1 The nursing assistant in LTC

LTC (Long term care) Is given in long-term care facilities for people who need 24-hour skilled care.

Skilled care Is medically necessary care given by a skilled nurse or therapist; it is available 24 hours a day

Their length of stay (the number of days a person stays in a care facility) may be short, such as a few days or months, or longer than six months.

Terminal illness- This means that the illness will eventually cause death.

Diagnoses- medical conditions determined by a doctor.

Home health care, or home care, is provided in a person’s home

Assisted living facilities are residences for people who need some help with daily tasks, such as showering, eating, and dressing. Help with medications may also be given. People who live in these facilities do not need 24-hour skilled care.

Adult day services are for people who need some help and supervision during certain hours, but who do not live in the facility where care is provided. Generally, adult day services are for people who need some help but are not seriously ill or disabled.

Acute care is 24-hour skilled care given in hospitals and ambulatory surgical centers. It is for people who require short-term, immediate care for illnesses or injuries.

Subacute care is care given in hospitals or long-term care facilities. It is used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness. Treatment usually ends when the condition has stabilized or after the set time for treatment has been completed.

Outpatient care is usually given to people who have had treatments, procedures, or surgeries and need short-term skilled care. They do not require an overnight stay in a hospital or other care facility.

Rehabilitation is care given by specialists. Physical, occupational, and speech therapists help restore or improve function after an illness or injury.

Hospice care is given in facilities or homes for people who have about six months or less to live. Hospice workers give physical and emotional care and comfort until a person dies. They also support families during this process.

The typical long-term care facility offers personal care for all residents and focused care for residents with special needs. Personal care includes bathing; skin, nail, and hair care; mouth care; and assistance with walking, eating and drinking, dressing, transferring, and elimination. All of these daily personal care tasks are called activities of daily living, or ADLs.

Person-centered care emphasizes the individuality of the person who needs care, and recognizes and develops his or her capabilities

Trauma-informed care is an approach to patient care that recognizes that people may have experienced trauma in their lives.

Medicare (medicare.gov) is a federal health insurance program that was established in 1965 for people aged 65 or older.

Medicaid (medicaid.gov) is a medical assistance program for people who have a low income, as well as for people with disabilities. It is funded by both the federal government and each state. Eligibility is determined by income and special circumstances. People must qualify for this program.

A nursing assistant (NA) performs assigned nursing tasks, such as taking a resident’s temperature. A nursing assistant also provides personal care, such as bathing residents and helping with hair care. Promoting independence and self-care are other very important tasks that a nursing assistant does

Another duty of the NA is noting and recording important information about the resident. This is called charting, or documenting.

Responsibility for Residents

All residents are the responsibility of each nursing assistant. An NA will receive assignments to perform tasks, care, and other duties for specific residents. If he sees a resident who needs help, even if the resident is not on his assignment sheet, the NA should provide the needed care.

Assistive or adaptive devices - hearing aids,braille,magnifiers, etc

Resident as Member of Care Team All members of the care team should focus on the resident. The team revolves around the resident and his or her condition, treatment, and progress. Without the resident, there is no care team.

Chain of command- It describes the line of authority and helps to make sure that residents get proper health care. The chain of command also protects employees and employers from liability.

Liability is a legal term. It means that someone can be held responsible for harming someone else

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

The care plan is individualized for each resident. It is developed to help achieve the goals of care. The care plan lists the tasks that team members, including NAs, must perform

A policy is a course of action that should be taken every time a certain situation occurs.

A procedure is a method, or way, of doing something.

Professional means having to do with work or a job.

Personal refers to life outside a job, such as family, friends, and home life

Professionalism is behaving properly when on the job

The care plan must always be followed. Tasks not listed in the care plan or approved by the nurse should not be performed.

Compassionate means being caring,concerned, empathetic, and understanding.

Empathy means identifying with the feelings of others.

Showing sympathy means sharing in the feelings and difficulties of others.

Honest: An honest person tells the truth and can be trusted

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

People who are conscientious try to do their best. They are guided by a sense of right and wrong

Dependable: NAs must be able to make and keep commitments.

Patient: People who are patient do not lose their temper easily.

Respectful: Being respectful means valuing other people’s individuality.

Unprejudiced: NAs work with people from many different backgrounds

Tolerant: Being tolerant means respecting others’ beliefs and practices and not judging them

Ethics are the knowledge of right and wrong. An ethical person has a sense of duty toward others.

