Hospice and Respite Care Services
Nursing Home Care
In clinical practice, long-term
care (LTC) has become synonymous with nursing home care. LTC for adult clients
with medical-surgical problems can occur either in the home or in facilities
such as nursing homes, subacute units, chronic care facilities,
or rehabilitation centers. In general, long-term
care implies that clients receive care for a prolonged period of time, usually
weeks or months. A small percentage of clients may remain in a facility
indefinitely, perhaps a lifetime. Nursing home care can be very expensive, with
annual costs between $30,000 and $45,000 in the
Nursing homes in the
Types of Nursing Homes
Nursing homes can be divided into
residential care homes, nursing facilities, skilled nursing facilities, and
chronic care facilities. Some nursing homes are part of retirement communities,
and others have specialty units, such as dementia, ventilator, or subacute units.
Residential facilities include domiciliary homes, care homes, rest homes,
assisted-living facilities, and group homes. Some of these facilities are small
and much like boarding homes before the advent of Medicare (Ignatavicius,
1998). Others are large communities managed by national corporations. Many of
the larger complexes are life care or continuing care retirement centers that
offer a continuum of services, from independent living to skilled care. The
typical resident in a residential facility is fairly independent and is able to
perform most or all self-care activities. Employees in these facilities are
usually unlicensed staff. Formerly called intermediate care facilities, nursing
facilities (NFs) provide a custodial, maintenance
level of care. Certified, licensed NFs receive
Medicaid funding for the care of residents who cannot perform activities of
daily living independently. Each state has specific guidelines for
reimbursement. Skilled nursing facilities (SNFs, pronounced
"snifs") provide care that requires
licensed health care professionals, such as nurses and therapists. Only a small
portion of most nursing home residents are categorized as skilled and therefore
eligible for Medicare reimbursement. Examples of skilled care include new tube
feedings, daily rehabilitative care for postoperative fractured hips, and care
of stage 3 and stage 4 wounds. Chronic care facilities provide care for
long-term, chronically ill clients, such those with severe head injuries or
those who need chronic ventilator support. These facilities are often managed
by county or state governments.
Documentation in Long-Term Care
Documentation in nursing homes is
highly regulated by both federal and state governments. The Minimum Data Set (MDS)
is a federally mandated assessment form that is completed for all residents
regardless of the level of care or reimbursement system. This document is an
interdisciplinary tool completed by each member of the health care team. The
team develops an interdisciplinary care plan for all actual or potential
resident problems. Depending on the resident's level of care, this plan is
updated every 30 to 60 days, or more often as the resident's condition changes.
Hospice and Respite Care Services
Respite care is a service that is receiving increasing
attention. It is aimed primarily at caregivers’ needs. Many older people at
home are cared for by a spouse or other family member. The demands of such care
can be exhausting unless the caregiver gets some relief,
or respite—thus the name of this service (see Chapter 37). Respite care may be
available through an agency that provides volunteers to relieve caregivers,
giving them time off regularly or permitting a periodic vacation. Some skilled
nursing facilities or board and care homes provide an extra room to give
temporary institutional housing for the elderly while caregivers take a break.
Elderly
clients may also need a change from the constant interaction with their
caregivers.
Hospice care may be offered
through an institution, such as a hospital or home health agency, or it may be
a freestanding facility existing solely as an inpatient hospice. Hospices and
other agencies providing hospice care offer services that enable dying people
to stay at home with the support and services they need. The purpose of hospice
care is to make the dying process as dignified, free from discomfort, and
emotionally, spiritually, and socially supportive as possible. Some community
health nursing agencies offer hospice programs staffed by their nurses. It is a
service that has been well received by elders, meets important needs, and is growing
in use. Hospice and respite care are two services most needed and used by the
families of clients with AD.
Organization of palliative care
•In any setting
•Based on guidelines and [nursing] standards
•Continuity of care
•Team approach
•Multidisciplinary
•Coordination of care
•Specialized care
•Level of care needed [low, medium, high care]
Levels
in palliative care
Depending on complexity:
–Low care [care workers, volunteers, nurse as a consultant]
–Medium care [nurses, care workers, volunteers]
–High care [nurses, volunteers]
In our understanding finding a
new balance of Cure and Care in a nursing home means promoting independence in dependence.
Factors:
–Autonomy and dignity
–Attitudes of healthcare professionals
–Exposure of staff to healthy older people
–Education and training
–Information provision
–Cultural expectations
Spirituality, Advance Directives, and Preparing for
Death
A final
need of the elderly, and one that is receiving increasing attention, is that of
preparing for a dignified death. Elisabeth Kubler-Ross
(1975) described death as the final stage of growth and one that deserves the
same measure of quality as other stages of life. Many older people fear death
as an experience of pain, humiliation, discomfort, or financial concern for
their loved ones. Planning for a dignified death is an important issue for many
older people. For most, this includes choosing, if possible, where and under
what circumstances death will occur; being free of financial worries; knowing
that their affairs and their family members are taken care of; having the
opportunity to receive spiritual counseling; and dying in peaceful
surroundings, preferably at home with the support of loved ones (Cicirelli, 2002; O’Brien, 2003).
Some
elders make arrangements with a funeral home of their choice, selecting
interment or cremation, a memorial service or a celebration of life gathering,
music to be played, and other personal details rather than leaving these
choices to their families. Others place less emphasis on the rituals, as was
demonstrated by one elder who left these choices to her children by telling
them, “Surprise me!”
Summary
Levels of care are dependent of the product
Levels of care are dependent of the organization
Levels of care are dependent of the concept / vision
of the organization
Levels of care are dependent of
Most important is the level of care who is dependent
of the wish of the ‘client’
Hospice “De Winde” in the Netherland city of
The dining room in the “De Winde”
Hospice gives the possibility for socialization of its clients: having coffee
or some parties together, inviting friends and relatives inside.
Relaxation room is a part of holistic care: a
place for meditation, prayer.
There is a peaceful environment in the yard of
the hospice.
Boards with photos of all the staff members of
the hospice give clients and their relatives
possibility to be familiar with them.
The
rooms in the hospice don’t look like hospital rooms: it’s a house. Clients are
encouraged to bring their own staff from their home.
Allender, J. A., Spradley,
B.W. (2001). Community Health Nursing: Concepts and Practice (5th
edition). Lippincott Williams & Wilkins; 5th edition (January 15, 2001). 799 pages. ISBN-13: 978-0781721226. Chapter 30, Pp. 719-726.
Stanhope,
M., & Lancaster, J. (2000). Community and Public Health Nursing (5th Edition)
Stanhope,
M., & Lancaster, J. (2006). Foundations of Nursing in the Community: Community-Oriented Practice
(2nd Edition)
Allender, J. A.,
Spradley, B.W. (2004). Community
Health Nursing: Promoting and Protecting the Public's Health (6th
Edition) Lippincott Williams & Wilkins, 2004. –
992 p.
Additional readings:
Age-friendly Primary
Health Care Centres TOOLKIT // World Health
Organization, 2008.
Cicirelli, V.G. (2002). Older
adults’ views on death.
Ebersole, P., & Hess, P. (2004). Toward healthy aging (6th ed.).
WEB SITES on Aging
American Diabetes
Association, Facts and Figures: http://www.diabetes.org
Assisted Living
Federation of
National
Institute on Aging. http://www.nia.nih.gov