Nursing Home

A nursing home is a facility for the residential care of elderly or disabled people.[1] Nursing homes
may also be referred to as skilled nursing facility (SNF), long-term care facilities, old people's
homes,[2] care homes, rest homes, convalescent homes or convalescent care. Often, these
terms have slightly different meanings to indicate whether the institutions are public or private, and
whether they provide mostly assisted living, or nursing care and emergency medical care. Nursing
homes are used by people who do not need to be in a hospital, but cannot be cared for at home.
The nursing home facility nurses have the responsibilities of caring for the patients' medical needs
and also the responsibility of being in charge of other employees, depending on their ranks. Most
nursing homes have nursing aides and skilled nurses on hand 24 hours a day.
While nearly 1 in 10 residents age 75 to 84 stays in a nursing home for five or more years, nearly 3
in 10 residents in that age group stay less than 100 days, the maximum duration covered by
Medicare, according to the American Association for Long-Term Care Insurance. Some nursing
homes also provide short-term rehabilitative stays following surgery, illness, or injury. Services may
include physical therapy, occupational therapy, or speech-language therapy. Nursing homes also
offer other services, such as planned activities and daily housekeeping. Nursing homes may
offer memory care services, often called dementia care.[3]

History[edit]

Poorhouses/workhouses were the first implemented national framework to provide a basic level of care to the
old and infirm. Pictured, is "The workroom at St James's workhouse" from The Microcosm of London (1808).
Starting in the 17th century, the concept of poorhouses (also referred to as almshouses) were
brought to North America by English settlers. All orphans, mentally ill and the poor elderly were
placed into these living commons. In the twenty-first century, nursing homes have become a
standard form of care for the most aged and incapacitated persons. Nearly 6 percent of older adults
are sheltered in residential facilities that provide a wide range of care. Yet such institutions have not
always existed; rather, their history and development reflect relatively recent demographic and
political realities that shape the experience of growing old. Before the nineteenth century, no age-
restricted institutions existed for long-term care. Rather, elderly individuals who needed shelter
because of incapacity, impoverishment, or family isolation often ended their days in an almshouse.
Placed alongside the insane, the inebriated, or the homeless, they were simply categorized as part
of the community's most needy recipients. These poorhouses gave a place where they could be
given shelter and daily meals. Poorhouses continued to exist into the early 20th century despite the
criticism they faced. Much of the criticism stemmed from the conditions of the poorhouses. The
Great Depression overwhelmed the poorhouses as there were a lot of people that needed help and
care but not enough space and funding in the poorhouses. Due to Muck Raking in the 1930s the
less than favorable living conditions of the poorhouses were exposed to the public.[4]
Poorhouses were then replaced with a different type of residential living for the elderly. These new
residential living homes were called board-and-care homes or also known as convalescent homes.
These board-and-care homes would provide basic levels of care and meals in a private setting for a
specific fee. Board-and-care homes proved to be a success and by World War 2, the new way of
nursing homes began to take shape. As the times continued to change, the government identified
the issue of people spending extensive amounts of time in hospitals. To combat these long stays in
short-term settings, board-and-care homes began to convert into something more public and
permanent that was state and federally funded. From this, by 1965 nursing homes were a solid
fixture. Nursing homes were a permanent residence where the elderly and disabled (poor elderly
and disabled specifically) could receive any necessary medical care and receive daily meals.
Though nursing homes in the beginning were not perfect, they were a huge step above almshouses
and poorhouses in regards to following laws and maintaining cleanliness. From the 1950s through
the 1970s the dynamics of nursing homes began changing
significantly. Medicare and Medicaid began to make up much of the money that would filter through
the homes and the 1965 amendment laws enforced nursing homes to comply with safety codes and
required registered nurses to be on hand at all times. Additionally, nursing homes may sue children
for the costs of caring for their parents in jurisdictions which have filial responsibility laws. Later in
1987, the Nursing Reform Act was introduced to begin defining the different types of nursing home
services and later added the Residents' Bill of Rights.[citation needed]
Today nursing homes are very different across the board. Some nursing homes still resemble a
hospital while others look more like a home. Nursing home residents can pay for their care out of
pocket, others may receive medicare for a short time and some may use long-term insurance plans.
Across the spectrum, most nursing homes will accept medicaid as a source of payment.[citation needed]

Elder abuse[edit]
There are 3 major types of abuses reported in nursing homes: physical, emotional, and sexual
abuse. Physical abuse is the intention or action to hurt an elderly person resulting
in scars and bruising. Emotional abuse occurs when an employee makes verbal threats and
continuously degrades the patient, resulting in the patient experiencing mood swings, anxiety,
and depression. Sexual abuse is when an elderly patient is being forced into unwanted sexual
activity by an employee, resident or visitor, usually attempted and reported when the patient is
sleeping, sick, or weak. Nursing home neglect is similar to elder abuse. It is when employees begin
to repeatedly ignore and leave a patient alone, neglect the patient's personal hygiene like bathing
and brushing of teeth, provide the patient a reasonable amount of food and water, and neglect to
provide the patient with the correct amount of medication he or she requires. One factor unique to
elder abuse in nursing homes is that many nursing home contracts require residents to
sign delegation clauses, giving up their right to trial by jury and instead using an Arbitrator to settle
disputes.[5]

Staff[edit]
All of the nursing homes employees are all required to be licensed or uphold a certificate in the state
of which they work. In most facilities, nursing homes are required to provide enough staff to
adequately care for residents. In the U.S., for instance, nursing homes must have at least
one registered nurse (RN) available for at least 8 straight hours a day throughout the week, and at
least one licensed practical nurse (LPN) on duty 24 hours a day.[citation needed] Direct care nursing home
employees usually include registered nurses, licensed practical nurses, certified nursing assistants,
and physical therapists, amongst others.

Nurses[edit]
Main article: Nursing
Nursing homes require that a registered nurse (RN) be present to assess and monitor residents.
Registered Nurses are typically required to have between two and six years of education. The RN's
job duties include implementing care plans, administering medications, recording and maintaining
accurate reports for each resident, monitoring and recording medical changes and providing
direction to the nursing assistants and licensed practical nurses (LPN).[6] RNs are not required to
choose a specialization. To gain recognition as a specialized nurse professional, RNs typically need
to undergo further experience through clinical practices, and becoming educated in their specialized
field. LPNs are typically required to have a year of training before working with any patients. The
LPNs monitors residents' well-being and administers treatments and medications, such as dressing
wounds and dispensing prescribed drugs. LPNs responsible for patients direct bed care and carry
out a daily routine