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GENERAL PRINCIPLES OF NURSING HOME CARE
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Nearly half of adults in the United States over the age of 65 years will need to spend time in a nursing home, also called a care home, a long-term care home, a convalescent home, or a skilled nursing facility (SNF). Older adults often transition between levels of care, and it is easy for the older adult, families, and even clinicians to be confused by the differences in types of care available. If clinicians are going to care for the older adults who call these sites “home,” even if only for a short period of time, it is important to understand the sites’ teams, services, and regulations. In this chapter, we discuss the nursing home as model of care, the differences between short-term and long-term nursing home care, the composition of the interprofessional nursing home team, and some of the regulations that govern these sites.
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DEFINING THE NURSING HOME
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The term nursing home takes on different meaning for patients, families, and providers, depending on their experiences and perspectives. For many people, nursing home placement carries stigma. In the late 20th century, poor-quality care in nursing homes and cases of outright abuse led to the Institute on Medicine report, Improving the Quality of Care in Nursing Homes, and the subsequent passage of nursing home reform as part of the Omnibus Budget Reconciliation Act of 1987 (commonly known as OBRA 87). This led to the development of the minimum data set (MDS) to standardize the quality of care for nursing home residents. Soon after, a grassroots effort, the “culture change” movement, developed with the mission of improving quality of life for nursing home residents. Despite these national efforts and regular surveys and monitoring, more recent research demonstrates ongoing challenges to providing both high-quality medical care and quality of life for the people who stay in nursing homes.
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Unlike residential care facilities, like assisted living facilities or group homes, the nursing home is a medical care model that is tightly regulated by state and federal guidelines. Each nursing home includes an interprofessional team of on-site licensed nurses, nursing assistants, physical therapists, occupational therapists, recreation therapists, and social workers. Other key members of the interprofessional team, including speech and language pathologists, dietitians, pharmacists, chaplains, and physicians, usually are not on site all the time. They work together to provide residents with assistance with their daily care needs, acute medical issues, and functional mobility. Despite a requirement to provide 24/7 access to medical care, the presence of physicians in nursing homes is highly variable, as is that of nurse practitioners and physician assistants. In addition to the focus on medical issues, nursing homes are also mandated to provide activities for their residents, guided by recreation therapists and sometimes with the support of volunteer services.
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A nursing home is a site for people needing access to 24-hour care ...