LONG-TERM

CARE
OBJECTIVES

Describe the long-term care setting and

population characteristics
Discuss personnel and staffing issues in
the long-term care setting
Explore approaches to care to promote
function and quality of care
Older persons often
prefer to “AGE IN
PLACE”
GOAL

Promoting the highest

quality of life possible for
all residents.
CHARACTERISTICS OF RESIDENTS

Primarily women over age 80 who

have dementia and functional
deficits
STAFF IN NURSING HOMES

Nursing Staff
Licensed Practical Nurses
Certified Nursing Assistants
Nursing Administrators
Advanced Practice Nurses
Medical Director
Social Worker
Dietician
Pharmacist
Speech Therapist
Recreational Therapist
Family
Nursing Home Administrators
QUALITY INDICATORS FOR NURSING
HOMES

Accidents
Behavioral/emotional patterns
Clinical management
Cognitive patterns
Elimination
Infection control
Nutrition/ eating
Physical functioning
Psychotropic drug use
Quality of life
Skin care
PSYCHOSOCIAL ENVIRONMENT

Social interaction
Support system
Atmosphere of acceptance, trust and
positive expectations
PHYSICAL ENVIRONMENT

Bright colors and different textures should

be used
Walls and doors painted in different colors
Letterings and signs should be large and
clear
Hallways should be wide
NEW TRENDS AND APPROACHES

Restorative care
Eden Alternative
 Restorative care
- designed to help assist residents in
maintaining or improving functional abilities.

Eden Alternative
- encourages nursing homes to create a
“Human Habitat” by including pets, plants
and children in the daily environment.
SPECIAL CARE UNITS

Admission of residents with dementia

Special staff specifications, selection and
training
Activity programming tailored to residents
with dementia
 Family programming and involvement
A segregated and modified physical and
social environment

 Goal of care: To maintain function and

dignity while allowing individuals to live a
meaningful life
CHOOSING A LONG-TERM CARE FACILITY

Identify available nursing facilities

Evaluate the philosophy of care,
resources available, financial details
RELOCATION AND TRANSITION

Relocation
- moving from one environment to another for
various reasons.

Classification:
Interinstitutional
Intrainstitutional
Residential or institutional
STAGES OF RELOCATION
Preinstitutionalization Search for an appropriate facility,
medical and legal consults,
decisions about personal property

Immediately after institutionalization Feelings of helplessness,

vulnerability and abandonment are
common

Postinstitutionalization Residents’ perceptions of the

amount of control they retain affect
their psychological response
PHASES OF ADAPTATION
PHASE CHARACTERISTICS CHALLENGES
Disorganization They feel displaced, Dealing with losses of
vulnerable and physical abilities,
abandoned. relationships, and
accustomed space
Reorganization They feel problem is Finding meaning in the
solved; ask questions; experience of living in a
explain needs; resolve/ nursing home
justify being in a nursing
home
Relationship building Form emotional links; Developing and
engage in conflicts; maintaining the support
prefer one person over of others
another; feel the loss
when staff or residents
leave
OUTCOMES OF RELOCATION

NEGATIVE
Mortality
Morbidity
Psychological or social changes
BENEFITS

Access to health care services

Health monitoring
Convenience
CARE OF OLDER ADULTS IN NURSING
HOME SETTINGS

ASSESSMENT

Minimum Data Set (MDS) – the standardized

screening and assessment tool to measure
physical, medical, psychological and social
functioning of residents.
MDS

RCP

Implement
and
Evaluate
NURSING DIAGNOSIS

 Impaired adjustment
 Anxiety
 Ineffective coping
 Compromised family coping
 Deficient diversional activity
 Interrupted family process
INTERVENTIONS

 To facilitate successful adaptation

 To promote family adjustment
EVALUATION

 Healthy adaptation
 Enhanced sense of control
 Reduced anxiety level
 Improved coping