have nursing homes that are called nursing facilities (NF), which do not have beds certified for Medicare patients, but can only treat patients whose payments source is Private Payment, Private Insurance or Medicaid.
[edit] Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 resident beds and 13 per 100 resident beds, respectively.
Nursing facilities that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[1] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicaid also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
Almost no one can afford to pay for nursing home care "out of pocket." They cost $5,000 per month or more. Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals. However, they require that the patient be "spent down" to poverty levels first, thus depleting their life savings.
[edit] Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors.
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.
For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below).
Care homes for adults in England are regulated by the Commission for Social Care Inspection.
Nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).[2]
[edit] Consumer choices
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.
Beginning in 2002, Medicare began hosting an online resource known as Nursing Home Compare (see the "External Links" section at the bottom of the page). The program is intended to foster quality improving competition between nursing homes. Informed consumer choice has long been missing from decisions regarding the placement of the elderly in need.
The website My Patient Guide provides a directory of New Jersey nursing homes and assisted living communities, along with a question-and-answer section.
[edit] Trends
Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Greenhouse nursing home, the Pioneer Network, and the Eden Alternative. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry.
[edit] Quality of life
This article does not cite any references or sources. (February 2007)Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed.
[edit] Resident-oriented care
Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patients. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical.
[edit] Scientific findings
According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows them to dispel many feelings of loneliness and discontent.
"Resident assignment" refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this system can cause difficulties for the nurse or care-giver should one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are caring for.
In coming to this conclusion three guidelines must be assessed: structure, process and outcome. Structure is the assessment of the instrumentalities of care and their organization; Process being the quality of the way in which care is given; Outcome being usually specified in terms of health, well being, patient satisfaction, etc. Using these three criteria find that are strengthened when residents experience resident oriented care.
Communication is also heightened when residents feel comfortable discussing various issues with someone who is experienced with their particular case. In this particular situation nurses are also better able to do longitudinal follow up, which insures the implementation of more lasting results.
Various findings suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result decide not to share information at all.
Patients usually complain of loneliness and feelings of displacement.
"Resident assignment" is allocated to numerous nurses as opposed to one person carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable to identify with gradual emotional and physical changes experienced by one particular resident. Resident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deal with one resident.[citation needed]
[edit] Task-oriented care
Task oriented care is where nurses are assigned specific tasks to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of tasks, nurses are declined the ability to develop more in depth relations with any particular resident.
[edit] United Kingdom
[edit] Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 resident beds and 13 per 100 resident beds, respectively.
Nursing facilities that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[1] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicaid also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
Almost no one can afford to pay for nursing home care "out of pocket." They cost $5,000 per month or more. Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals. However, they require that the patient be "spent down" to poverty levels first, thus depleting their life savings.
[edit] Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors.
The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.
For United States homes, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below).
Care homes for adults in England are regulated by the Commission for Social Care Inspection.
Nursing homes are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).[2]
[edit] Consumer choices
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, it is important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.
Beginning in 2002, Medicare began hosting an online resource known as Nursing Home Compare (see the "External Links" section at the bottom of the page). The program is intended to foster quality improving competition between nursing homes. Informed consumer choice has long been missing from decisions regarding the placement of the elderly in need.
The website My Patient Guide provides a directory of New Jersey nursing homes and assisted living communities, along with a question-and-answer section.
[edit] Trends
Nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less "hospital-like." In these homes, nursing home units are replaced with a small set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they want to do during the day. They also have access to more companionship such as pets. Some organizations working toward these goals are the Greenhouse nursing home, the Pioneer Network, and the Eden Alternative. Many of the facilities utilizing these models refer to such changes as the "Culture Shift" or "Culture Change" occurring in the LTC industry.
[edit] Quality of life
This article does not cite any references or sources. (February 2007)Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed.
[edit] Resident-oriented care
Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patients. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical.
[edit] Scientific findings
According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows them to dispel many feelings of loneliness and discontent.
"Resident assignment" refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this system can cause difficulties for the nurse or care-giver should one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are caring for.
In coming to this conclusion three guidelines must be assessed: structure, process and outcome. Structure is the assessment of the instrumentalities of care and their organization; Process being the quality of the way in which care is given; Outcome being usually specified in terms of health, well being, patient satisfaction, etc. Using these three criteria find that are strengthened when residents experience resident oriented care.
Communication is also heightened when residents feel comfortable discussing various issues with someone who is experienced with their particular case. In this particular situation nurses are also better able to do longitudinal follow up, which insures the implementation of more lasting results.
Various findings suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result decide not to share information at all.
Patients usually complain of loneliness and feelings of displacement.
"Resident assignment" is allocated to numerous nurses as opposed to one person carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable to identify with gradual emotional and physical changes experienced by one particular resident. Resident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deal with one resident.[citation needed]
[edit] Task-oriented care
Task oriented care is where nurses are assigned specific tasks to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of tasks, nurses are declined the ability to develop more in depth relations with any particular resident.
[edit] United Kingdom
Subscribe to:
Comments (Atom)