Quality in Nursing Home Care – Sample

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Abstract

The quality of nursing home care may vary from institution to institution. While throughout the decades, nursing homes have continued to provide care for elderly’s societies, changes in the health trends and demographics made some nursing homes irrelevant or unsuitable. Government institutions and health care providers have risen up to the challenge and are continuously developing regulations and recommendations to make nursing homes better for the elderly. In choosing a nursing home, it is important to consider the special needs and requirements of an individual. Institutions such as Medicare have developed checklists and recommendation guidelines that prospective residents and their families can use to adequately assess the appropriateness of a specific nursing home. These checklists cover all aspects of a nursing home, including safety, cleanliness, its ability to provide for the global needs of an individual, and its thrust in upholding the rights of the residents. It is also important to be aware of the security threats that may occur inside nursing homes. Taking time to choose the best nursing home for an individual will ensure better long-term health outcomes, quality of life, and sense of well-being.

Introduction

Improvements in health care management and technology have brought an overall increase in life expectancy. With this came the rise of nursing homes and other long-term care facilities and more individuals requiring the services of such facilities. Choosing the right nursing home for a loved one may be daunting. Much research is required to choose the right institution, and even with adequate research, some family members may still have reservations about placing a loved one under the care of such institutions. Medicare (2008a) provides laypeople with recommendations on how to choose the right nursing home. A checklist that the institution developed makes it more convenient for prospective nursing home residents and their families to choose among different homes and determine what aspects are important to them and which nursing home fit them best. Thus, as the requirement for skilled nursing care heightens, seeing how to evaluate – and subsequently enhance – the nature of care in nursing homes is progressively imperative.

Health care providers are also rising up to the challenges of providing the best possible care to the society’s elderly. Unwin, Provaznik, and Spoelhof (2010a) outline the responsibilities of the medical staff in nursing homes. These include administrative responsibilities, such as meeting documentation requirements of the government and other relevant medical institutions and providing the residents and family members with staff contact information. Medical staffs are also mandated to assess the needs and capabilities of the residents under their care and assist in care planning and coordination. In providing the utmost care, medical staffs are urged to develop a plan for emergencies, implement an interdisciplinary approach to care which includes screening for diseases, prevention of accidents, palliative and hospice care, and schedule visits to the doctor. Health professionals are also developing clinical recommendations that can standardize the level of care across different nursing homes. While there are still many pitfalls in the practice and implementation of nursing homes, much is being done by the government and health care institutions to address these problems. The overall goal is to provide the elderly with a safe, stimulating, and healthy environment.

Long-Term Care

Long-term care, which encompasses nursing homes, home-care services, and other institutions have seen some major changes over the decades. In the United States, more elderly were being brought to nursing homes in the 1980s as compared to the present. This shift may be due to changes in health outcomes and also health financing. Due to advancements in health management and its accessibility, less elderly are impaired to a point requiring assistance. Long-term care facilities are also being replaced by acute care-related home services (Feder, Komisar, & Nierfeld, 2000).

Service utilization

Long-term care, as elaborated by Feder, Komisar, & Nierfeld (2000) targets people who are in need of assistance due to a variety of reasons. They may need assistance due to a chronic illness, or a physical or a mental disability, or due to the frailty and dependency of aging. Services offered by institutions for long-term care include assistance with activities of daily living, such as grooming, eating, bathing, and transport from one place to another. It may also include management of chronic conditions.

Consequences

Due to the burgeoning need for long-term care facilities, some problems have arisen with regards to the institutions. Feder, Komisar, & Niefeld (2000) enumerate some of these problems. First is the issue of unmet needs. People who need long-term care often do not get the care they need or prefer, possibly due to the lack of individualization of services. There is also a heavy financial burden on the family, due to some policies of health financing institutions that may not be advantageous to everyone. The continuous changing demographics are also to blame for some of these problems. The increasing number of the elderly population and the various chronic illnesses that are starting to develop and become prevalent do not match with the current number and quality of facilities. These also do not match with current Medicare and other health financing institutions’ policies. However, these problems are being continuously addressed by undertaking measures that improve the quality of nursing homes. Institutions and professionals are also developing ways to integrate acute and long-term care for a more overarching approach to health. The government is also taking steps towards expanding insurance for long-term care.

