Medical Issues in Long Term Care

WHAT DO MEDICAL ISSUES HAVE TO DO WITH NURSING FACILITIES?

Medical needs and issues have everything to do with today's nursing facilities. In years past, nursing facilities were simply places to which old people without families were sent. Today's nursing facility is a thoroughly modern approach, based on the fact that modern medicine is able to extend people's lives and keep them active longer then ever before. But individuals with multiple chronic medical problems and those who are taking multiple medications need both social and physical stimulation, as well as medical monitoring, to ensure that they are able to enjoy their lives to the fullest extent possible.

Through trained and licensed staff, nursing facilities monitor all the various infirmities of residents and their medications, and stay in touch with the physicians who are the only ones who can prescribe medication and other treatments. In addition, the nursing facility staff works very hard to involve residents in every possible type of social activity so that their lives are enriched.

Unlike nursing facilities, however, places called assisted living facilities or "adult foster care" are not licensed to offer these same services. Regulations may change soon, so check with a facility in your area, or call the Texas Health Care Association office at 800-380-2500 for more information.

ARE THERE DIFFERENT TYPES OF NURSING FACILITIES?

In most cases, no, only different programs and services offered. Any facility licensed as a nursing facility must undergo stringent state and federal government licensing regulations. They are not only monitored by the Texas Department of Human Services, but also by the U.S. Department of Health and Human Services, the U.S. Occupational Safety and Health Administration (OSHA), state and local fire safety agencies, and a variety of other government agencies. In all, there are about two dozen agencies monitoring licensed facilities on a regular basis.

 The main differences you will find have to do with financing and specialties offered. For example, a facility that has a wing or unit certified for Medicare must - on that wing - meet higher staffing requirements than on wings certified for Medicaid. But both wings must meet the stringent requirements of 24-hour-a-day licensed nursing care.

While all nursing facilities provide general medical and social services to residents, they may also specialize in care for certain types of residents- such as those who need physical therapy, Alzheimer's care, or other specific types of care. In general, you will find that most nursing facilities offer a variety of specialized services. It is up to you, however, to ask about the availability of specialized services.

WHAT IS NURSING CARE?

Nursing care requires the professional skills of a registered nurse or a licensed vocational nurse. These include administering medications, injections, catheterizations, and similar procedures ordered by the attending physician.

WHAT KIND OF TRAINING DO NURSES AND NURSE AIDES RECEIVE BEFORE BECOMING EMPLOYED?

Registered nurses (RN) must, at a minimum, complete 2 - 4 years of training in an accredited program at a college or hospital. An RN must pass a licensure exam administered by the Texas Board of Nurse Examiners (BNE) and maintain a license through the BNE.

Licensed Vocational Nurses (LVN) must complete one to two years of training. They must also pass a licensure examination administered by the Board of Vocational Nurse Examiners and one year of training.

Certified Nursing Assistants (CNAs) must complete an 75-hour certification training program that focuses on care of the elderly and those with long term care needs. Certified nurse aides must take additional training in order to administer medication.

RNs, LVNs, and nurse aides must meet continuing education requirements in order to maintain their credentials.

Primary caregivers in most Adult Foster Care homes are not required to go through any sort of training prior to becoming a caregiver.

WHAT ABOUT MEDICAL CARE?

Specific types of care and services include Subacute Units, Transitional Care, and Alzheimer's specialty units.

Post-hospital stroke, heart, or orthopedic care is usually available with related services such as physical therapy, occupational therapy, dental services, laboratory and X-ray services. Be sure to ask about the cost, as these services are not part of the care covered by the facility contract and the monthly fee. Most transitional care is paid for by Medicare and/or Managed Care contracts.

WHO DECIDES WHICH ACTIVITIES THE RESIDENT CAN PARTICIPATE IN?

The resident's physician should be consulted as to the level of activity that would be appropriate for the resident's physical condition. His or her interests and level of comfort should also be considered. A plan of care will be developed by the appropriate staff.

WHO DETERMINES WHETHER THE RESIDENT'S CONDITION HAS IMPROVED TO THE POINT THAT HE OR SHE CAN RETURN HOME, OR TO A FACILITY WITH A LESS INTENSIVE LEVEL OF CARE.

The resident's physician, along with the resident, his or her family, and the nursing facility staff will develop a relationship in which such decisions are made. Adult residents have the same rights as any adult, especially the right to self determination. So this should be given the highest consideration.

WHAT ABOUT SPECIAL DIETS

The resident's physician will give dietary instructions to the nursing facility staff. You and the resident can also provide a list of favorite and least favorite foods to the dietary staff.

WHAT IS AN ADVANCE DIRECTIVE?

An advance directive provides nursing facility staff, medical staff, and relatives with information about what treatment the resident does and does not want in terminal or irreversible conditions, such as a stroke or coma, that would prevent the resident from telling the doctor how he or she wants to be treated.

Competent adults have the right to refuse or accept medical treatment. However, there is growing concern over how medical care decisions will be made when people are unable to make decisions for themselves. Today, medical technology presents options of a number of treatments that prolong life. Some people do not want such treatment; others wish to take advantage of every treatment available. Often, decisions must be made when the patient is no longer able to state preferences. Approximately 50% of residents and patients in Texas nursing facilities have advance directives in effect.

There are three types of advance directives available in Texas. They are:

• Directive to Physician (Living Will),

• Medical Power of Attorney, and

• Out of Hospital Do Not Resuscitate Order (OHDNR).

Copies of these signed documents should be on file with the nursing facility, the resident's physician, and in the resident's medical record.

A Directive to Physician (Living Will) helps to ensure that if, at any time, the resident has an irreversible or terminal condition, and that death is imminent, his or her wishes will be carried out.

An Out of Hospital Do Not Resuscitate Order is a physician's order. It directs health care entities other than hospitals not to resuscitate the individual. An OHDNR is executed between an individual and his or her physician and the individual must be certified as having a terminal condition by the physician.

A Medical Power of Attorney appoints a specific person to make health care decisions for the resident if the resident becomes unable to make such decisions.

DO I NEED A LAWYER TO EXECUTE ADVANCE DIRECTIVES?

No. These documents are meant to be easy to complete without the need for an attorney's assistance. The nursing facility administrator can answer any questions you may have.

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