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Skilled nursing facilities are continuing to evolve in the services offered and in their role within the health care system. Nursing facilities are increasingly offering care for post-acute, short-stay patients such as those needing rehabilitation after a stroke, medical illness, or surgery. Short-term care may also include respite care and hospice-type care. Typically, over half of the long-term residents in a nursing facility suffer from dementia. The trend toward a variety of assisted living arrangements has left skilled nursing facilities with more medically complex, functionally and behaviorally impaired residents. Issues of informed consent, use of restraints, and medication prescribing and management must all be addressed at both the clinical and administrative levels. Quality improvement efforts must include regulatory and legal requirements in addition to the benchmarks set by the nursing facilities themselves.
The American nursing facility is an important community resource, a refuge of last resort for those among us whose needs exceed the capacities of our families to provide care at home. Although often feared and reviled, the American nursing home is a dynamic microcosm, a subculture within the broader community. Nursing homes reflect the values of the communities of which they are a part. The call for “culture change” within the nursing home is really a call for an examination and evolution of the parent culture that created the nursing home in the first place. If the nursing home neglects its residents, the blame in part may be placed at the feet of the community. Although a corporation may own the nursing home, it belongs to the community in a moral sense. In America today, however, we are more apt to adopt a highway than a nursing home or the nursing home resident without any family of her own.
The best nursing homes are likely to be those staffed by local men and women who take pride in their work and are respected for helping their neighbors care for family members who are infirm and disabled. They are likely to be those facilities in which: families, including children, remain actively involved in the lives of their loved ones entrusted into institutional care; organizations such as faith communities, schools, and clubs are routinely present to enrich and enhance the quality of life for the residents; and frail older people can remain spiritually alive and engaged in relationships, celebrations, and community life.
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