Acute Long Term Skilled Care: A Case Study

Nurse Practitioners (NPs) play a key role in long term health care by ensuring provision of holistic healthcare services particularly in remote areas and in those areas that have few physicians. Currently, there is a concern where there is a shortage of physicians in nursing homes and in other critical health care services questioning the care being provided (Colwill, Cultice, & Kruse, 2008). Due to population growth,

The purpose of this paper is to identify the type of facility and the resident being served. In addition, this paper will identify the role of the Nurse Practitioner (NP), and the regulatory issues as it supports this role.

Nurse practitioners work with other doctors to ensure that patients stay healthy or become healthier once again. Due to their training in clinical medicine, nurse practitioners are able to make diagnoses and treat patients for many different health problems (Family Nurse Practitioner (FNP), n.d.). Although nurse practitioners are not doctors, they are advanced registered nurses. The description of duties that are expected of a nurse practitioner are as followed: developing treatment plans for different conditions, educating patients on proper healthy habits, conduct exams, preform different tests and exams, caring for patients and helping prevent further sickness,

Based upon the information provided, it has been determined that: the requested admission/day(s) is not/or are no longer medically necessary because: After review of the clinical information provided by North Shore University Hospital -Manhasset, the Medical Director has denied your admission to North Shore University Hospital - Manhasset. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 58 year old male, with a pre-authorized outpatient procedure on 09/02/2015 for a cardiac catheterization with an intervention, which was converted to an inpatient level of care. Based on the Interqual criteria (a decision based program to determine medical necessity) this procedure does not require an inpatient level of care, therefore, it does not meet criteria.

The past several decades, has shown and increased inquired interest on nursing home facilities, and making them more than just a facility, and more like a home for the elderly population. There have been a significant number of facilities that have actually strived to maintain an individual residing in nursing home facilities sense of autonomy; dignity and right over their lives in order have control over their own well-being. The Social Security Act, Sections 1819 and 1919 require facilities to be in compliance with federal requirements of quality of care and quality of life. CMS emphasizes on Person-Centered Care, Quantity of Staff, Individualized Approaches to care and Engagement of Resident and /or Representative in decision-making. These regulations are based upon values of respect and freedom for older persons in various ways to include an individual 's right to take risks or to make their own choices.

The core competencies of adult gerontology acute care nurse practitioner center around health promotion, health protection, disease prevention and treatment (AACN, 2012). Consequently, The National Organization of Nurse Practitioner Faculties (NONPF) endorsed the evolution of the Doctorate of Nursing Practice (DNP) as the entry level for nurse practitioner and expanded related professional competencies. As outlined in the Nurse Practitioner Core Competencies statement (2011), demonstration of the independent and interprofessional practice; analytic skills for evaluating and providing evidenced-based, patient-centered care across settings; and advanced knowledge of the health care delivery system are essential qualities delineating full scope of practice for NP as a licensed independent practitioner (NONPF, 2011,

NP can perform comprehensive and focused physical assessments, diagnose and treat common acute and chronic illnesses, prescribe medications and perform minor procedures in the office. NP can also work independently of physicians as allowed by state regulations.

In this article, it explains the duties, work environment, licenses and certificates and also the education of a Nurse Practitioner. Nurse practitioners typically take or review patient’s medical histories. Besides doing that, nurse practitioners also are known to examine patients, order and interpret diagnostic tests, such as x-rays or blood tests. NPs also are able to diagnose a patient’s injury or illness like a doctor can and can also give treatments for patients with broken bones or even immunization get patients. Along with physicians, NPs can also work independently. Their particular obligations and the degree to which they should be regulated by doctors or specialists contrast from state to state. They are not confined to work in a specific area of medicine. A Nurse Practitioner area of work includes primary care and family medicine, emergency medicine, surgery, psychiatry also mental health. Some APRN duties are the same as those for registered nurses, including gathering information about a patient’s condition and taking action to treat or manage the patient’s health. The only difference is that NPs have the ability to refer patients to specialists, both diagnose and treat ailments and order tests. APRNs likewise may

