Understand healthcare facilities and organizational structure with focus on LTC .

1. Unit ANurse Aide Workplace FundamentalsEssential Standard 1.00Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.01Understand healthcare facilities and organizational structure with focus on LTC. Understand healthcare facilities and organizational structure with focus on LTC. Nursing Fundamentals 7243

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3. Hospitals Provide care for individuals of all ages with a broad range of health problems Nursing Fundamentals 7243

4. Hospitals Services varied and extensive • Diagnostic • Therapeutic • Medical • Surgical • Emergency Nursing Fundamentals 7243

5. So what does Diagnosticmean? Remind me from HSII… Nursing Fundamentals 7243

6. Diagnosticmean? Pertaining to the Identificationof a medical condition or disease as determined by a physician. A statement of what is wrong with a resident. Nursing Fundamentals 7243

7. So what does Therapeuticmean? and…. Pertains to treating, fixing, or correcting a medical or surgical problem Nursing Fundamentals 7243

8. So what does Medical mean? aaaaaaaand …. • Pertaining to the science of treatment that includes drugs, diet, exercise and other non-surgical means. Nursing Fundamentals 7243

9. What isSurgical… Nursing Fundamentals 7243

10. Surgical….. Pertains to the treatment of injury, deformity, and disease by manual and instrumental operations. … Nursing Fundamentals 7243

11. So what does Emergencymean? and last but not least…. Sudden occurrence of a serious and urgent nature that demands immediate attention. Nursing Fundamentals 7243

12. Hospitals Nursing Fundamentals 7243

13. So what does Acutemean? OK so…..remind me • An acute illness has a sudden onsetfrom which the resident is expected to recover. • Acute therapy is short-term medical treatment, usually in a hospital, for patients having an acute illness or injury or recovering from surgery. • Example: Outpatient care, rehab or hospice Nursing Fundamentals 7243

14. Chronic means…. Then… • A chronic illness has slow or gradual on set, for which there is no known cure, the illness can be controlled and complications prevented. • Chronic care is medical and nursing services that focus on long term care of people with chronic diseases or conditions, either at home or in a medical facility. It includes measures specific to the problem, as well as others to encourage self-care, promote health, and prevent loss of function. Nursing Fundamentals 7243

15. What are some examples of Chronic conditions? • Physical disabilities • Heart disease • Strokes Nursing Fundamentals 7243

16. What does Terminal mean? An illness from which the resident is not expected to recover and will die. Residents with terminal illnesses are given Palliative (comfort) care instead of curative care. Nursing Fundamentals 7243

17. Long term Care Facilities Referred to as: • Extended care facilities • Skilled care facilities • Nursing homes • CCRC – continuing care retirement community (includes skilled nursing) Nursing Fundamentals 7243

18. Long term Care Facilities Provide healthcare services to individuals unable to care for themselves: • elderly persons • disabled or handicapped persons • people with chronic illness Nursing Fundamentals 7243

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20. Homes for the aged (HA)Homes for the aged License (HAL) Formerly called: • Rest home • Assisted living Nursing Fundamentals 7243

21. Homes for the aged Types: • Family Care Home – serves 2-6 unrelated persons • Adult Care Home – serves 7 or more unrelated persons • Group Home – for developmental disabled adults • Multi unit housing with services Nursing Fundamentals 7243

22. Homes for the aged such as rest homes or assisted living • Assists resident with medication administration • Assists with personal care, dressing, or grooming • Provides three meals a day • Provides housekeeping • LIMITED MEDICAL SUPERVISION Nursing Fundamentals 7243

23. Homes for the aged • Monitored by: Adult Home Specialist within County Department of Social Services • Licensed by Nursing Fundamentals 7243

24. Home Care Agencies Provide care in the home for people needing health services, but not hospitalization Nursing Fundamentals 7243

25. What are roles of home care CNAs: • Bathing • Cook meals or pre • Assist with feedings • Laundry • Clean the house • Shop for groceries • Take to doctors appt Nursing Fundamentals 7243

26. Home Care Agencies Services provided include: • Nursing / CNA / PCA • Physical therapy • Occupational therapy • Speech therapy • Social services • Nutritional and food services • Respiratory therapy • Homemaker services Nursing Fundamentals 7243

27. Healthcare facility Organizational structure • Displays chain of command • Shows lines of authority • Identifies health care worker’s position • Identifies immediate supervisor Nursing Fundamentals 7243

28. Healthcare facility Organizational structure • Responsible for provision of safe and adequate care at a reasonable cost • Makes facility policies • Delegates management to an administrator Governing body = (Board of Directors) Nursing Fundamentals 7243

29. Healthcare facility Organizational structure Department heads • Have specific areas of responsibilities • Supervise department staff • Finance • Ancillary services • Nursing Nursing Fundamentals 7243

30. Healthcare facility Organizational structure Medical Director Supervises medical staff activities • Physicians • Residents • Interns Nursing Fundamentals 7243

