Nursing Home Care

Aka: Nursing Home Care, Nursing Home Management, Nursing Home, Skilled Nursing Facility, Transitional Care Unit, Intermediate Care Facility, Long-Term Care Facility, Longterm Care

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II. Definitions

  1. Longterm Care Facility
    1. Healthcare facility attending to patients and residents in need of ADL assistance
    2. May offer rehabilitation, skilled nursing care, and adjunctive health and social services
    3. Includes various levels of care from SNF and TCU to Nursing Homes and intermediate care
  2. Skilled Nursing Facility (SNF)
    1. Facility offering continuous 24 hour nursing, with medical supervision and adjunctive health and social services
    2. Provides a level of care below acute hospital care and above intermediate care and custodial care
    3. Intended for rehabilitation to greater functional capacity in ADLs and self care (often as a TCU stay after hospitalization)
    4. Tailored services based on patient needs include physical therapy, occupational therapy, speech therapy
    5. SNF in U.S. are typically Medicare certified to provide subacute care and rehabilitation services
  3. Transitional Care Unit (TCU)
    1. Short-term care (typically up to 21-28 days) in a Skilled Nursing Facility
    2. Intended for medically complex patients, typically recovering after hospitalization or surgery
  4. Intermediate Care Facility
    1. Facility offers 24 hours health-related care and services below the level of hospitals and skilled nursing facilities
    2. Intended for patients with physical, cognitive or mental health conditions requiring more than routine custodial care (room and board)
  5. Nursing Home
    1. Facility offering continuous, Longterm Care to patients unable to perform Activities of Daily Living
    2. Intended for patients with chronic, physical and mental health limitations, not requiring acute or subacute care
    3. Most U.S. Nursing Homes have 24 hour care with nursing assistants and nurse supervision, as well as dining services
    4. Most Nursing Homes also offer additional services, such as physical therapy, occupational therapy, speech therapy

III. Management: Dementia and Behavior

  1. See Dementia Management
  2. See No-fail Environment in Dementia
  3. See Dementia Related Malnutrition
  4. See Agitation in Dementia
  5. See Sleep Problems in Dementia
  6. See Wandering Behavior in Dementia

IV. Management: Infectious Disease

  1. See Pneumonia Management in the Nursing Home Resident
  2. See Infection in the Nursing Home Resident
  3. See Infections in Older Adults

V. Management: Medications

  1. See Medication Use in the Elderly (STOPP, Beer's List)
  2. See Polypharmacy
  3. See Drug-Drug Interactions in the Elderly
  4. See Medication Causes of Delirium in the Elderly

VI. Prevention

  1. Fitness, Function and Fall Prevention
    1. See Frailty
    2. See Exercise in the Elderly
    3. See Strength Training in the Elderly
    4. See Geriatric Balance Training
  2. Vaccination
    1. Influenza Vaccine for all residents and staff annually
    2. Covid Vaccine
    3. Pneumococcal PolysaccharideVaccine (Pneumovax)
    4. Herpes Zoster Vaccine (Zostavax)
  3. Prevent Methicillin Resistant Staphylococcal Aureus (MRSA)
    1. Strict Handwashing practices by residents, guests, staff
    2. Barrier precautions for wounds and medical devices
    3. No routine screening, isolation, or aggressive housekeeping

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