Many aging Americans often struggle to pay for home care, assisted living and other forms of long term care. When choosing the right type of care much consideration and research should be given. In determining whether one must self-fund their care can be a process which can leave the door open for many unanswered questions. Questions like, what is the expected cost, will Medicare help to cover any cost, or can one use their property to pay the cost for long term care. Since elder care and senior care can be in a variety of forms, the biggest concern is who takes on the brunt of payments. According to Benjamin (2015), “99% of our services are a private pay product with some assistance for veterans; long-term care insurance does account for part of the remaining 1%, along with some waivers provided by Medicare. “Private Pay can be funded by savings and investments, long term care insurance or annuities, social security or other retirement benefits, Veterans’ benefits, and through the conversion of a life insurance policy into a Life Care Benefit Plan or Long Term Care Benefit Plan” (Orestis, 2013, para 1). Most anyone can pay or arrange their care cost, however cost is usually determined by ones need and where they live.

Hospitals can be set up as nonprofit or for-profit facilities. The differences between the nonprofit and for profit hospitals will be discussed. Hospitals have experienced different trends in the last thirty years. This paper will identify at least three major trends that have occurred within the hospital sector. Three examples that describe and differentiate the roles of hospitals and nursing homes are providing long-term care. The conclusion of this paper will be a brief critiquing of the current state of long-term care policy in the United States.

The profession of nursing has come a long way from when it first began. In the 18th century, before nurses were established, health care in homes was provided by mothers or housewives, and health care in hospitals was provided by untrained servants (Novak, 1988). The role of nurses was not recognized until an American public health reformer by the name Lemuel Shattuck, who is known as the father of Public Health, suggested a change. Shattuck recommended that health departments and boards become more organized and sanitary by educating nurses to care for the sick (Novak, 1988). In today’s population, many hospitals and communities rely on the work of nurses to provide health care. The research conducted for this paper identifies health promotion and the nurse’s role within in it, and health promotion specifically for nurses working in the specialty of Gerontology. Nurses that specialize in Gerontology have been trained to work with anyone over the age of 65 with complex health problems and to help them achieve a sense of wholeness and well-being while keeping their body, spirit, and mind healthy and active (Eliopoulis, 1997).

Many individuals contemplating on placing their loved one into a Long term care facility, also known as a nursing home, may shiver at the thought. Why is that? Well one thought that may arise is the concern that the individual residing within the nursing home is not being cared for in the manor you feel is justified. The staffing seems to be so rushed that concern arises. What is the ratio of nurses to patients at this facility? How can this ensure quality of care and safety to my loved one? These questions are what have formed the topic of this paper. In long

Long-term care is a range of services and supports you may need to meet your personal care needs, which required extended care may need it for either a relatively short time or for a long time. “Health is the major factor in creating the need for Long-term care. People often need long-term care when they have serious, ongoing health conditions or disabilities” (Batnitzky, Hayes, & Vinall, 2014). A person needing long term care may need assistance with activities of daily living (ALDLs) of eating, dressing, grooming, and assistance with everyday task or instrumental activities of daily living (IADLs) of taking medicine, managing money, shopping for groceries.

Overall, Ms. Abdirahman did a fantastic job with this presentation and I believe that the grade given reflects this. All criteria was met throughout this presentation. Ms. Abdirahman talked about the role of the pharmacist in Long Term Care (LTC) Pharmacy by describing some of the roles such as dispensing and management operations, making drug interactions, and also making formulary decisions. Within the presentation, she also did a great job describing the impact that LTC has on the patient. She discussed how with the aging population, many of the patients a LTC Pharmacist works with is of an older age, she also describes how the elderly are more likely to need medication relations and counseling, and lastly she described how some of the patients may even be in correctional institutions or mental health facilities.

Studies have shown long-term care facilities, such as a nursing home, are changing and evolving into a “system” in which care can be provided in settings that are more appropriate for consumers’ needs. According to the National Nursing Home Survey (2004), “in the United States, approximately 1.6 million elderly and disabled persons receive care in 1 of 17,000 nursing homes” (p.426). However, the number of older adults living in long term care settings is supposed to double by 2050 (Zeller & Lamb, 2011, p.114). With a portion of our elders going into long term care facilities, this leaves family members with the question of quality of care. Castle & Ferguson (2010), state that a significant influence on nursing home quality has come from federal and state oversight bodies” (p.427). The State health departments use a licensure process to establish such standard for nursing home