31. Healthcare facility Organizational structure Director of Nursing and Assistant DON • Supervises nursing staff activities • Responsible for safe nursing care • Registered nurses Nursing Fundamentals 7243

32. Healthcare facility Organizational structure Nursing supervisor • Assists director of nursing • Licensed nurse • Assigned areas of responsibility • Assigned to specific shift Nursing Fundamentals 7243

33. Healthcare facility Organizational structure Charge Nurse • Has specific areas of responsibility • Responsible for resident care in specific area Nursing Fundamentals 7243

34. Healthcare facility Organizational structure Charge Nurse Supervises staff in specific area • Registered nurses (RNs) • Licensed practical nurses (LPNs) • Nurse aides (NAs) Nursing Fundamentals 7243

35. LTC Facilities regulation Federal Level State Level Nursing Fundamentals 7243

36. Federal Level • Federal agency that works with state agencies • Runs two national care programs • Medicare- • Medicaid Nursing Fundamentals 7243

37. Medicare- Covers people over age of 65 or who are disable and cannot work • Has 4 parts-A-Pays for hospitals/skilled nursing facilities B-doctor services, equipment, medical services C. Allows private insurances to provides Medicare benefits D. Medication and prescriptions plan Medicaid • Insurance for people who fit within the income guidelines • Pays for doctors office visits, dental, emergency rooms, surgery and prescriptions Nursing Fundamentals 7243

38. Federal Level • Helps pay for health care including nursing home care • Sets quality standards for long term care facilities • Nursing homes must be certified to receive Medicare and Medicaid funds Nursing Fundamentals 7243

39. Federal Level • Nursing Home Compare for Consumers http://www.cms.gov/CertificationandComplianc/Downloads/consumerppt.pdf • Five Star rating system • Quality of care information • Characteristics of nursing homes Nursing Fundamentals 7243

40. LTC Facilities regulation State Level • Two Sections of DHSR: • Nursing Home Licensure and Certification Section • Health Care Personnel Registry Section Nursing Fundamentals 7243

41. LTC Facilities regulation • Nursing Home Licensure and Certification Section • Determines location and number of nursing homes needed in NC • Issues licenses to nursing homes giving permission to operate and provide care • "Surveyors" conduct inspections to find out whether the nursing home meets federal rules • Routine inspections take place in nursing homes that receive payment through Medicare and Medicaid every 9 to 15 months • Surveys take three days on average Nursing Fundamentals 7243

42. LTC Facilities regulation • Responsibilities of the nurse aide during the survey process • Provide quality care • Protect residents rights • Provide for resident and personal safety • Keep center clean and safe • Conduct yourself in a professional manner • Demonstrate good work ethics • Follow center policies and procedures • Answer surveyor questions honestly and completely Nursing Fundamentals 7243

43. LTC Facilities regulation • LTCs can be put on “SANCTION”because of: • Substandard care • CMP – Civil Money Penalty Nursing Fundamentals 7243

44. LTC Facilities regulation CMP-Civil Money Penalty • Fines collected as a result of nursing home violations • Fines are redirected back in the nursing home industry to improve the quality of care • In NC – Win A Step Up is funded by CMP Nursing Fundamentals 7243

45. LTC Facilities regulation • Health Care Personnel Registry SECTION • There are two branches: • Investigations Branch • Center for Aide Regulation and Education (CARE) Branch Nursing Fundamentals 7243

46. LTC Facilities regulation • Health Care Personnel Registry SECTION • InvestigationsBRANCH responsible for: • Health Care Personnel Registry • Receiving reports from health care facilities • Unlicensed health care worker investigations • Listing "Pendings" and "Findings" on the Nurse Aide I and Health Care Personnel Registries Nursing Fundamentals 7243

47. LTC Facilities regulation • Health Care Personnel Registry SECTION • Center for Aide Regulation and Education (CARE) BRANCH is responsible for • Nurse Aide I Registry, training and competency programs • Medication Aide Registry and competency programs • Geriatric Aide Registry and training • Feeding assistant training curriculum • Providing registry access and listing verification Nursing Fundamentals 7243

48. LTC Facilities regulation • NCNew Organizational Vision Award • ~NC NOVA~ • http://www.ncnova.org/index.html • NC Special State License that honors excellence in the workplace for people employed by home care agencies, adult care homes, and nursing homes. Nursing Fundamentals 7243

49. LTC Facilities regulation • NCNew Organizational Vision Award • NC NOVA facilities have the following: • Well trained staff, satisfied and loyal workers helping families by caring for their loved ones; • Stronger links among workers, residents, families, and management; Nursing Fundamentals 7243

50. LTC Facilities regulation • NCNew Organizational Vision Award • NC NOVA facilities have the following: • Chances for staff to better their skills and advance their careers; • Stable, quality worker available now and for the future. Nursing Fundamentals 7243