Rest home for seniors in Český Těšín, Czech Republic
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A nursing home, convalescent home, skilled nursing unit (SNU), care home, rest home, intermediate care, or old folk's home[1] provides a type of residential care. They are a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living[citation needed]. Nursing aides and skilled nurses are usually available 24 hours a day.
Residents include the elderly and younger adults with physical or mental disabilities. Residents in a skilled nursing facility may also receive physical, occupational, and other rehabilitative therapies following an accident or illness. Some nursing homes assist people with special needs, such as Alzheimer patients.[2]
Residents may have certain legal rights depending on the nation the facility is in.
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Contents
- 1 Canada
- 2 United Kingdom
- 3 United States
- 3.1 Services
- 3.2 U.S. Government regulations and oversight
- 3.3 Consumer choices
- 3.4 User Reviews
- 3.5 Quality of life
- 3.5.1 Task-oriented care
- 3.5.2 Resident-oriented care
- 3.5.2.1 Scientific findings
- 4 See also
- 5 References
- 6 External links
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Canada
Quebec
Long-term care facilities exist under three types, public, subsidized and private. Public and subsidized differ only in their ownership, all other aspects of funding, admission criteria, cost to the individuals are all regulated by the Quebec Ministry of Health and Social Services[3].. Private facilities are completely independent from government ownership and funding, they have their own admission criteria. They must maintain certain provincial[clarification needed] standards and require licensing from the ministry.
United Kingdom
In 2002 nursing homes became known as care homes with nursing, and residential homes became known as care homes.[4]
In the United Kingdom care homes and care homes with nursing are regulated by different organisations in England, Scotland, Wales and Northern Ireland. To enter a care home, a candidate patient needs an assessment of needs and of their financial condition from their local council. The candidate may also have an assessment by a nurse, should the patient require nursing care. The cost of a care home is means tested in England.
As of April 2009 in England, the lower capital limit is £13,500. At this level, all income from pensions, savings, benefits and other sources, except a "personal expenses allowance" (currently £21.90), will go to paying the care home fees. The local council pays the remaining contribution provided the room occupied is not more expensive than the local council's normal rate, currently £364.48 for Hampshire for example. If the resident is paying more than this the council will not pay anything and contributions from a third party or charity must be found or the resident move to a cheaper care home. Between the lower and the upper capital limits, the resident pays their income less personal expenses allowance + £1/week for every £250 capital between lower and higher limit. The council pays the rest, subject to the same conditions as before. It is therefore preferable to find a home within the council's limit if council funding is likely to be required to avoid a forced move later. Patients with capital over more than £23,000 pay the full cost of the care home, until the total value of their assets fall below the threshold.[5] Patients who require additional nursing care are assessed for this (Hampshire nursing limit 2009 £483pw) and receive additional financial support (£103.80pw) through the National Health Service (NHS); this is known as Funded Nursing Care.
The NHS has full responsibility for funding the whole placement if the resident in a care home with nursing meets the criteria for NHS continuing Health Care. This is identified by a multi-disciplinary assessment process as detailed on the DOH website.
Care homes for adults in England are regulated by Care Quality Commission, which replaced the Commission for Social Care Inspection, and each care home is inspected at least every three years. In Wales the Care Standards Inspectorate for Wales has responsibility for oversight, In Scotland Social Care and Social Work Improvement Scotland otherwise known as the Care Inspectorate, and in Northern Ireland the Regulation and Quality Improvement Authority in Northern Ireland.
In May 2010, the Coalition Government announced the formation of an independent commission on the funding of long-term care, which is due to report within a 12-month timeframe on the financing of care for an Ageing population. The Care Quality Commission have themselves implemented a re-registration process, completed in October 2010, which will result in a new form of regulation being outlined in April 2011.[citation needed]
United States
In the United States, a "Skilled Nursing Facility" or "SNF" is a nursing home certified to participate in, and be reimbursed by Medicare. Medicare is the federal program primarily for the aged who contributed to Social Security and Medicare while they were employed. A "Nursing Facility" or "NF" is a nursing home certified to participate in, and be reimbursed by Medicaid. Medicaid is the federal program implemented with each State to provide health care and related services to those who are "poor." Each State defines poverty and; therefore, Medicaid eligibility. Those eligible for Medicaid may be aged, disabled or children (e.g. State Children's Health Insurance Programs - SCHIPs, and Maternal-Child wellness and food programs).[citation needed]
Each state licenses its nursing homes, making them subject to the state's laws and regulations. Nursing homes may choose to participate in Medicare and/or Medicaid. If they pass a survey (inspection), they are "certified" and are also subject to federal laws and regulations. All or part of a nursing home may participate in Medicare and/or Medicaid.[citation needed]
In the United States, nursing homes which participate in Medicare and/or Medicaid are required to have Licensed practical nurses (LPNs) (in some States designated "vocational nurses" or "LVNs") on duty 24 hours a day. For at least 8 hours per day, 7 days per week, there must be a registered nurse on duty. Nursing homes are managed by a Licensed Nursing Home Administrator. There are no standardized training and licensing requirements for administrators, though most states require a Federal License, and many states such as California have their own licensure for administrators.[citation needed] On April 18, 2005 there were a total of 16,094 nursing homes in the United States, down from 16,516 on December 12, 2002.[citation needed]
There are states that have other levels of care offered to elderly and other adults who need assistance and are able to live in the community. For instance, Connecticut has Residential Care Homes or RCH that are licensed by the State Department of Public Health. These homes provide 24-hour supervision and typically offer a more "home-like" environment. Many are actually large homes that have been converted to dwellings that offer a residential community that promotes an independent lifestyle and fosters fellowship with others who need some form of assistance to live in the community.[6]
Services
Services provided in nursing homes include services of nurses, nursing aides and assistants; physical, occupational and speech therapists; social workers and recreational assistants; and room and board. Nursing homes also provide transportation.[7] Most care in nursing facilities is provided by CNAs (certified nursing assistants), not by skilled personnel. In 2004, there were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were 7 per 100 resident beds and 13 per 100 resident beds, respectively.
