A nursing home is a place where elderly or disabled persons can receive residential care.[1] Long-term care facilities, skilled nursing facility (SNF), and care homes are other names for nursing homes. Frequently, these names have slightly distinct connotations to reflect if the facilities are private or public, and whether their primary services are emergency medical care, assisted living, or nursing care.
Those who are unable to receive care at home but do not require hospitalization use nursing homes. Depending on their level, nursing care facility nurses are accountable for overseeing other staff members in addition to attending to the medical needs of their patients.
The majority of nursing facilities have licensed nurses and nursing assistants on duty around-the-clock.
According to the American Association for Long-Term Care Insurance, while approximately 1 in 10 Americans between the ages of 75 and 84 remain in a nursing home for five years or longer, nearly 3 out of 10 of those same individuals stay for fewer than 100 days, which is the longest period of time that Medicare will pay.
Additionally, some nursing facilities offer brief stays for rehabilitation in the wake of an operation, disease, or accident. Physical therapy, occupational therapy, and speech-language pathology are a few possible services. Additional services provided by assisted living facilities include daily housekeeping and organized activities. Memory care, often known as dementia care, is a service that some nursing homes provide.[2]
History of Nursing home
Many families have taken care of their elderly members in their homes from before the 17th century to the present. Although many communities and families still follow this custom, it has grown more challenging over time as life expectancy rises, family sizes shrink, and a greater level of experience in providing care for an individual with a chronic illness is required. In order to handle these complications, nursing homes have evolved into the norm for the majority of elderly and disabled people in the twenty-first century.
A little over 6% of senior citizens are housed in residential settings offering a variety of services. However, these establishments have not always existed; rather, their evolution and past events mirror the more recent political and demographic realities.
Poorhouses, also known as almshouses, were first established in England in the 17th century when it was expected of municipalities to provide for their impoverished citizens. In these dwelling commons were frequently housed orphans, the mentally sick, and the elderly, while able-bodied persons were obliged to work and faced imprisonment if they did not. English colonizers brought this model to North America.[4]
There were no age-restricted long-term care facilities prior to the 19th century, therefore old people who need housing due to illness, poverty, or familial seclusion frequently passed away in almshouses. Putting them with the deranged, the drunken, or the homeless, they were just labeled as members of the most vulnerable beneficiaries in the community.
Poorhouses provided a location for them to get daily meals and shelter.
In the United States, women’s and religious organizations started to build senior housing in the 1800s. Private care facilities for the elderly were established in these communities due to the common fear that members of their own ethnic or religious communities would pass away alongside members of the most hated society.[3] Despite complaints over their substandard circumstances, poorhouses persisted until the early 1900s.
The US poorhouse system was overrun by the Great Depression, which resulted in a shortage of funds and space. The public became aware of the horrible living conditions in the poorhouses throughout the 1930s thanks to muckraking.
Due of this, the Social Security Act of 1935 included a clause requiring pension payments to be made exclusively to those who were able to live in private institutions rather than poorhouses.[5]
Residential living facilities, sometimes referred to as board-and-care homes or convalescent homes, eventually took the role of poorhouses in the US. For a predetermined price, these board-and-care facilities provide meals and minimal care in a private setting. Due to the popularity of board-and-care facilities, a new model of nursing homes started to emerge by World War II.
The government became aware of the problem of patients being in hospitals for extended periods of time as times changed. Board-and-care facilities started to transform into more public spaces in an effort to counteract these extended stays in short-term settings.
As a result, nursing homes were a common sight by 1965. Nursing homes served as permanent residences for the elderly and disabled, providing daily meals and access to medical care as needed. When compared to poorhouses and almshouses, these nursing institutions shown an improvement in upholding standards of cleanliness and care.
Significant changes in the dynamics of nursing homes started to occur in the 1950s and continued until the 1970s. In the US, Medicare and Medicaid started to account for a large portion of the funds that would flow through the homes, and the 1965 amendment legislation mandated that nursing homes adhere to safety regulations and have registered nurses on staff at all times. Furthermore, in states with laws allowing for it, nursing facilities may sue kids for the expenses incurred in providing care for their parents.
Later in 1987, the Residents’ Bill of Rights was added to the Nursing Reform Act, which was established in the US to start outlining the many kinds of services provided by nursing homes.[6]
In the United Kingdom, following World War II, a large number of troops and civilians who required medical attention due to war-related injuries were admitted to the hospital alongside several elderly people, resulting in congestion. The Old Poor Law’s repeal and the NHS’s establishment in 1948 made it possible to establish what would eventually become public nursing facilities.
