Long-Term Care System: A Case Study

Hello Dr. Ullom, majority of the long term care facilities are under staffed. There is usually one registered nurse in charge to manage a 240 bed facility, with LPN's  and nursing assistance. I feel that these patients would benefit from having one RN to every six -eight patients with a nursing assistance. Not only would this benefit the patient but the nurse as well. Patient are placed in long term care facility with a certain problem, but ends up with additional condition such as UTI, MRSA, pressure ulcers, and etc. These issues are related to poor care they receive because of unstaffing. I'm not placing blame on the LPN or nursing assistance, but with a RN and low nurse to patient ratio, they will receive better care.

IntroductionThere has been an issue with lack of care in long term care facilities. Some examples ofthese issues include the following: pressure ulcers, falls, dehydration, insomnia, abuse ofrestraints, etc. of the elderly residents. Therefore, there has been studies performed to determinewhat needs to be changed and what the effect these changes would have on the facility as well asthe workers or nursing assistants. These studies take place in two different facilities in Quebec,Canada. It is sad how the majority of the workers interviewed have the same complaints thatdirectly relate to the reasons why proper care is not provided, yet nothing has been done to fixthose issues.DevelopmentThe most important factor to the career of a nursing assistant and the care of the elderlyin facilities is time.

According to the U.S. Department of Health and Human Services (HHS), the aging population is likely to impact the necessary size and composition of the health care workforce (Center for Health Workforce Studies, 2006). There are now 35 million people over the age of 65 in the United States. It is estimated that about 1.6 million older adults will be living in nursing homes with almost half of the residents being over the age 85 years old (Kovner, Brewer, Fairchild, Poornima, Kim, and Jadjukic, 2007). The purpose of this paper is to he identify of facility and number of residents being care for. What would be the role of the nurse practitioner in this facility and the regulatory issues as it supports this role?

The long-term care system consists of an integrated continuum of many institutional and non-institutional providers who deliver extended care when needed. Long-term care providers distribute a variety of care to individuals with chronic, mobility and/or cognitive impairments/limitations. These providers include: nursing facilities, subacute care, assisted living, residential care, elderly housing options and community based adult services (CBAS) (Pratt, 2010). CBAS is broken down into subdivisions, which include: home health care, hospice care, adult day care and adult day health care (ADHC). ADHC’s falls under the category of non-institutional care, allowing individuals to be independent, stay within their community, live at home, and age in place, while being of high quality and low cost. The ultimate goal of ADHC’s is to keep individuals out of hospitals and nursing homes (institutional care), and allow them to live their life comfortably, independently and in their households with their loved ones (Alteras, 2007).

The purpose of this paper is to discuss the challenges in providing quality care to the elderly. I will conduct an evidenced-based literature review addressing quality improvement initiatives and programs for older adults. Following the literature review, I will describe barriers and solutions of quality programs and initiatives for older adults. Lastly, I will identify the future impact on nursing care of older adults resulting from this experience.

The demographic of clients in the long term care delivery model has a range that starts in infants and ends with the elderly, this care also includes persons with disabilities (mental and physical). According to Hooyman (2014),”to address escalating health and long-term care costs, the locus of care for older adults and persons with disabilities is shifting from institutional to community-based settings (p.25). Community based settings would fall under the realm of assisted living, nursing homes where there would be onsite staff that included nutritionist to ensure residents had a balanced diet, physicians, certified nurse aides or medical assistants, nurses, physical therapists, pharmacy technicians, and a health care administrator, but a large portion of long term care is also carried out by family members and friends due to the financial costs associated with facility care which offsets the coverage provided by private insurance, Medicaid and Medicare. The ultimate goal is to have a positive outcome and assist the person receiving care in regaining their

Long Term Care (LTC) is an area where change is needed. According to the CDC, by 2030, older adults will account for roughly 72 million of the U.S. population. In 2030, when the last baby boomers turn 65, one in every five Americans will be over the age of 65, and will account for roughly 20% of the population. As the growing population of baby boomers continued to aged they will become more reliant on long term care services. Nurses will be at the forefront of providing care to this demographic of the population. Leadership and accountability are needed in long term care to provide efficient care to the aging population.

