Nursing Homes Health Article

Communication

As in other health care settings, communication among nursing home staff is very important. In nursing homes, the care is based on a team approach. Physicians, nurses, and allied health professionals work together to make sure the resident is able to experience the highest quality of life possible.

In many cases, physicians who have had a long-term relationship with a patient continue treatment after the patient has been admitted to a nursing home. It is important for the nursing home staff to leave blocks of time open in the schedule for physician visits. It is also the staff's duty to keep the personal physicians apprised of a resident's medical condition.

The resident, physician, and resident's legal guardian and family must be told immediately if any of the following situations arise: an accident involving the resident, the need for a major treatment change, and a decision regarding discharge or transfer. Unless an emergency arises, the nursing home must give 30 days written notice of discharge or transfer. The family may appeal the decision.

Results

The quality of care in nursing homes is an important issue. Quality issues include:

• Ratios of staff to patients. Advocacy groups are pushing for increased staff-to-patient ratios in nursing homes. The National Citizens' Coalition for Nursing Home Reform recommends one direct care staff (R.N., L.V.N., or C.N.A.) per five residents during the day shift, 10 residents during the evening shift, and 15 residents during the night shift.
• Elder abuse. It is important for nursing home personnel to look for signs of abuse or neglect when a resident checks in and during a resident's stay. Signs of abuse include bodily injuries that appear suspicious, visible
  harm to the wrist or ankles that may indicate the use of restraints, skin ulcers that seem neglected, poor hygiene, inadequate nutrition, unexplained dehydration, untreated medical problems, or personality disorders such as excessive nervousness or withdrawal. The nurse or allied health professional is to report any signs of abuse to the supervisor or physician.
• Reimbursement. Nursing home administrators report that reimbursements do not cover the expenses, while nursing home advocates would like a higher portion of revenues to be allocated for direct patient care.