Professor Peter Townsend exposed the disparities in care standards between publicly and privately funded assisted living facilities in the 1950s, which resulted in changes to health policy.
In the UK, care homes grew to be a significant industry in the 1980s and 1990s. As a result, laws such as the Care Standards Act of 2000 and the Registered Homes Act of 1984 were created to guarantee that patient needs were satisfied in private care facilities.[6]
Nursing facilities are diverse today. While some nursing homes have a hospital-like appearance, others have a more homey appearance. Residents of nursing homes have two options for paying for their care: privately or through government funding. Some may get short-term Medicare coverage in the US, while others may use long-term insurance plans or access public assistance in other nations. All things considered, the majority of US nursing homes will take Medicaid as payment.[7]
Considerations
Here are some explanations for thinking about a nursing home.
coping with an illness that is getting worse and progressing, such Alzheimer’s, following a recent hospital stay and not being prepared to move to self-care when the primary caregiver at home is unable to handle their own medical needs.[8]
Think about the activities and/or medical needs that residents would require from the nursing home when researching them. Don’t forget to account for money, including personal savings and health insurance. Verify the nursing home’s personnel qualifications and license status. If you have the time, take a personal tour of the nursing home and, if you get the chance, chat with residents or their families to learn more about their experiences.
Staff
All workers in nursing homes must hold a license or certification from the state in which they are employed. Most institutions mandate that nursing homes have a suitable staffing level to provide residents with the care they need. For example, in the United States, nursing homes are required to have a minimum of one licensed practical nurse (LPN) on duty around-the-clock and a minimum of one registered nurse (RN) on staff for at least eight hours a day, seven days a week.[9]
Among the staff members of direct care nursing homes are licensed practical nurses, certified nursing assistants, social workers, registered nurses, and physical therapists.
Medical staff
Nurses
A registered nurse (RN), who normally needs to have between two and six years of education, is necessary to assess and monitor the inhabitants of nursing homes. Implementing care plans, giving medication, keeping accurate records for each resident, monitoring and documenting medical changes, and directing the licensed practical nurses (LPN) and nursing assistants are all part of the RN’s work responsibilities.[10]
It is not necessary for RNs to select a specialty. RNs normally require schooling in their specialized sector as well as additional experience gained via clinical practices in order to be recognized as specialist nurse professionals. Usually, a year of training is necessary for LPNs before they may begin working with patients. In addition to treating wounds and giving out prescription drugs, the LPN keeps an eye on the health of the inhabitants.
Nursing assistants
Working directly under an RN or LPN, a nursing assistant gives patients basic care. Often known as activities of daily living, these basic care tasks can involve helping residents dress and bathe, helping them eat or serve themselves, transferring them to and from a wheelchair or bed, making and cleaning their beds, helping them use the restroom, and responding to call lights.[Reference required]
The official titles of nursing assistants can change depending on the facility and the jurisdiction. Personal care attendants (PCAs), caregivers, patient care technicians, Certified Nursing Assistants (CNAs), and nursing assistants are a few examples of them.
Physicians
In addition to providing the necessary round-the-clock competent nursing, skilled nursing facilities also assign a licensed physician to supervise each patient.[8] Patients receiving care from physicians who are not associated with the nursing home are treated in nursing homes other than skilled nursing facilities.
These doctors are usually engaged by a private company that dispatches doctors to assisted living facilities at the patient’s, assisted living facility’s, or family’s request. While internists and family physicians make up the majority of these providers, independent visits from specialists like cardiologists and nephrologists may be made to augment their care.[11]
Non-medical staff
Administration
An executive director or a nursing home administrator may be employed by a nursing home, depending on its size. Both may be present in some nursing homes, but their responsibilities are similar and may include managing finances, providing medical supplies, and supervising employees. Human resources staff members work at some nursing facilities and are in charge of all hiring-related matters.
The responsibilities of a human resources professional can vary, but they may also involve managing payroll, planning new hire orientation programs, conducting interviews, taking disciplinary action when necessary, and making sure state and federal laws are followed.[12] Most of the time, nursing facilities are subject to strict regulations and require a license. Regular reviews of compliance with federal and state legislators ensure that high standards of construction codes, care plans and behavior.