Meaning of experiences

Medicare (2008a) has developed criteria for ensuring that an elderly will be able to obtain the best experience possible from a nursing home. The checklist criteria includes evaluation of the nursing home for certifications by Medicare and Medicaid if the level of care and special services is appropriate to the resident, and its closeness of location to other family members. The checklist also helps the resident and the family members to evaluate other relevant aspects of a nursing home: the appearance of other residents, nursing home living spaces, staff, residents’ rooms, hallways, stairs, lounges, and bathrooms, menus and food, activities, and safety and care.

Respecting Resident’s Dignity

Medicare (2008b) lists the rights of residents living in nursing homes. Residents, first and foremost, have a right to be treated with dignity and respect. They have a right to be informed in writing about services and fees before entering the nursing home. They also have a right to manage their own money or choose someone else to do it. Residents have a right to privacy and a right to medical care which includes being informed about condition and medications, having the own doctor, and refusing treatment.

The right to privacy

A good nursing home will provide the residents the right to have personal belonging and/or furniture in their rooms, a storage space of their own, a choice of roommates, and policies and procedures to protect the possessions of the residents (Medicare, 2008a). Residents also have the right to confidentiality, wherein they are able to have private conversations with other residents and staff.

Noticing the little things

In choosing a nursing home, the littlest things may be of utmost value. Checking if residents are clean, appropriately dressed for the season or time of day, and well-groomed are important parameters that point to a quality nursing home. Gestures as simple as the staff knocking first before entering a resident’s room, or addressing residents by their names and looking them in the eye, can have a significant impact on residents’ experience in the nursing home (Medicare, 2008a).

Resident meetings

Resident meetings are also an important aspect of the total nursing home experience. Resident meetings provide venues for planning the care of the residents with the medical staff and the family members. It is also a good venue for interacting with other residents, voicing out concerns and complaints, and offering suggestions on how to improve the overall management of the nursing homes. For the elderly, it is also a source of cognitive stimulation, which may have long-term effects on their health.

Nutrition for Elders

Unwin, Porvaznik & Spoelhof (2010b) identify malnutrition and weight loss as factors that lead to major health complications such as pressure ulcers and infections. These problems are largely preventable if the proper food is made available. Apart from the nutritional value of food, other factors are also important in improving the nutrition of the elderly, such as an appealing eating environment, and staff assistance to those unable to eat.

How food heals

The nutritional status of individuals plays a large part in their overall health. Adequate and proper nutrition prevents illnesses such as those related to vitamin deficiencies, and caloric inadequacies or excesses. Kenkmann et al. (2010) hypothesized that interventions to make food served in nursing homes healthier would reduce the rate of falls, weight, hydration, anemia, cognitive status, depression and serum lipids. Quality and variety of food given to residents in nursing homes will guarantee that they do not develop deficiencies or excesses in their diets. It will also improve the eating experience and make food palatable to the elderly.

Physical therapy

One of the appeals of nursing homes is that it can offer the elderly activities that are designed especially for them. Because people in nursing homes are typically similar in age and health status, the institution is better able to develop activities suited for their residents.

Mayer et al. (2011) showed the importance of strength training among the elderly. Strength training increases muscle strength by increasing muscle mass, allowing them to perform more activities, including those needed for daily living. The study recommends that healthy old people should train 3 or 4 times a week, using up 60-85% of their maximum strength. Those with poor health can still achieve some improvement even with minimal training.

Activities that stimulate the brain are important in giving the residents of a nursing home a good experience. It may also improve their long-term health. Medicare (2008a) deems it important for a nursing home to provide a variety of activities that can anyone can participate into, including those that cannot leave their rooms. There should also be adequate outdoor areas that can provide visual and cognitive stimulation, and active volunteer programs wherein residents can continue to hone their skills and organizational planning.