This paper will review the many aspects of long-term care problems and many challenges there are within Long-Term care. We will look at rising costs within long-Term Care, patient abuse, will look at the quality of life, shortages of nurses and demand that the elderly are putting on the medical field. The type of care that Long-Term Care had been giving to its patients and the changes within Long-Term Care.

Long-term care organizations provide twenty-four hour around the clock care to seniors that are unable to function independently (“Government of Canada,” 2016). One of the strengths of providing LTC within the community is that they are responsive to seniors changes in health across various life stages (Bravo, Wals, Dubois, Charpentier, 1999). Health care professionals can contribute towards enhancing the quality of care by continuously following up with the residents as well as, collaborating with other health professionals that are involved in administering care to the resident such as nurses, social workers, physicians and anyone else involved in delivering their care (Chaplin, 2017). However, monitoring residents health and service delivery

The need for effective health care and incidence of chronic health conditions are expected to increase considerably with the aging of the baby boomers’ population. It is estimated that number of Americans with chronic health conditions will reach 150 million by the year 2030 (Joseph 2006). Furthermore, current long-term care facilities designed decades ago are lagging behind the legal regulation that were established, while not accommodating the needs of the staff and the clients comfortably. Some the facilities are facing regulatory challenges that emanate from the original design and intended use. Subsequently, the requirements for cost-effective long-term care facilities must be carefully

SP discussed future care with client daughter and advise Cindy that client needs to follow up with doctors as recommended immediately after she is discharged. Cindy also discussed with SP that Mrs. Figueroa may be discharged into the NF for short-term rehab and she wanted to know if this would interfere with her CO waiver or MA. SP explained that no interference would occur with CO waiver and MA if client remains in the NF for less than 30 days. After 30 days, Mrs. Figueroa MA will change from STC to LTC. SP is in the process of requesting additional hours from DHMH since client health is significantly declining, SP is waiting to obtain client discharged summary as medical documentation to support the request for 63 hours of personal assistance

Centuries ago as people aged and needed assistance with care including hygiene, meals, toileting and moving around, were given assistance from members of their family within the home. Most of these cares were provided by elderly patient daughters to care for them so they can continue to live home. The number of females in the workforce has increased over the years however the increase of females in the workforce is affecting the age females are having children therefore parents are entering their elderly years when their daughters are in their prime of their work years making it difficult to be available to provide care. Life expectancy has increased which means there are more people living longer and entering the age when they may need care. People who need assistance with care tend to find it hard to seek help, as they believe this is a sure sign they are getting old as they can no longer effectively care for themselves and sometimes takes a toll on the self esteem. Children of elderly patients tend to reluctant to admit they can no longer care for their parents as this may imply they no longer care to their parents. As older people we often pride on our independence and privacy and the thought of giving that control someone else is very scary for many elderly patients. This does hinder elderly patients from starting the process of seeking long term care (LTC).

CS will be discharged to home with assistance from a home care agency. Along with being a primary caregiver, CS’s wife also works as a nurse. Thus, a home care agency can provide an aid when his wife is at work. By then, the home modifications for the kitchen, bathroom, and lighting system will be in near completion. CS will fully comprehend how to drive a powered wheelchair in both indoors and outdoors. CS will perform his ADL tasks with mod I using adaptive equipment, which will be provided for him to take home.

The ability to exhibit the key factors required in preparing for the future of long-term healthcare will determine how well the facility will succeed in its community and stand out from its competitors. There are factors required from not only personnel but from the facility also. There are internal and external factors. The internal factors include the ability to self-assess oneself, adaptability to change, and plan management skills. The external factors the individual must be knowledgeable about includes information from customers, the serviced community, and the organization. The facility must be able to collaborate and communicate with individuals within and out. The facility must have an open environment that encourages personnel to interact

Long term care needs are increasing for the elderly population beginning significantly around 2015 (Shi & Singh, 2005). Multiple factors contribute to this increased need but the majority of the barriers evolve around the increasing age of the baby boomer population. The aging population is expected to grow from 125 million in 2010 to 157 million in 2020 (Shi & Singh, 2005). When looking at this aging population, it is expected that those over 70 years needing long term care will increase from 10 million in 2010 to 15 million in 2020 to 21 million in 2030 (Shi & Singh, 2005). The population is aging and people are living longer. Consequently, the need for long term care is increasing as will the duration of the need (CDC, 2013).