(Nursing homes)

Skilled nursing facilities are licensed by each state according to state Medicare criteria and certified. Skilled nursing facilities offer a wide range of health services for people ? 65 years (and for younger disabled human nursing homes at a glance) usually. Among the services Skilled care (ie care that is ordered by a doctor and that can only be done by a nurse) include rehabilitation services (physiotherapy, speech therapy and occupational therapy) Nursing Care (z. B. meals, assistance with personal care) Medical social services Pharmaceutical Leisungen diet-related services that are tailored to the needs of each person Many nursing homes also offer additional community-based services (for. example, day care, respite care). Many offer short-term post-acute care (incl. Intensive physical, occupational, respiratory therapy and speech therapy) after an injury or illness (eg. As hip fracture, myocardial infarction, stroke) to. Hospitals (incl. Rural hospitals with licensed beds) or may be affiliated with a hospital or non-autonomous bodies, act as nursing homes. A Unterbrigung in a nursing home may not be necessary if community-based long term care services are (z. B. independent living for the elderly, nursing homes, assisted living, Life Care Communities) available, accessible and affordable. The proportion of people in nursing homes has declined, because assisted living facilities and home care, which depend largely on informal care services, are more common. Approximately 45% of the ? 65-year-olds spend some time in a nursing home; ? 50% of which remain ? 1 year, and a minority of them died there. The probability that a person will be accommodated in his life in a nursing home, is closely linked with age; for people aged 65-74 years, the probability is 17%, for the> 85-year-olds, however, 60%. However, twice as many older functionally dependent people living in the community than in nursing homes. About 25% of all unsupervised living elderly have no relatives to help them restore and maintain. The special attention to the health and care needs of older people living unsupervised could give them better quality of life and time, while limiting the cost by preventing inpatient care. Nursing homes at a glance factor Details Statistics Number of certified houses about 16,000 (in 2011) Number of beds About 1.7 million (in 2011) occupancy status 81.6% (in 2011) Number of inhabitants 1,390,000 (in 2011) Average monthly cost (depend largely on the state beginning) $ 6,752 (in 2012) Residents requirements for Medicare benefits must daily skilled nursing or rehabilitative measures need must in nursing home or Rehabilitätions service within 30 days after at least 3 days of hospitalization included are risk factors for placement in a nursing home Advanced age alone live inability to take care of themselves immobility Limited r mental status (eg. As dementia) incontinence lack of social or informal support poverty Female gender Potential Benefits for residents strength outline opportunities for socialization encouragement to diet exercise and activities Access to care assistance in maintaining the medication scheme (adherence, compliance) Possible problems for residents inability to leave the plant rare visit discomfort, not believed in, or which can not be taken seriously because the residents are sick, elderly abuse, which can be subtle (eg. as use of drugs and physical restraints that are not adequate for the mastery of disruptive behavior are) o the significantly (eg. B. pinching, hitting, tugging) decline in functionality * malnutrition and weight loss * pressure ulcers Incontinence * constipation * Infections * Depression * polypharmacy * Establish requirements for Medicare reimbursement A licensed nurse on site 24 hours / day Certified nursing assistants A full-time social worker, provided the establishment of> 120 beds has a medical director and a licensed nursing home administrator a qualified therapist, recreational programs offered by a rehabilitation therapist a dietician doctors, pharmacists, dentists and spiritual services should be available when needed, but are not required on site Possible additional services Special medical services (eg. B. ophthalmologic, otolaryngologisch, neurological, psychiatric, psychological) that require the transport of patients to other facilities iv therapy Enteral nutrition via feeding tubes long-term O2 treatment or respiratory support special care units (eg. As in patients with Alzheimer’s or dementia cancers) † Planned recreational events in groups range of leisure activities for patients v. a. for those who are cognitively impaired or bedridden are personal services (eg. as a hairdresser, make-up), they are usually paid by the patient from personal funds * These problems frequently occur in nursing home residents or worsen, can sometimes attentive care be prevented. † Special care units must specify programs and eligibility criteria, to train staff specifically for the unit, comply with regulations and requirements for repayment and have a distinct area or a separate room. Supervision of care physicians must bring the first admission of residents in a nursing home at the end. Then they can pass the routine follow-up of the inhabitants of a nurse or medical assistant, which alternate with the doctor during the visits of the residents. Visits must take place as often as medically necessary, but not less frequently than every 30 days during the first 90 days and thereafter at least once every 60 days. During routine visits, patients should be investigated, evaluated their medication