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

The Omnibus Budget Reconciliation Act (OBRA) was passed in 1987. It has been updated several times since. OBRA was passed in response to reports of poor care and abuse in long-term care facilities

OBRA requires that the Nurse Aide Training and Competency Evaluation Program (NATCEP) set minimum standards for nursing assistant training. NAs must complete at least 75 hours of training that covers topics like communication, preventing infections, safety and emergency procedures, and promoting residents’ independence and legal rights. Training must also include basic nursing skills, such as how to measure vital signs. NAs must also know how to respond to mental health and social services needs, rehabilitative needs, and how to care for residents who are cognitively impaired. OBRA requires that NAs pass a competency evaluation (testing program) before they can be employed. NAs must also attend regular in-service education (a minimum of 12 hours per year) to keep their skills updated.

To cite means to find a problem through a survey

Residents’ Rights specify how residents must be treated while living in a facility.

Quality of life: Residents have the right to the best care available. Dignity, choice, and independence are important parts of quality of life.

Services and activities to maintain a high level of wellness: Residents must receive the correct care. Healthcare professionals at facilities must develop a care plan for residents, and their care should keep them as healthy as possible. A baseline care plan for residents, which includes instructions for providing person-centered care, must be developed within 48 hours of admission. Residents’ health should not decline as a direct result of the care given at the facility.

The right to be fully informed about rights and services: Residents must be told what services are available. They must be told the fee for each service. They must be informed of charges both orally and in writing. Residents must be given a written copy of their legal rights, along with the facility’s rules. Legal rights must be explained in a language they can understand. Residents must be given contact information for state agencies relating to quality of care, such as the ombudsman program (more information may be found later in the chapter). When requested, survey results must be shared with residents. Residents have the right to be notified about any change of room or roommate. They have the right to communicate with someone who speaks their language. They have the right to assistance for any sensory impairment, such as vision loss.

The right to participate in their own care: Residents have the right to participate in planning their treatment, care, and discharge. Residents have the right to see and sign their care plans after all significant changes. Residents have the right to be informed of risks and benefits of care and treatment, including treatment options and alternatives, and to choose the options they prefer. They have the right to request, refuse, and/or discontinue treatment and care. They can refuse restraints and refuse to participate in experimental research. Residents have the right to be told of changes in their condition. They have the right to review their medical record. They have the right to choose

Informed consent is the process by which a person, with the help of a doctor, makes informed decisions about his or her health care.

The right to make independent choices: Residents can make choices about their doctors, care, and treatments. They can make personal decisions, such as what to wear and how to spend their time.

The right to dignity, respect, and freedom: Residents must be respected and treated with dignity by caregivers. Residents must not be The right to security of possessions: Residents’ personal possessions must be safe at all times. Facilities must make an effort to protect residents’ property from loss or theft. Possessions cannot be taken or used by anyone without a resident’s permission. Residents have the right to manage their own finances or choose someone else to do it for them. Residents can request that the facility handle their money. If the care facility handles residents’ financial affairs, residents must have access to their accounts and financial records, and they must receive quarterly statements, among other things. Residents have the right to not be charged for any care that is covered by Medicaid or Medicare.

The right to privacy and confidentiality: Residents have the right to speak privately with anyone. They have the right to privacy during care and the right to confidentiality regarding every aspect of their lives.

Rights during transfers and discharges: Residents have the right to be informed of and to consent to any location changes. Residents have the right to stay in a facility unless a transfer or discharge is needed. Residents can be moved from the facility due to safety reasons (their safety or others’ safety), if their health has improved or worsened, or if payment for 12 The Nursing Assistant in Long-Term Care 1 care has not been received for a determined period of time.

The right to security of possessions: Residents personal possessions must be safe at all times. Facilities must make an effort to protect residents' possessions at all times.

The right to complain: Residents have the right to make complaints and voice grievances without fear for their safety or care. Facilities must work quickly to address their concerns.

The right to visits: Residents have the right to visits from doctors, family members (including spouses and domestic partners), friends, ombudsmen, clergy members, legal representatives, or any other person. Visits cannot be restricted, limited, or denied on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.

Rights with regard to social services: The facility must provide residents with access to social services. This includes counseling, assistance in solving problems with others, and help contacting legal and financial professionals.

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

Physical abuse is any treatment, intentional or not, that causes harm to a person’s body. This includes slapping, bruising, cutting, burning, physically restraining, pushing, shoving, or even rough handling

Psychological abuse is emotional harm caused by threatening, scaring, humiliating, intimidating, isolating, or insulting a person, or by treating him or her as a child.

Verbal abuse is the use of spoken or written words, pictures, or gestures that threaten, embarrass, or insult a person.

Sexual abuse is the forcing of a person to perform or participate in sexual acts against his or her will. This includes unwanted touching or exposing oneself to a person. It also includes sharing pornographic material.

