CNA Week 1 (Ch. 1–3) Resident Care Foundations & Communication

Long Term Care (LTC)

care given in long-term care facilities for people who need 24-hour skilled care.

Skilled Care

medically necessary care given by a skilled nurse or therapist (available 24 hours/day) & involves a treatment plan. Examples - catheter care, physical therapy, and monitoring of vital signs and medical, IV injections

Demographics of Long-Term Care Facilities

• May be disabled

• Are often elderly, although younger adults sometimes require long-term care, too

• May arrive from hospitals or other healthcare settings

• Length of stay - the number of days a person stays in a care facility. The length of stay may be short, such as a few days or months, or longer than 6 months.

• Often have chronic health conditions, such as heart disease, physical disabilities, or dement

Terminal Illness vs. Chronic Condition

• Terminal Illness - a disease or condition that will eventually cause death & Some cancers & serious illnesses

• Chronic Condition - long-term or long-lasting & Physical Disabilities, heart disease, dementia

diagnoses

medical conditions determined by a DOCTOR or PHYSICIAN (MD).

• Medical Abbreviation – Dx

• Stages of illness or disease affect how sick people are and how much care will be needed.

• Each resident has different symptoms, abilities and needs.

Home Health Care

Also known as home care, is provided in the comfort of a person's home

Assisted Living

For individuals who need some assistance with daily tasks, but do not require 24-hour skilled care.

Adult Day Services

For individuals who need help and supervision during specific hours

Acute Care

24-hour skilled care provided in hospitals and ambulatory surgical centers.

Subacute Care

For people who need less care than for a sudden-onset, short-term illness, but more care than for a chronic (long-term) illness. 

• Can include dialysis, chemotherapy, ventilation care, complex wound care, and other inpatient medical and nursing services.

• Ends when the condition has stabilized or after set time for treatment has been completed.

Outpatient Care

For individuals who have undergone treatments, procedures, or surgeries and require short-term skilled care

• DO NOT require an overnight stay in a hospital or other care facility

Rehailitation

Care provided by specialists and professionals, including physical, occupational, and speech therapists.

• Includes physical, occupational, and speech therapists

Hospice Care

For individuals with six months or less to live.

• Given in facilities or homes

• Hospice workers come and give physical and emotional care and comfort until a person dies.

• They also support families during this process.

home health care

care that is provided in a person’s home.

• Generally given to elderly people who are chronically ill and want to remain at home.

   

• May also be needed when a person is weak after a recent hospitalization.

long-term care facility

businesses that provide skilled nursing care 24 hours a day.

• may offer assisted living housing, dementia care, or subacute care

Other common services offered at these facilities include the following:

The Nursing Assistant in Long-Term Care

• Physical, occupational, and speech therapy.

• Wound care

• Care for different types of tubes, such as catheters (thin tubes inserted into the body to drain fluids or inject fluids)

• Nutrition therapy

• Management of chronic diseases, such as (Alzheimer’s disease, acquired immunodeficiency syndrome (AIDS), diabetes, COPD, cancer, and CHF

All of these daily personal care tasks are called activities of daily living or ADLs.

• Bathing

• Skin

• Nail

• Hair Care

• Mouth Care

• Assistance with walking (ambulating)

• Eating

• Drinking

• Transferring

• Elimination

Different long-term care facilities may offer different services

• Some may offer specialized care for residents with dementia

   

• Some may include assisted living facilities

   

• If a facility provides specialized care, employees will be specifically trained to provide that care

person-centered care

a type of care that places the emphasis on the individuality of the person who needs care and recognizes and develops his or her capabilities.

• Revolves around the resident and promotes his or her individual preferences, choices, dignity and interests.

• Each person’s background, culture, language, beliefs and traditions ARE RESPECTED.

• Improving each resident’s quality of life is an important goal.

trauma-informed care 

an approach to resident care that recognizes people may have experienced trauma in their lives.

• seeks to consider each person’s trauma, experiences, and preferences

• provides a person-centered approach to care

CMS (Centers For Medicare & Medicaid Services

• a federal agency within the US Department of Health and Human Service

• runs two national healthcare programs

• They both help pay for health care and health insurance for millions of Americans.

Medicare

• Established in 1965

• a federal health insurance program for people who are 65 or older.

• Also covers people of any age with permanent kidney failure or certain disabilities.

• Medicare will ONLY PAY for care it determines to be MEDICALLY NECESSARY.

Medicare Part A

helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice.

Medicare Part B

helps pay for doctor services and other medical services and equipment.

Medicare Part C

allows private health insurance companies to provide Medicare benefits.

Medicare Part D

helps pay for medications prescribed for treatment.

Medicaid

a medical assistance program for people with low incomes, as well as for people with disabilities.

• People qualify based on income and special circumstances.

• Funded by both federal government and each state.

Medicare & Medicaid in Long-Term Care

• Essential coverage for elderly, disabled, and those with limited financial means.

• Facilities not paid per service. Operate on a fixed amount system.

• Predetermined amount per resident, based on needs upon admission and during their stay.

• Ensures residents receive necessary support, promoting tailored care and overall well-being.

