1: The Nursing Assistant in Long-Term Care

long-term care (LTC)

given in LTCFs for people who need 24-hr skilled care

Skilled Care

medically necessary care given by a skilled nurse or therapist; available 24hrs/day

What are nursing homes called now?

LTCFs, SNFs, rehabilitation centers, extended care facilities

Length of Stay

the number of days a person stays in a healthcare facility

Terminal Illness

an illness will eventually cause death

Chronic

lasting a long period of time, even a lifetime

What are examples of chronic conditions?

physical disabilities, heart disease, dementia

What are people called who live in these facilities?

residents

Diagnoses

medical conditions determined by a doctor

Home Health Care

care provided in a person’s home

Assisted Living Facilities

people who need help with some daily tasks, such as showering, meals, and dressing, sometimes help with medication

Adult Day Services

for people who need some help and supervision during certain hours, but who do not live in the facility where care is provided

Acute Care

is 24hr skilled care given in hospitals and ambulatory surgical centers, for people who require short-term, immediate care for illnesses or injury

Subacute Care

care given in hospitals or long-term care facilities, for people who need less care than for an acute illness, but more care than for chronic illness

Outpatient Care

given to people who have had treatments, procedures, or surgeries and need short-term skilled care

Rehabilitation

is care given by specialists and professionals; physical, occupational, speech therapists help restore or improve function

Hospice Care

given in facilities or homes for people who have six months or less to live, given emotional and physical care until a person dies

Activities of Daily Living (ADLs)

bathing, skin, nail, and hair care, mouth care, and assistance with walking, eating, and drinking, dressing, transferring, and elimination

What type of care do LTCFs offer?

specialized care, personalized care, daily personal care tasks are called ADLs

Person-Centered Care

emphasizes the individuality of the person who needs care, and recognizes and develops the person’s capabilities

Trauma-Informed Care

a person-centered approach to patient care that recognizes people having experienced trauma in their lives; seeks to consider each person’s trauma, experiences, and preferences and provide a person-centered approach to care

Medicare

a federal health insurance program that was established in 1965 for people aged 65 or older

Medicare Part A

helps pay for care in a hospital or SNF or for care from home health agency or hospice

Medicare Part B

helps pay for doctor services and other medical services, 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 who have a low income, as well as people with disabilities funded by both federal and state; eligibility is determined by income and special circumstances

Charting (Documenting)

NA is noting and recording important information about the resident

NA

performs assigned tasks like measuring vital signs, provides or assists with personal care and elimination needs, must have 75 hours of training

RN

in a LTCF, coordinates, manages, and provides skilled nursing care, giving special treatments and medication

LPN/LVN

gives medications and treatments

APRN

an RN who has completed training at the postgraduate level, make diagnoses and prescribe treatment

MD/DO

diagnoses disease or disability and prescribes treatment and medication

PA

a licensed professional who diagnoses disease or disability, and develops treatment, as well as prescribes medication

PT

evaluates a person and develops a treatment plan to increase movement, improve circulation, promote healing, reduce pain, prevent disability, and regain or maintain mobility

OT

helps residents learn to adapt to disabilities, helps train residents to perform activities of daily living, such as bathing, dressing, and eating, often involves the use of assistive devices; evaluates the resident’s needs and plans a treatment program

SLP

identifies communication disorders, addresses factors involved in recovery, and develops a plan of care to meet goals, teaches exercises to help the resident improve or overcome speech problems, evaluates a person’s ability to swallow food and drink

RD/RDN

assesses a resident’s nutritional status and develops a treatment plan to improve health and manage illness, creates diets to meet residents’ special needs and may also supervise the preparation of food and educate people about nutrition

MSW

determines resident’ needs and helps get them support services, such as counseling and financial assistance, help obtain clothing and personal items if the family is not involves or does not visit often

Activities Director

plans activities for residents to help them socialize and stay active, meant to improve and maintain residents’ well-being and to prevent further complications from illness or disability

Resident and Resident’s Family

providing person-centered care means placing the resident’s well-being first, and giving her the right to make decisions and choices about her own care

Chain of Command

the line of authority and helps make sure that residents get proper health care

Liability

a legal term meaning that someone can be held responsible for harming someone else

Scope of Practice

defines the tasks that healthcare providers are legally allowed to do according to state or federal law

Care Plan

individualized for each resident, developed to help achieve the goals of care and meet the resident’s specific needs, listing the tasks, services, and treatments that team members must perform

Policy

a course of action that should be taken every time a certain situation occurs

Procedure

a method or way of doing something

NAs must be:

• compassionate

• empathetic

• sympathetic

• honest

• tactful

• conscientious

• dependable

• patient

• respectful

• unprejudiced

• proactive

Tactful

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

Ethics

the knowledge of right and wrong

Laws

rules set by the government to help people live peacefully together and to ensure order and safety

Omnibus Budget Reconciliation Act (OBRA)

passed in 1987, requires the NATCEP set minimum standards for NA training, requires that NAs pass a competency evaluation before employment, minimum of 12 hours per year of in-service education, requires that states keep a list of NAs in a state registry, identifies the standards that instructors must meet in order to train NAs

Residents’ Rights

specifies how residents must be treated while living in a facility, providing an ethical code of conduct for healthcare workers

What are the residents’ rights?

• quality of life

• services and activities to maintain a high level of wellness

• to be fully informed about rights and services

• to participate in their own care (informed consent)

• to make independent choices

• to privacy and confidentiality

• to dignity, respect, and freedom

• to security of possessions

• during transfers and discharges

• to complain

• to visits

• regard to social services

Abuse

purposeful mistreatment that causes physical, mental, or emotional pain or injury to someone

What are forms of abuse?

• physical

• psychological

• verbal

• sexual

• assault

• battery

• domestic violence

• false imprisonment

• involuntary seclusion

• workplace violence

• sexual harassment

• substance abuse

• neglect

• negligence (malpractice)

Neglect

failure to provide needed care that results in physical, mental, or emotional harm to a person

Negligence

actions, or the failure to act or provide the proper care for a resident, resulting in unintended injury

Malpractice

occurs when a person is injured due to professional misconduct through negligence, carelessness, or lack of skill

Ombudsman

assigned by law as the legal advocate for residents, they visit facilities and listen to residents to decide what action to take if there are problems, can help resolve conflicts and settle disputes concerning residents’ health, safety, welfare, and rights

Health Insurance Portability and Accountability Act (HIPAA)

1996, help keep health information private and secure

Protected Health Information (PHI)

information that can be used to identify a person and relates to the patient’s condition, any healthcare that the person has had, and payment for that health care

True or False: Care should be documented before it has been done.

False

Minimum Data Set (MDS)

a detailed form with guidelines for assessing residents, nurses must complete the MDS for each resident within 14 days of admission and again each year, a new one must be done when there is any major change in the resident’s condition

Incident

an accident/mistake, problem, or unexpected event during the course of care, must be recorded in an incident report, must be reported immediately to the charge nurse