Financial abuse is the improper or illegal use of a person’s money, possessions, property, or other assets

Assault is a threat to harm a person, resulting in the person feeling fearful that he or she will be harmed. Telling a resident that she will be slapped if she does not stop yelling is an example of assault.

Battery is the intentional touching of a person without his or her consent. An example is an NA hitting or pushing a resident. This is also considered physical abuse. Forcing a resident to eat a meal is another example of battery.

Domestic violence is abuse by spouses, intimate partners, or family members. It can be physical, sexual, or emotional. The victim can be a man or woman of any age or a child.

False imprisonment is unlawful restraint that affects a person’s freedom of movement. Both the threat of being physically restrained and actually being physically restrained are types of false imprisonment. Not allowing a resident to leave the facility is also considered false imprisonment.

Involuntary seclusion is the separation of a person from others against the person’s will. An example is an NA confining a resident to his room.

Workplace violence is abuse of staff by other staff members, residents, or visitors. It can be verbal, physical, or sexual. This includes improper touching and discussion about sexual subjects.

Sexual harassment is any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment. Requests for sexual favors, unwanted touching, and other acts of a sexual nature are examples of sexual harassment.

Neglect is the failure to provide needed care that results in physical, mental, or emotional harm to a person. Neglect can be put into two categories: active neglect and passive neglect.

Active neglect is the purposeful failure to provide needed care, resulting in harm to a person.

Passive neglect is the unintentional failure to provide needed care, resulting in physical, mental, or emotional harm to a person. The caregiver may not know how to properly care for the resident, or may not understand the resident’s needs.

Negligence means actions, or the failure to act or provide the proper care for a resident, resulting in unintended injury. An example of negligence is an NA forgetting to lock a resident’s wheelchair before transferring her. The resident falls and is injured.

Malpractice occurs when a person is injured due to professional misconduct through negligence, carelessness, or lack of skill is the repeated use of legal or illegal drugs, cigarettes, or alcohol in a way that harms oneself or others. For the NA, substance abuse can lead to unsafe 14 The Nursing Assistant in Long-Term Care 1 practices that result in negligence, malpractice, neglect, and abuse. It can also lead to the loss of the NA’s certification.

In long-term care facilities in the United States, an ombudsman is assigned by law as the legal advocate for residents (ltcombudsman.org)

To respect confidentiality means to keep private things private.

Congress passed the Health Insurance Portability and Accountability Act (HIPAA) (hhs.gov/hipaa) in 1996. It has been further defined and revised since then. One reason this law was passed is to help keep health information private and secure. All healthcare organizations must take special steps to protect health information.

Protected health information (PHI) is information that can be used to identify a person and relates to the patient’s condition, any health care that the person has had, and payment for that health care.

Document care immediately after it is given. This makes details easier to remember. Do not record any care before it has been done.

It is called the Minimum Data Set (MDS). The MDS is a detailed form with guidelines for assessing residents. It also lists what to do if resident problems are identified.

An incident is an accident, problem, or unexpected event during the course of care. It is something that is not part of the normal routine. A mistake in care, such as feeding a resident from the wrong meal tray, is an incident

Communication is a process of exchanging information with others. it is the process of sending and receiving messages.

Verbal communication uses spoken or written words.

Nonverbal communication is communicating without using words.

Different languages

NAs should speak in a language that residents can understand or find an interpreter to help (family members should not be asked to interpret medical information)

If a resident has chest pain- immediately tell nurse because it could mean a heart attack

Never pick up an elderly if they fall, instead call the nurse and report everything you saw.

NAs should ask open ended questions

NAs should call residents by the name they prefer

Objective information is based on what a person sees hears touches or smells

Subjective information is something a person cannot or did not observe. It is based on something that the resident reported that may or may not be true. It is also called symptoms.

Incontinence is the inability to control the bladder or bowels. Breath order could suggest use of alcohol or tobacco in digestion or poor mouth care.

Defense mechanisms are unconscious behaviors used to release tension or cope with stress.

Body mechanics is the way the parts of the body work together when a person moves

Scalds are Burns caused by hot liquids

An abrasion is an injury that rubs off the surface of the skin

The occupational safety and health administration (OSHA) is a federal government agency that makes rules to protect workers from hazards on the job.

Being conscious means being mentally alert and having awareness of surroundings sensations, and thought

First aid is emergency care given immediately to an injured person by the first people to respond to an emergency.

Cardiopulmonary Resuscitation (CPR) refers to medical [procedures used when a person's heart or lungs have stopped working. CPR is used until medical help arrives.