Nursing Homes

Part 4

Plan of Care
A nursing home must assess a new patient within 14 days of admission. Assessments must be redone once a year after that or when any significant change in the patient’s health occurs. After an assessment, a plan of care must be developed that specifies how the nursing home plans to treat the patient. It is important for the patient and family members to get a copy of this plan and understand it. If you do not agree with something in the plan, say so.

Staff and Facilities
Nursing home must have 24-hour staffing. A registered nurse must be present at least once a day. If there are more than 120 beds, there must be a staff social worker. Dental care, as well as a medical care, must be provided to patients. Residents are free to choose their own doctors.

NOTE: Be aware that the staff that will have the most contracts with you will be aides who will handle personal care, meal assistance, and minor medical care.

There can be no more than four beds per room and each room must have a bathroom accessible with bathing facilities. There must be a system in place for residents to summon assistance. Restraints (physical or drug induced) are not permitted as a general policy, but are allowed by individual order when necessary.
Nursing homes have a board of trustees, who set the overall policies of the facility. The administrative staff handles the day-to-day operations. In addition to nurses and aids, there are therapists, activity coordinators, dieticians, physical therapists, volunteers, and pastoral staff.

Hospice
Hospice or palliative care is a type of in-home or residential care for patients with life-ending illnesses. Hospice care seeks to support the patient and family through this difficult time while keeping the patient comfortable and managing his or her pain. Hospice care is patient and family oriented and uses a different approach than traditional medical care.
The goal of hospice care is to provide a pain-free and dignified death, while minimizing symptoms of illness. Hospice care does not try to extend or shorten life. Instead, it attempts to make what is left of life pleasant and livable. Most hospices are not in favor of life support systems, feeding tubes, aggressive treatments, or other care designed to prolong life.
Hospice care is designed for patients who have six or fewer months to live. You must be referred to hospice by a doctor for it to be covered by insurance. Once a referral is made, most hospice programs are able to make contact with the patients and family within one day and can begin to provide a full range of services within one week.

Payment
Private insurance and Medicaid cover hospice care. Medicare offers some coverage. To be eligible for Medicare coverage, a patient must receive Medicare Part A and be certified as terminally ill with six or fewer months to live.
Care must be provided by Medicare-approved hospice. The coverage includes medical staff care, medication, brief hospital stays, in-home health aides, social workers and family therapists. While receiving hospice care, the patient cannot receive treatment for the disease. So if a person has cancer and is receiving hospice care, he or she cannot receive chemotherapy or radiation-anything designed to treat the disease instead of the pain.

Care at Home
Hospice programs were originally created to allow patients to die at home, in comfort, with their family present. Hospice still mainly provides in-home care. Hospice workers visit the home on a regular basis, and immediate support and advice is available by phone. Hospice programs maintain relationships with hospitals so that a patient who needs temporary hospice care can be transferred to hospital and then returned home while under hospice care.