Nursing assistants perform assigned tasks, such as

• Bathing residents

• Helping with elimination needs

• Assisting with range of motion exercises and ambulation (walking)

• Transferring residents from a bed to a chair or wheelchair

• Measuring vital signs (temperature, pulse rate, respiratory rate, and blood pressure)

• Assisting with meals

• Helping residents dress and undress

• Giving backrubs

• Helping with mouth care

• Making and changing beds

• Keeping residents' areas neat and clean

• Caring for supplies and equipment

NAs are not permitted to do any of the following:

• Insert or remove tubes

• Give tube feedings

• Change sterile dressings

Some states allow NAs to give medications if they have completed an additional, specialized course for medications and meet the requirements of the individual facility.

Nursing assistant(’s)...

• Spend more time with residents than any other care team members.

• Observations are very important in making sure residents receive the best possible care.

• Are the “eyes and ears” of the healthcare team.

All residents are the responsibility of each nursing assistant. If an NA sees a resident who needs help, she must help—even if the resident is not assigned to her/him.

charting

documenting information and observations about residents.

• Charting or Documenting:

  • Noting and recording important information about the resident

• Collaboration within the Healthcare Team:

  • Team includes doctors, nurses, social workers, therapists, dietitians, specialists, residents, and families

  • Working closely together to meet goals, including helping residents recover from illnesses and promoting independence

Long-term care facilities may use any of the following titles for nursing assistants:

• Nurse aide

• Certified nurse aide

• Patient care technician

• Certified nursing assistant

• Nursing assistant

Resident care is provided by a care team made up of the following team members:

• Nursing assistant

• Registered nurse

• Licensed practical nurse/licensed vocational nurse

• Physician or doctor

• Physical therapist

• Occupational therapist

• Speech-language pathologist

• Registered dietitian

• Medical social worker

• Activities director

• Resident and resident’s family

Protection from Liability

• scope of practice defines the tasks that healthcare providers are legally allowed to do as permitted by state or federal law.

• chain of command he line of authority within a facility.

• A nursing assistant carries out instructions given to her by a nurse. The nurse acts on the instructions of a doctor or other member of the care team.

• liability a legal term that means someone can be held responsible for harming someone else.

chain of command

assistive devices

 

special equipment that helps a person who is ill or disabled to perform activities of daily living. Examples: grab bars for bathroom safety, adapted utensils for easier eating, button hooks for dressing, long-handled sponges for bathing

NA

• Each state has different laws, but some tasks are never performed by NAs. NAs never make diagnoses or perform procedures involving sterile technique, for example.

• An NA must never honor a request to do something outside his scope of practice. Report such requests to the nurse

care plan

a plan developed for each resident to achieve certain goals; it outlines the steps and tasks that the care team must perform

policy

a course of action that should be taken every time a certain situation occurs. Ex. As required by fire departments, each school must hold a fire drill each month.

procedure

a method or way of doing something.

Ex.

1. Teachers located in Hall A will lead students out of the building through Door A.

2. Teachers in Hall B will lead students out of the building through Door B.

3. Staff members who are not teaching a class at that time will exit the building via the nearest door and help to supervise students outside.

4. The last person to leave a room must turn off the light and close the door behind him or her.

These policies and procedures are common in LTC facilities:

• All resident information is confidential. (HIPPA)

• Residents’ care plan must be followed.

• NAs only perform tasks in job descriptions.

• Always chart events or changes in residents to nurse.

• NAs should not discuss personal problems with residents or families.

• NAs should not accept gifts and money from residents or families.

• NAs must be dependable.

NAs can have a professional relationship with residents by

• Provide person centered care.

• Be positive, polite and cheerful.

• Doing only tasks in care plan & scope of practice.

• Keep residents’ information confidential.

• The Nursing Assistant in Long-Term Care

• Call residents by his or her name or preferred name.

• Do not use a personal phone in residents’ rooms or in resident care areas.

• Do not discuss personal problems.

• Do NOT call residents terms such as (sweetie, honey, dearie).

• NEVER give or accept gifts.

• Explain care before giving it.

NAs can have a professional relationship with an employer by

• Completing tasks efficiently

• Following policies/procedures

• Documenting and reporting carefully

• Reporting problems

• Reporting anything that interferes with duties

• Taking direction and criticism

• Being clean and neatly dressed and groomed

• Being on time

• Notifying the employer if absent

• Following the chain of command

Nursing assistants must…

• be - compassionate

  being caring, concerned, considerate, empathetic, and understanding.

•  show - sympathy

  sharing in the feelings and difficulties of others.

• demostrate - empathy

  identifying with the feelings of others.

Nursing assistants must be…

conscientious guided by a sense of right and wrong; principled.

• Low Conscientious Behaviors - Prefers spur-of-the-moment action to planning; unreliable; hedonistic; careless; lax

• High Conscientious Behaviors - Never late for a date; organized;

hardworking; neat; persevering; punctual; self-disciplined

tactful

showing sensitivity and having a sense of what is appropriate when dealing with others.

• Unfiltered Opinions - For example, a relative who bluntly and unkindly points out that you have gained weight.

• Respectfulness - For example, greeting your neighbors and their guests with a friendly demeanor.