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The Nursing Assistant in Long-Term Care

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The Nursing Assistant in Long-Term Care 1. Compare long-term care to other healthcare settings Welcome to the world of health care. Health care happens in many places. Nursing assistants work in many of these settings. In each setting similar tasks will be performed. However, each setting is also unique. This textbook will focus on long-term care. Long-term care (LTC) is given in long-term care facilities (LTCFs) for persons who need 24-hour skilled care. Skilled care is medically necessary care given by a skilled nurse or therapist; it is available 24 hours a day. It is ordered by a doctor and involves a treatment plan. This type of care is given to people who need a high level of care for ongoing conditions. The term nursing homes was once widely used to refer to these facilities. Now they are often known as long-term care facilities, skilled nursing facilities, rehabilitation centers, or extended care facilities. People who live in long-term care facilities may be disabled. They are often elderly, but younger adults sometimes require long-term care, too. They may arrive from hospitals or other healthcare settings. Their length of stay (the number of days a person stays in a care facility) may be short, such as a few days or months, or longer than six months. Some of these people will have a terminal illness. This means that the illness will eventually cause death. Other people may recover and return to their homes or to other care facilities or situations. Most people who live in long-term care facilities have chronic conditions. This means the conditions last a long period of time, even a lifetime. Chronic conditions include physical disabilities, heart disease, and dementia. (Chapters 4 and 5 have more information about these disorders and diseases.) People who live in these facilities are usually referred to as residents because the facility is where they reside or live. These places are their homes for the duration of their stay. People who need long-term care will have different diagnoses, or medical conditions determined by a doctor. The stages of illnesses or diseases affect how sick people are and how much care they will need. The jobs of nursing assistants will also vary. This is due to the fact that each person has different symptoms, abilities, and needs. Other healthcare settings include the following: Home health care is provided in a person’s home (Fig. 1-1). This type of care is also generally given to people who are older and are chronically ill but who are able to and wish to remain at home. Home care may also be needed when a person is weak after a recent hospital stay. Home care includes many of the services offered in other settings. Fig. 1-1. Home care is performed in a person’s home. Assisted living facilities are residences for people who need some help with daily care, such as showers, meals, and dressing. Help with medications may also be given. People who live in these facilities do not need 24-hour skilled care. Assisted living facilities allow more independent living in a home-like environment. An assisted living facility may be attached to a long-term care facility, or it may stand alone. Adult day services are for people who need some help and supervision during certain hours, but who do not live in the facility where care is provided. Generally, adult day services are for people who are not seriously ill or disabled. Adult day services can also provide a break for spouses, family members, and friends. Acute care is 24-hour skilled care given in hospitals and ambulatory surgical centers. It is for people who require short-term, immediate care for illnesses or injuries (Fig. 1-2). People are also admitted for short stays for surgery. Fig. 1-2. Acute care is performed in hospitals for illnesses or injuries that require immediate care. Subacute care is care given in a hospital or in a long-term care facility. It is used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness. Treatment usually ends when the condition has stabilized or after the set time for treatment has been completed. The cost is usually less than a hospital but more than long-term care. Outpatient care is usually given for less than 24 hours. It is for people who have had treatments or surgery and need short-term skilled care. Rehabilitation is care given by specialists. Physical, occupational, and speech therapists restore or improve function after an illness or injury. Chapter 9 has information about rehabilitation. Hospice care is given in facilities or homes for people who have about six months or less to live. Hospice workers give physical and emotional care and comfort. They also support families. Information about hospice care can be found in Chapter 3. 2. Describe a typical long-term care facility Long-term care facilities (LTCFs) are businesses that provide skilled nursing care 24 hours a day. These facilities may offer assisted living housing, dementia care, or subacute care. Some facilities offer specialized care. Others care for all types of residents. The typical long-term care facility offers personal care for all residents and focused care for residents with special needs. Personal care includes bathing, skin, nail and hair care, and assistance with walking, eating, dressing, transferring, and toileting. All of these daily personal care tasks are called activities of daily living, or ADLs. Other common services offered at these facilities include the following: • Physical, occupational, and speech therapy • Wound care • Care of different types of tubes, such as catheters (thin tubes inserted into the body to drain fluids or inject fluids) • Nutrition therapy • Management of chronic diseases, such as Alzheimer’s disease, AIDS, diabetes, chronic obstructive pulmonary disease (COPD), cancer, and congestive heart failure (CHF) When specialized care is offered at long-term care facilities, the employees must have special training. Residents with similar needs may be placed in units together. Non-profit companies or for-profit companies can own long-term care facilities.