Having amenities that are relevant to and suit the needs of prospective residents are very important in selecting the proper nursing home. Choosing a nursing home that is able to cultivate and nourish an individual’s interests will have a long-term impact on his or her health and quality of life.

Entertainment

Having a source of entertainment is vital in giving the elderly a meaningful experience. This could be as simple as having an area where the elderly could stay and do meaningful activities, such as reading, hearing or watching the news, or discussing with fellow residents. Nursing homes could also plan sports and leisure activities that will bring together the residents and their family members, giving them a chance to interact with each other and have fun at the same time.

Tools for staff and residents

Proper and adequate tools and materials for everyone in the nursing home are also crucial in contributing to the overall resident experience. Lack of materials may impede in the proper and efficient management of a nursing home, and may contribute to the souring of staff-resident relationships.

Providing the elderly with home-like surroundings will contribute greatly to their sense of well-being. It will make the pain of being separated from loved ones and being taken out of their routine easier to bear. Medicare (2008a) recommends looking for nursing homes wherein there are no unpleasant odors; rooms are clean and well-kept, the temperature is comfortable, there are good lighting and a comfortable level of noise, and furnishings are sturdy and comfortable.

Feeding the senses

Availability of things that could feed the senses of the residents in a nursing home makes a big difference. An outdoor area can help the residents feel calmer and at peace. A reading area can continue stimulating the minds of the residents. A place to do things like cooking, artworks, and sports will keep the elderly stimulated and with a heightened sense of well-being.

Visitations are very important as it provides the residents a constant link to their previous lives outside the nursing home. Keeping in constant touch with family and friends may help alleviate the fear of elderly people of being forgotten and left behind. It is also a source of communication with the outside world so that they can keep in touch with what is happening in their wider environments.

A safe and clean environment improves the health outcomes of residents in the nursing homes and gives them a better sense of security and wellbeing. Unwin, Porvaznik, & Spoelhof (2010a) includes in their clinical recommendations the provision of annual influenza vaccination and pneumococcal vaccination every five years to residents and two-step tuberculosis testing.

Alexander (2008) showed that the composition of the nursing home staff is directly related to the quality of care obtained by its residents. Both the level of staffing and the mix of staff are important. It has also been shown that more residents with additional needs for assistance with activities of daily living were identified in nursing homes staffed with more licensed nurses. Other health concerns such as pain due to chronic illness and pressure ulcers due to immobilization are lessened in the presence of more licensed nurses.

Security officials

While currently security officials in nursing homes are not yet very popular, Centers for Medicare and Medicaid Services (2011) mandates that health inspections are done to check if adequate care is given by the staff to residents. This includes evaluating how the staff treats residents, the activities and daily life of residents, the condition of resident rooms and cleanliness, sanitation, and maintenance of the nursing home. This is accomplished by reviewing clinical records, interviewing residents, family members, and staff.

In choosing nursing homes, other security issues to address include the following: nursing home is in a safe location, personal belongings are secure in a room, and the nursing home is locked at night.

Nursing homes should also be prepared for emergencies. Medicare (2008a) recommends that nursing homes should have exits that are clearly marked, smoke detectors and sprinklers, handrails in the hallways and grab bars in the bathrooms. They also recommend having an emergency evacuation plan and holding regular fire drills. It is also best to have arrangements with nearby hospitals for emergencies.

Openness Free From Fear

The Centers for Medicare and Medicaid Services (2011) lists the minimum rights of a resident. Residents should be treated with respect, be able to participate in activities and be free from discrimination. They should be free from abuse and neglect, which includes being free from restraints and being able to make complaints. Residents also have a right to proper medical care and social services. They have a right to manage their money, get proper privacy, property, and living arrangements, spend time with visitors, leave the nursing home, have protections against unfair transfer or discharge, form or participate in resident groups, and have family and friends involved.