status and be requested as required laboratory tests. The findings are to be documented in the medical record, to keep other employees to date. Some doctors limit their practice to nursing homes. They stand for team activities available and discuss with other employees, which, unlike promotes urgent visits every other month better care. Some nurses and doctors work together to manage the patient’s disease. By the administration of antibiotics and monitoring i.v. access, suction and sometimes ventilators nurses can prevent the patients are hospitalized. Detecting and preventing abuse is also an object of doctors, nurses and additional health care professionals. All professionals involved in the care of the elderly should be familiar with signs of abuse or neglect and for intervention to be ready if it appears elder abuse. A public interest group exists, nursing homes can be summoned by the regulatory authorities. The governments of sowing and states are legally responsible for ensuring that a device provides a good supply; Inspectors try to assess the quality of a facility and uncover defects by checking the results, monitoring of care, talking with patients and staff and review of medical records. Hospitalization Will require hospitalization, the doctor who takes care of a patient in a nursing home should coordinate with the doctor of this patient in the hospital. A hospital stay but because of its risks as possible avoided (hospital admission). When patients are referred to a hospital, they should bring their medical records as well as their living wills and medical devices (or medical instructions) for life-sustaining treatments. It is helpful if a nurse is called the hospital from the nursing home to explain the diagnosis and the reason for the relocation and describe the functional and psychological initial state of the patient, medication and living wills. Reverse the patients from the hospital to the nursing home back should call analogy a nurse in the hospital with a nurse in a nursing home. Cost Inpatient care is expensive, it cost in 2012 averaged $ 80,000 per year. In the US nursing home costs amounted in 1980 US $ 21 billion in 2000, US $ 70 billion in 2005, US $ 121.9 billion and> US $ 140 billion will be approximately 44% of the cost in 2010 paid for by Medicaid, 26.5% of the patients, 16% of Medicare, 7.5% by private insurance and about 4% with other private funds. Problems related to the reimbursement critics recommend: The refund amount may be too low, so that the patients get limited access to rehabilitation and services to improve the quality of life, v. a. Patients with dementia. The financial incentives for restorative care and rehabilitation for patients with impaired functioning may be insufficient. Nursing homes can be encouraged to promote dependency or maintain the need for care at the highest level in order to maximize reimbursement. Accommodation in a nursing home preferences and needs of the patient can be most effectively determined by a comprehensive geriatric assessment, incl. Identification and assessment of all diseases and evaluation of patient functioning (Geriatric Assessment). Disability leading or distressing disorders-most common dementia, incontinence and immobility-can trigger the carriages of a nursing home. However, a moderate improvement of a disease can even avoid the need for a nursing home (strategies to avoid institutionalization). Strategies to avoid institutionalization Problem Possible Solutions urinary incontinence Treating the cause may allow the patient to stay at home. Dementia members or other caregivers can learn strategies to deal with frustrating or disruptive behavior. The use of purchased or rented monitoring devices can help with behaviors such as nocturnal wandering. Functional impairments physiotherapists, occupational therapists and home nurses can Patients in their home assessed helping to determine whether placement in a nursing home or in an assisted living facility is necessary to propose ways to help the patient to train better functional to be patient, to use adaptive equipment to exercises ermutern Permanente medical devices can be provided if required. Need for elaborate and detailed care services to support and pauses in breathing can prevent develop the members or other caregivers resentment or burn out. Doctors can help by listening when caregivers address their burden, and inform them about support groups for caregivers in the community as well as paid options for short-term care. Selection nursing homes differ in the type of offered medical, nursing and social services. Some states set minimum ratios of nurses and patients that are more stringent than the federal requirements; the numerical ratio between other staff and patients is very different. Doctors should help families in selecting a nursing home that puts the needs of the patient and the care services in line. Physicians should consider the following points into consideration: Which clinical care model, the nursing home uses (eg private individual medical practices, large networks of general practitioners who visit a particular group of nursing homes routinely.) Which hospitals transfer agreements with the nursing home have What special therapeutic services , palliative care, hospice and other services are available whether the staff full-time or part-time employees are What does the medical care of the patient, especially if it is a project funded by Medicare program that covers certain aspects of the ongoing medical care, but no long-term care

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