Working in long-term care
Objectives
• Define the key terms and key abbreviations listed in this chapter.
• Describe the types, purposes, and organization of long-term care centers.
• Describe members of the nursing team.
• Describe the interdisciplinary health care team.
• Describe four nursing care patterns.
• Describe the programs that pay for health care.
• Explain why standards are met.
Key terms
acute illness A sudden illness from which a person is expected to recover
Alzheimer’s disease (AD) A disease that affects brain tissue; memory loss and confusion increase until the person cannot tend to simple personal needs
assisted living residence Provides housing, personal care, support services, health care, and activities in a home-like setting
board and care home Provides rooms, meals, laundry, and supervision to independent residents in a home-like setting; group home
case management A nursing care pattern; a case manager (an RN) coordinates a person’s care from admission through discharge and into the home setting
chronic illness An ongoing illness, slow or gradual in onset; it has no cure; the illness can be controlled and complications prevented with proper treatment
functional nursing A nursing care pattern focusing on tasks and jobs; each nursing team member has certain tasks and jobs to do
group home See “board and care home”
hospice A health care agency or program for persons who are dying
independence Not relying on or requiring care from others
interdisciplinary health care team The many health care workers whose skills and knowledge focus on the person’s total care; health team
licensed practical nurse (LPN) A nurse who has completed a 1-year nursing program and has passed a licensing test; called licensed vocational nurse (LVN) in some states
licensed vocational nurse (LVN) See “licensed practical nurse”
Medicaid A health care payment program sponsored by the federal government and operated by the states
nursing assistant A person who gives basic nursing care under the supervision of a licensed nurse; nurse aide, nursing attendant, and health care assistant are some other titles
nursing facility (NF) See “nursing center”
nursing home See “nursing center”
nursing team Those who provide nursing care—RNs, LPNs/LVNs, and nursing assistants
primary nursing A nursing care pattern; an RN is responsible for the person’s total care
registered nurse (RN) A nurse who has completed a 2-, 3-, or 4-year nursing program and has passed a licensing test
skilled nursing facility (SNF) Provides health care and nursing care for residents who have many or severe health problems or who need rehabilitation; may be part of a nursing center or a hospital
KEY ABBREVIATIONS
| AD | Alzheimer’s disease |
| ALR | Assisted living residence |
| DON | Director of nursing |
| HMO | Health maintenance organization |
| LPN | Licensed practical nurse |
| LVN | Licensed vocational nurse |
| PPO | Preferred provider organization |
| RN | Registered nurse |
| SNF | Skilled nursing facility |
Working in long-term care offers many new and rewarding experiences. Your focus is the resident—the person needing care. You must provide quality care and promote the person’s quality of life. This includes promoting his or her independence. Independence means not relying on or requiring care from others.
Long-term care centers
Long-term care centers provide health care to persons who cannot care for themselves at home. They do not need hospital care. Care needs range from simple to complex. Medical, nursing, dietary, recreational, rehabilitative, and social services are provided. So are housekeeping and laundry services.
Persons in long-term care centers are called residents. They are not patients. This is because the center is their temporary or permanent home.
Residents are older or disabled. Some are recovering from illness, injury, or surgery. Long-term care centers are designed to meet their needs. Some people return home when well enough. Others need nursing care until death.
Board and care homes
Board and care homes (group homes) provide rooms, meals, laundry and supervision to independent residents in a home-like setting. Care is given that meets the person’s basic needs. A safe setting and supervision are provided. So are housekeeping and transportation services. There is an emergency call system and a 24-hour caregiver. This person may be a nursing assistant.
Residents can usually dress themselves. They usually tend to grooming and bathroom needs with little help. They receive help with personal care and drug reminders as needed.
Assisted living residences
Assisted living residences (ALRs) provide housing, personal care, support services, health care, and activities in a home-like setting (Chapter 30). Many look like apartment buildings. Some are part of retirement communities or nursing centers.
The person has a room or an apartment. Help is given as needed with personal care, meals, or taking drugs. Three meals a day are provided. So are housekeeping, laundry, and transportation services. Social and recreational activities are provided. There is access to health and medical care.
Nursing centers
A nursing center provides health care and nursing care to persons who need regular or continuous care. Nursing facility (NF) and nursing home are other names. Licensed nurses are required.
Residents have more severe health problems than do board and care or ALR residents. These services are provided:
Skilled nursing facilities (SNFs) provide health care and nursing care for residents who have many or severe health problems or who need rehabilitation. The SNF may be part of a nursing center or a hospital.
SNFs provide more complex care than nursing centers do. Many persons are admitted from hospitals. They need to recover or have rehabilitation after an illness, injury, or surgery. Some return home. Others do not.
Purposes and goals
Long-term care serves to promote physical and mental health. Most residents have one or more health problems. They are helped and encouraged to:
• Understand and accept the limits of their health problems
• Understand and accept physical and mental changes
• Function within those limits
• Focus on abilities, not disabilities
• Do as much for themselves as possible
• Change habits that make health problems worse
The family needs to accept and understand what is happening to the loved one. The family is taught how to help the person maintain the highest possible level of function.
Long-term care also serves to treat chronic illness. A chronic illness is an on-going illness, slow or gradual in onset. It has no cure. The illness can be controlled and complications prevented with proper treatment. An acute illness is a sudden illness from which the person is expected to recover. An acute illness may require hospital care.
Communicable diseases are prevented. A communicable disease can be spread from one person to another (Chapter 15). The common cold and influenza (flu) are examples. They can cause major health problems for older and disabled persons. Often you are the first person to detect signs and symptoms of a communicable disease.
Rehabilitation or restorative care helps persons return to their highest possible level of physical and mental function (Chapter 46). They are helped to become or remain as independent as possible. This includes persons who need nursing center care until death.
Rehabilitation starts when a person is admitted to the center. Weakness after an acute illness is common. Deconditioning is the process of becoming weak from illness or lack of exercise (Chapter 26). Strokes, fractures, and surgery are common causes. All staff members follow the rehabilitation plan.
Other services
Some nursing centers offer learning experiences for students. They study to become nurses, nursing assistants, doctors, or other health team members. All students focus on the center’s purposes and goals.
Many nursing centers have special care units. Hospice and Alzheimer’s disease units are common.
• Alzheimer’s Units (Dementia Care Units). These units are for persons with Alzheimer’s disease and other dementias (Chapter 44). Alzheimer’s disease (AD) affects brain tissue (Chapter 44). Memory loss and confusion increase until the person cannot tend to simple personal needs. Over time, the person forgets names of self and others. The person may wander and become agitated and combative. The unit is usually closed off from the rest of the center. This provides a safe setting for residents to wander freely. AD worsens over time. When wandering is no longer a problem, a closed unit is no longer needed. The person is transferred to another unit in the center.
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