A nursing home minibus, Pittsfield Township, Michigan
Nursing homes that participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[8] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified to participate in Medicare, Medicaid, or both.
Medicare covers nursing home services for up to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hospitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary needs daily skilled nursing care or other skilled rehabilitation services that are related to the hospitalization, and that these services, as a practical matter, can be provided only on an inpatient basis. For example, a beneficiary released from the hospital after a stroke and in need of physical therapy, or a beneficiary in need of skilled nursing care for wound treatment following a surgical procedure, might be eligible for Medicare-covered SNF care.[citation needed]
SNF services may be offered in a free-standing or hospital-based facility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care insurance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.
Medicaid also covers nursing home care for certain persons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 24-hour care.
The cost of staying in a nursing home can be equal to several thousand US dollars per month or more.[9] In fact, cheaper nursing homes cost about US$45,000 a year, whereas the most expensive ones can cost up to US$200,000 per year.[10] Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover continued stays in nursing home for these individuals for life. However, they require that the patient be "spent down" to a low asset level first by either depleting their life savings or asset-protecting them, often using an elder law attorney.
U.S. Government regulations and oversight
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors. State surveyors may inspect for compliance with licensure (State regulations) and/or certification (Medicare and Medicaid regulations).[citation needed]
The "Mininimum Data Set" assessment (MDS) is part of the U.S. federally mandated process for comprehensive assessment of all residents in Medicare or Medicaid certified nursing homes. The MDS assessment is a screening assessment that forms the basis of a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify and help residents meet or cope with health and other needs. The MDS also yields "Resource Utilization Groups" (RUGS) which are used for all Medicare reimbursement to SNFs, and is used in many States to set reimbursement for NFs.[citation needed]
For United States SNFs and NFs, the Centers for Medicare and Medicaid Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below). CMS also publishes a list of Special Focus Facilities - nursing homes with "a history of serious quality issues."[11][12] The US Government Accountability Office (GAO), however, has found that state nursing home inspections understate the number of serious nursing home problems that present a danger to residents. The GAO concluded that while CMS oversight has improved, there are still weaknesses in its oversight of nursing homes.[13][14] A report issued in September 2008 found that over 90% of nursing homes were cited for federal health or safety violations in 2007, with about 17% of nursing homes having deficiencies causing "actual harm or immediate jeopardy" to patients.[15]
SNFs and NFs are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the United States (the other being the nuclear power industry).[16]
Consumer choices
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This section does not cite any references or sources. (August 2009) |
Current trends are to provide people with significant needs for long term supports and services with a variety of living arrangements. Indeed, research in the U.S. as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursing agencies may be able to provide live-in nurses to stay and work with patients in their own homes.
When considering living arrangements for those who are unable to live by themselves, potential customers consider it to be important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently. While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.
