Nurse Aide in Long-Term Care

Long-Term Care & Acute Care

• Types of Health Care:
  • Independent Living
  • Home Health Care
  • Adult Day Care
  • Assisted Living Facility
  • Nursing Home
  • Hospice
  • Continuum of Care Facility
  • Rehabilitation
  • Hospital (inpatient & outpatient)
  • Dementia/Memory Care

Payment Options for Long-Term Care Facilities

• Private Pay: Resident pays for healthcare from personal resources.
• Group Insurance: Resident's healthcare is paid for by insurance the resident has previously paid.
• Medicaid: Medical assistance program for low-income residents that pays for the resident’s healthcare.
• Medicare:
  • Health insurance program for residents over the age of 65 that pays for resident’s healthcare.
  • Funded by Social Security.
  • Minimum Data Set (MDS) report required for each Medicaid resident.

Omnibus Budget Reconciliation Act of 1987 (OBRA-87)

• Federal regulation.
• Sets standards of care for long-term care facilities.
• Requires all nurse aides in long-term care facilities to:
  • Complete training program.
  • Pass certification exam.
• Requires each state to have a registry of nurse aides:
  • Available to the public.
  • Contains information on nurse aide’s performance, including resident abuse.
  • Information to be kept for a minimum of five (5) years.
• Requires continuing education:
  • Minimum of 12 hours in-service each year for nurse aides.
• Requires nurse aide who has not worked for 2 consecutive years to retake the certification exam.

The Health Care Team

• The Nurse:
  • Registered Nurse (RN)
  • Licensed Practical Nurse (LPN)
• The Nurse Aide:
  • Care for residents.
  • Assist the RN and LPN.
  • Supervised by the RN or LPN.
• Interdisciplinary Team:
  • Resident
  • Physician
  • Registered Dietitian/Nutritionist
  • Physical Therapist
  • Occupational Therapist
  • Family Member
  • Social Worker
  • Licensed Nurse
  • Nurse Aide
  • Activities/Enrichment

Common Tasks for the Nurse Aide

• Activities of Daily Living (ADLs):
  • Bathing
  • Dressing
  • Grooming
  • Mouth Care
  • Toileting
  • Eating & Hydration
  • Caring for skin; prevention of pressure ulcers
• Bed Making
• Taking/Recording Vital Signs; Height & Weight
• Observing/Reporting Resident Changes to Licensed Nurse
• Maintaining Safety, Including Fall Prevention
• Caring for Equipment
• Infection Control

Professional Behavior of the Nurse Aide

• Attitude:
  • Outward Behavior
  • Disposition
  • Positive Attitude:
    • Caring
    • Compassionate
    • Committed to the Job
• Behavior:
  • Neatly Dressed Following Facility Uniform Policy
  • On Time to Work
  • Avoid Unnecessary Absences
  • Use Appropriate Language
  • Do Not Gossip About Co-Workers/Residents
  • Keep Resident Information Confidential
  • Speak Politely
  • Follow Facility Policies and Procedures
• Grooming:
  • Wear Clean, Neat, Unwrinkled Uniform
  • Attend to Personal Hygiene
  • Do Not Use Strongly Scented Fragrances (perfume, lotions, after-shave, body wash, hair spray)
  • Keep Hair Away From Your Face
  • Long Hair Should Be Secured at the Back of the Head or Neck
  • Keep Beards Neat and Trimmed
  • Use Make-Up Sparingly
  • Keep Nails Short
  • Do Not Wear False Nails
  • Keep Shoes/Laces Clean
  • Jewelry Should be Minimal
• Work Ethic:
  • Attitude Toward Work
  • Punctual
  • Reliable
  • Accountable
  • Conscientious
  • Respectful of Others
  • Honest
  • Cooperative
  • Empathetic

Delegation

• Transferring authority to a person for a specific task
• RN may delegate tasks to a nurse aide (NA)
• Criteria for Delegation:
  1. Nurse Aide can properly and safely perform task
  2. Resident health, safety and welfare will not be jeopardized
  3. RN retains responsibility and accountability for care of resident and supervises the NA
  4. Delegated task communicated to NA on a resident-specific basis
  5. Clear, specific instructions for performance, potential complications, expected results are given to NA
  6. NA is clearly identified with a name tag
  7. NA may not reassign a task that has been delegated to her/him

Applying for Employment as a Nurse Aide

• Considerations:
  • Type of Facility
  • Adequate Transportation
  • Childcare
• Complete Resume and Application
• Guidance Document 90-55:
  • Impact of Criminal Convictions on Potential Employment
  • Certain Convictions Prohibit Employment in Long-Term Care Facilities
  • Review Guidance Document 90-55
• Interview:
  • Arrive on Time
  • Dress Appropriately:
    • Professional Attire
    • Neat
  • Maintain Good Eye Contact
  • Be Prepared to Answer Questions
  • Be Prepared to Ask Questions
  • Thank the Interviewer at the End of the Interview
  • Mail Short Thank-You Note the Day After Interview

Qualities of Nursing Assistants

• Compassionate
• Honest
• Tactful
• Conscientious
• Dependable
• Patient
• Respectful
• Unprejudiced
• Tolerant

Chain of Command

• Administrator: Manages non-medical aspects of the facility, administers finances, and coordinates policy in consultation with medical professionals.
• Medical Director (MD): Reviews and consults on medical aspects of care, coordinating with attending physicians and nursing staff and encouraging quality care.
• Director of Nursing (DON): Manages the nursing staff at a facility.
• Assistant Director of Nursing (ADON): Assists the DON with the management of nursing staff.
• Staff Development Coordinator: Directs the training of employees at a facility.
• Minimum Data Set (MDS) Coordinator/Resident Assessment Coordinator: Manages the assessment of resident needs and delivery of required care in a long-term care facility (usually a specially trained nurse).
• Nursing Supervisor: Supervises and supports nursing staff of the entire facility or multiple nursing units, assisting with resident care as needed.
• Charge Nurse: Supervises and supports nursing staff of a particular unit and treats a limited number of residents.
• Staff Nurses (RNs, LPNs/LVNs): Provide nursing care as prescribed by a physician.
• Nursing Assistants (NAs, CNAs): Perform assigned nursing tasks, assist with routine personal care, and observe and report any changes in residents’ conditions and abilities.
• Other Services:
  • Physical Therapist (PT): Administers therapy to increase movement, promote healing, reduce pain, and prevent disability.
  • Occupational Therapist (OT): Helps residents learn to adapt to disabilities and trains them to perform ADLs.
  • Speech-Language Pathologist (SLP): Identifies communication disorders and swallowing problems and develops a plan of care.

Medicare and Medicaid

• Medicare:
  • For people 65 or older and people under 65 who are disabled or ill and cannot work.
  • Part A helps pay for care in a hospital or skilled nursing facility or for care from a home health agency or hospice.
  • Part B helps pay for doctor services and other medical services and equipment.
  • Part C allows private health insurance companies to provide Medicare benefits.
  • Part D helps pay for medications prescribed for treatment.
• Medicaid:
  • Medical assistance program for people who have a low income, as well as for people with disabilities.
  • People qualify based on income and special circumstances.

Decision Quiz Choices

• A reminder that choices made each day define the actions and ultimately impact the care provided.