Restraints

Unwin, Porvaznik & Spoelhof (2010b) includes in their clinical recommendation that in nonemergency situations, physical restraints should only be used if there is no safer alternative, and only upon careful review and assessment of the case. Gulpers et al. (2010) questions the use of restraints as safety measures. Studies have shown that they do not reduce falls or fall-related injuries, have multiple negative effects on the elderly, associated with pressure sores, loss of muscle strength and endurance, demoralization, low self-esteem, and impaired social functioning. Currently, attempts are being made to reduce the use of restraints in clinical practice. This is done by targeting residents’ underlying problems and training the staff on how to handle different situations that previously may have required the use of restraints

Threats and intimidation

Threats and intimidation may be a bigger problem in nursing homes than is reflected in mass media. In Safety Forum (2009) one person narrates his mother’s negative experiences while living in a nursing home. This mostly consists of delay in responding to call for help and rude behavior from the staff. The staff had also sometimes put pressure on residents, urging them to do things on their own even if they clearly could not because of their physical conditions. A responder suggested that this may be due to the fact that anyone in the health services can work in a nursing home. Staff selection is not very stringent. In light of this, it is all the most important the carefully select a nursing home for a loved one. People who witness such threats and intimidation should also not hesitate in reporting to the officials.

Conclusion

Nursing homes have been utilized by the society for many decades now. Its unique organization allows elderly people’s special needs to be addressed, and allows the residents to interact with people who have the same conditions. However, the evolution of health care, changes in demographics, and new policies regarding health financing has led to some problems in the management and utility of nursing homes. Some of these problems include unmet needs, inaccessibility to some groups, and inadequacy of the facilities to adapt to the changing demographics and society. To address this, the government, healthcare professionals, and various institutions are doing their best to rise up to the challenges in nursing home care.

While nursing homes should generally provide a safe and nurturing environment for the society’s elderly, the possibility of abuse and neglect inside the nursing homes threaten some families. These realities should be acknowledged and addressed rather than glossed over, so that action could be initiated against it. This should also highlight the importance of proper selection of a nursing home, tailored to the needs of each individual elderly.

References

Alexander, G. L. (2008). An analysis of nursing home quality measures and staffing. Quality Management in Health Care, 17(3), 242-251.

Centers for Medicare and Medicaid Services. (2011). Your guide to choosing a nursing home. Baltimore, Maryland.

Gulpers, M. J., Bleijlevens, M. H., van Rossum, E., Capezuti, E. & Hamers, J. P. (2010). Belt restraint reduction in nursing homes: design of a quasi-experimental study. Biomed Central Geriatrics, 10(11), 1-6.

Kenkmann, A., Price, G. M., Bolton, J., & Hooper, L. (2010). Health, wellbeing, and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision. Biomed Central Geriatrics, 10(28), 1-16.

Mayer, F., Scharhag-Rosenberger, F., Carlsohn, A., et al. (2011). The intensity and effects of strength training in the elderly. Dtsch Arztebl Int, 108(21), 359-364.

Medicare. (2008a). Nursing Home Checklist. Retrieved from http://www.medicare.gov/Nursing/Checklist.pdf.

Medicare. (2008b). Nursing Homes: Resident Rights. Retrieved from http://www.medicare.gov/nursing/ResidentRights.asp.

Unwin, B. K., Porvaznik, M. & Spoelhof, G. D. (2010a). Nursing home care: part I, principles and pitfalls of practice. American Family Physician, 81(10), 1219-1227.

Unwin, B. K., Porvaznik, M. & Spoelhof, G. D. (2010b). Nursing home care: part II, clinical aspects. American Family Physician, 81(10), 1229-1237.

Safety Forum. (2009, April 20). My mom’s experience in a nursing home. Message posted to http://sfdiscussions.proboards.com/index.cgi?board=nursinghome&action=display&thread=510.