Beginning in 2002, Medicare began hosting an online comparison site intended to foster quality improving competition between nursing homes.[citation needed]
Trends
In 2012 in the U.S. a few nursing homes are beginning to change the way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less institutional or "hospital-like." In these homes, units are replaced with a small set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have more choices about when they wake, when they eat, and their schedule for the day. They also have access to pets. The facilities utilizing these models may refer to such changes as the "Culture Shift" or "Culture Change" occurring in the Long Term Care, or LTC, industry. Sometimes this kind of nursing home is called a "greenhouse."[citation needed]
User Reviews
In addition to the Medicare Ratings, after the advent of social internet, websites have made it possible for families and seniors to submit user reviews about nursing homes. The largest such a repository of user reviews in the United States can be found in the external links section.[citation needed]
Quality of life
Task-oriented care
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This section does not cite any references or sources. (August 2009) |
Task oriented care is where nurses are assigned specific tasks to perform for numerous residents on a specific ward. Residents in this particular situation are exposed to multiple nurses at any given time. Because they cover a lot of patients, nurses do not develop an in depth relationship with any particular resident. Licensed (vocational) nurse training in the United States is task oriented. The primary care giver in a certified nursing home is a "Certified Nurses Aide" (CNA).[17] CNAs receive a minimum of 75 hours of didactic and practical task-oriented training and must pass an oral or written test.[18]
Resident-oriented care
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This section does not cite any references or sources. (August 2009) |
Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patients in an institution. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical. In contrast, institutional care is institution-centered. The focus is staff convenience and efficiency. Staff perform tasks rather than interact with residents to achieve desirable resident outcomes. Where resident-centered staff know residents by name, institutional staff identify residents by room number, diagnosis, or a task like "feeders" for residents who need help to eat.
Scientific findings
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This section does not cite any references or sources. (August 2009) |
According to various findings residents who receive resident-oriented care experience a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Once they experience it, nurses often prefer resident-oriented settings, too. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows them to dispel many feelings of loneliness and discontent.
"Resident assignment" refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this system can cause difficulties for the nurse or care-giver should one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are caring for.
Various findings suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of whom to disclose information to and as a result decide not to share information at all. Patients usually complain of loneliness and feelings of displacement.
See also
- American Geriatrics Society
- American Health Care Association
- American Society of Consultant Pharmacists
- Care Quality Commission previously known as Commission for Social Care Inspection
- Certified Medical Director
- Eldercare
- Home care
- International Association for Homes and Services for the Aging
- List of companies operating nursing homes
- Retirement village
References
- ^ "old people's home - Definition from Longman English Dictionary Online". Ldoceonline.com. http://www.ldoceonline.com/dictionary/old-people-s-home. Retrieved 2012-05-12.
- ^ "Nursing Homes". MedlinePlus. http://www.nlm.nih.gov/medlineplus/nursinghomes.html. Retrieved 2012-15-06.
- ^ "IndexSanté". http://www.indexsante.ca/articles/article-126.html. Retrieved 8 March 2012.
- ^ "NHS Continuing Healthcare, NHS funded healthcare and intermediate care,". Age Concern. August 2007. http://www.ipbh.org.uk/healthsocialcare/documents/NHScontinuinghealthcareNHS-fundednursingcareandintermediatecare.pdf.
- ^ Compare Care Homes Advice. "‘Funding a Care Home’ – a comprehensive financial guidance leaflet from Comparecarehomes.com." (PDF). http://www.comparecarehomes.com/images/CCH-finance%20detailed.pdf. Retrieved 01 March 2010.
- ^ "http". Carch.Net. http://carch.net. Retrieved 2012-05-12.
- ^ http://www.dhhs.state.sc.us/internet/pdf/NURSING%20HOME%20FAQs.pdf
- ^ 42 CFR Part 483
- ^ "ConsumerAffairs.com". ConsumerAffairs.com. http://www.consumeraffairs.com/news04/nursing_home_costs.html. Retrieved 2012-05-12.
- ^ "Care Communities". Care Communities. http://www.carecommunities.net/financing-senior-care/. Retrieved 2012-05-12.
- ^ Special Focus Facility (“SFF”) Initiative, Centers for Medicare and Medicaid Services (accessed 4/24/2008)
- ^ "Medicare: CMS Adds Searchable Database of Lowest-Quality Nursing Homes Nationwide to Web Site," Kaiser Daily Health Policy Report, Kaiser Family Foundation, April 24, 2008
- ^ United States Government Accountability Office, "NURSING HOMES: Federal Monitoring Surveys Demonstrate Continued Understatement of Serious Care Problems and CMS Oversight Weaknesses," GAO-08-517, May 2008 (GAO Summary)
- ^ "Coverage & Access | Inspectors Often Overlook Serious Deficiencies at U.S. Nursing Homes, GAO Report Finds," Kaiser Daily Health Policy Report, Kaiser Family Foundation, May 15, 2008
- ^ Robert Pear, "Violations Reported at 94% of Nursing Homes," The New York Times, September 29, 2008
- ^ NFPA Journal - Behind Closed Doors
- ^ Certified Nursing Assistant Information site
- ^ "CNA Certification", Retrieved on 27 October 2005.
External links
Australia
- Aged Care Facilities Australia - Health and Aged Assist
United Kingdom
- Care Home Review Service — Reviews, ratings and CQC's inspection reports of care homes in the UK
- MHA Charity providing care — Amongst the largest charities in Britain, providing services and specialist dementia care to older people for nearly 70 years
- Directory of Care Homes and Care Agencies — Directory of Nursing Homes, Care Homes and Care Agencies
United States
- Nursing Home Compare Tool — Medicare's past performance results of every certified nursing home in the USA
