Health care in long term care settings
Healthcare is a fundamental need in any society. Long-term healthcare has for many years provided an opportunity for many people unable to make their way to hospital get healthcares services. Long-term care settings consist of facilities or institutions such as skilled nursing facilities and nursing homes that provide healthcare to people unable to manage independently in communities (CDC, 2013). The cares represents chronic care management, custodial or short-term rehabilitative services. This discussion delineates on the issues concerning the care provided in these long-term care settings.
Long-term healthcare settings play a fundamental role in the provision of healthcare and this is the reason why quality and patient safety are important. According to CDC (2013), an estimated 3.2 million Americans live in the skilled nursing facilities and homes as they participated in the Medicaid and Medicare programs in 2008. Furthermore, it is estimated that more than one million people live in assisted living facilities. Many people use these facilities and are essential as they provide quality and patient safety.
At the same time a high level of care is required in these long-term care settings to avoid, prevent and lessen the effects of injury and harm on the patients. Research indicates that within nursing centers, one of the safety challenges is to prevent falls. Research shows that three out of four centers experience resident falls every year as an average resident falls around two to three times in every year (Rubenstein et al., 1990). Many of the centers have more than 100 patients falling every year (Rubenstein, Robbin, & Josephson et al., 1990). This therefore, is a concern and enough reason why they are required to put in place sufficient measures to ensure that they prevent such risks that further worsen the health and the recovery of the patients.
Maintaining a safe environment is a sign of compassion and vigilance on the welfares of the patients and is reflection of a competent healthcare. Quality and safety increase the confidence of the patients and is essential in motivating and attracting new students to nursing. This also engages current professionals to develop innovative models of care delivery that retains and nurtures future generations.
Quality and patient safety is the right of the patient. All patients have the constitutional right to better and quality healthcare (Rubenstein, Robbin, & Josephson et al. 1990). Therefore, ensuring high standards of care and personal safety is imperative. It also plays a key role in reducing or preventing other complications hence helping to reduce the time that the patient takes at a nursing facility.
One of the key challenges in the provision of quality/patient safety is the increased number of falls. These falls are caused by various factors and affect the quality of care provided to the patients. Most of the people fall because of various reasons such as impaired vision, because of being on medication and other medical complications such as dementia among others (Rubenstein, Robbin, & Josephson et al., 1990). Environmental factors also contribute to the increased number of people that fall such as the designs of the facilities. Some of the facilities have poor and inadequate lighting systems, slippery and wet floors. Poor organization and arrangement of facilities and equipment also is a risk challenge that increases the number of people that fall.
Another challenge that leads to compromise in quality and personal safety is lack of adequate and trained staff to take care of the nursing centers. Some of the centers have incompetent personnel who do not understand how to take good acre of the patients and this compromise on the level of quality.
Other challenges regarding the quality of patient safety is inadequate resources in terms of financials, which hampers effective provision of services in the facilities (Hill, Nguyen, & Shaha et al. 2009). Finances are essential in recruiting competent and enough staffs to take care of the patients in these centers. Money is also required to provide good housing facilities and medications for the patients. Therefore, in the circumstances where there is a shortage of funds, it poses a greater challenge on operations of the centers. Other challenges include water, basic sanitation and waste management. This is a challenge that occurs when the facility has inadequate financial support. The facilities provided may not be adequate for the patients and this compromise on the quality and patient safety.
Despite the challenges, there is always a room to improve the situation for the better. The quality of care is measured by assessing the structure, processes and the outcome. Structure is concerned about the availability, accessibility and quality of resources such as bed capacity, insurance cover and number of nurses and training among others, (Hughes, 2009). Processes measure the accessibility of services by patients and providers, while the outcome is the result of the care. The three strategies that can be adopted to ensure improvement in the quality and patient safety include, total quality management, continuous quality improvement and quality assurance. Total quality management is a strategy that brings all the stakeholders together and incorporates all the processes aimed at creating and environment that can be improved (Hughes, 2009). It requires the commitment of all the organization to quality and improvement in order to achieve better results. Continuous quality improvement strategy help in development of clinical practice and operates on the premise that there is always and opportunity for improvement in every occasion. The last is the quality assurance study that allows the concerned party to focus on the areas that have been identified by an oversight committee or any other body for improvement. All these strategies are effective if well implemented. The reason therefore, for selecting these strategies is that they have the potential of ensuring that there is commitment in achieving positive change as they incorporate or bring together all the stakeholders. They also ensure that gaps or areas that require attention are given priority and this helps to improve and enhance the quality and patient safety.
It is very essential for any healthcare facility to ensure that they uphold to the expected standards in their provision of services. To achieve this, there are various ways that these facilities get recommendation and go ahead or continue with their services. They include, licencure, certification, accreditation or through an oversight committee. The focus here is on licensure. This is a process that requires a government to grant permission for an individual or heath organization to operate in a given profession or occupation. They ensure that the individual or organization meets the standards to protect safety and public health. The procedure goes through various processes (Rooney & Van ostenberg, 1999). The first thing is that the individual is examined to establish the level of education to ascertain competence. The person may be required to pay some cash, renewable yearly. An organizational license is given after an on site inspection to establish whether it meets minimal health standards. The license needs yearly renewal the organization to continue its operation.
In conclusion, long-term healthcare settings play a significant role in the provision of healthcare. They need to be well served with equipment and qualified personals to help overcome various challenges. Various strategies can be adopted such as quality assurance to help manage some of the challenges in these facilities. Government authorities and other oversights committees have also a role to ensure that these facilities meet the standards through their licensure, accreditation and certification programs.
References
CDC. (2013). Healthcare-associated infections (HAIs). Retrieved form: http://www.cdc.gov/HAI/settings/ltc_settings.html
Hill, E., Nguyen, T., & Shaha M, et al. (2009). Person-environment interactions contributing to nursing home resident falls, Res Gerontol Nurs, 2(4):287-296.
Hughes, R. (2009). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from: http://www.ihf- fih.org/en/content/download/345/2692/file/Licensure,%20Accreditation,%20and%20Cert ification.pdf
Rooney, A., & Van ostenberg, P. (1999). Licensure, accreditation, and certification: Approaches to health service quality. Retrieved from: http://www.ihf- fih.org/en/content/download/345/2692/file/Licensure,%20Accreditation,%20and%20Cert ification.pdf
Rubenstein, L., Robbin, A., & Josephson, K et al. (1990). The value of assessing falls in an elderly population: A randomized clinical trial. Ann Intern Med 1990; 113(4):308-316.
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