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,
, federal guidelines concerning healthcare practices. These
ii guidelines change, and it is the reader’s responsibility to be
aware of these changes and of the policies and procedures of his
or her healthcare facility.
The publisher, authors, editors, and reviewers cannot accept any
responsibility for errors or omissions or for any consequences
Credits from application of the information in this book and make no
Managing Editor warranty, express or implied, with respect to the contents of the
Susan Alvare Hedman book. The publisher does not warrant or guarantee any of the
Designer products described herein or perform any analysis in connection
with any of the product information contained herein.
Kirsten Browne
Special Thanks
Cover Illustrator Jo
A heartfelt thank you goes to our insightful and wonderful
Tronc
reviewers, listed in alphabetical order:
Production
Theresa J. DeBon, RN, BS
Thad Castillo
Tulsa, OK
Photography
Ruth Hardke, RN
Matt Pence, Pat Berrett, Art Clifton, and Dick Ruddy
Stow, OH
Proofreaders
Charles Illian, RN, BSN, Infection Preventionist
Kristin Calderon, Kristin Cartwright, Melanie Futrell, and
Orlando, FL
Eliza Martin
Marie Johnston, RN
Sales/Marketing
Harrisburg, PA
Deborah Rinker, Kendra Robertson, Erika Walker, and
Belinda Midyette Sally Lyle, RN, BSN
Rock Hill, SC
Customer Service
Fran Desmond, Thomas Noble, Angela Storey, Wendy Pickard-Tanios, RN, BS, ONC
Eliza Martin, and Chris Whitlock Round Rock, TX
Warehouse Coordinator Chris Christine A. Smith, RN, MSN
Midyette Poquoson, VA
We are very appreciative of the many sources who shared
Copyright Information
their informative photos with us:
© 2014 by Hartman Publishing, Inc.
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Albuquerque, NM 87102 (505) 291- • Detecto
1274 web: hartmanonline.com email:
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• Exergen Corporation
All rights reserved. No part of this book may be reproduced, in
• Harrisburg Area Community College
any form or by any means, without permission in writing from
the publisher. • Dr. James Heilman
ISBN 978-1-60425-050-3 PRINTED IN • Hollister Incorporated
THE USA • Invacare Corporation
• Medline Industries • National Pressure Ulcer Advisory
Notice to Readers
Panel
Though the guidelines and procedures contained in this text are
based on consultations with healthcare professionals, they • North Coast Medical, Inc.
should not be considered absolute recommendations. The
instructor and readers should follow employer, local, state, and • Nova Medical Products

, . Describe a typical long-term care facility 2
• RG Medical Diagnostics of Wixom, MI
• Starkey Hearing Technologies . Explain Medicare and Medicaid 3

• Vancare, Inc. . Describe the nursing assistant’s role 3

• Welch Allyn . Describe the care team and the chain of
command 5
. Define policies, procedures, and professionalism 7
Contents Page Learning Objective Page . List examples of legal and ethical behavior and
Gender Usage explain Residents’ Rights 10
This textbook utilizes the pronouns he, his, she, and her . Explain legal aspects of the resident’s medical
interchangeably to denote healthcare team members and record 17
residents.
. Explain the Minimum Data Set (MDS) 19
1 The Nursing Assistant in Long-Term . Discuss incident reports 19
Care
1. Compare long-term care to other healthcare Foundations of Resident Care
settings 1
. Understand the importance of verbal and
2 written communications 20
3 . Describe barriers to communication 23

4
. List guidelines for communicating with
5 residents with special needs 25
. Identify ways to promote safety and handle
6 non-medical emergencies 30
7 . Demonstrate how to recognize and respond to
medical emergencies 35
8 . Describe and demonstrate infection prevention
practices 44
9 10
Understanding Residents
. Identify basic human needs 58
2
. Define holistic care 60
1
. Explain why promoting independence and
self-care is important 60
2
. Identify ways to accommodate cultural
3
differences 61
. Describe the need for activity 62
4
. Discuss family roles and their significance in
5 health care 63
3

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