Health Care Settings

Hospital
Nursing Homes
Home Care
Hospice
Adult Day Care
Assisted Living
Hospital
Hospital is the institution that provides a broad range of medical services
to sick or injured patients. Hospitals employ medical, nursing, and
support staff to provide inpatient care to those ho re!uire close medical
monitoring and outpatient care to people ho do need treatment but not a
constant medical attention.
"or many centuries they developed in association ith religious
institutions, such as the Hindu hospitals opened in #ri Lanka in the $th
century %C and the monastery&based 'uropean hospitals of the middle
ages ($th century to )$th century*.
+he H,tel Dieu in -aris, a monastic hospital founded in year ../, is still
in operation today.
+he first hospital established in the 0nited #tates as -ennsylvania
Hospital in -hiladelphia, hich as chartered in )1$).
Types of Hospitals
.. Hospitals may be classified by the services they provide (general or
speciali2ed*, the length of stay they offer patients (short stay or long&term
care*, and by their onership (not&for&profit, proprietary, or government
oned*.
a. Services Provided by Hospitals. General
Hospitals, regardless of their si2e, provide patients ith a
ide range of services, including emergency treatment,
surgery, and medical and nursing care. Specialized hospitals,
in contrast, may concentrate on a particular group of
patients, such as children, or a disease, such as cancer. #ome
speciali2ed hospitals combine treatment and research. #ome
general and speciali2ed hospitals also function as tertiary
care centers, treating the most difficult and comple3 cases or
the most seriously ill patients. +hese may include patients
ho need heart, lung, or liver transplants. Academic Medical
centres are usually massive urban hospitals linked closely
ith major medical colleges. 4any hospitals that serve as
teaching institutions train medical graduates ho are doing
postgraduate training in their areas of specialty. +eaching
hospitals also train others interested in a health care career,
including nurses and paramedic orkers.
b. Length of Stay.
short-stay or acute-care centers if their patients receive 30
days or less of inpatient treatment. #hort&stay hospitals are
geared for !uick intervention and constant monitoring of
serious, often life&threatening illnesses. +hese hospitals
provide immediate attention until a patient is stabili2ed
enough to be treated at home or in a health care setting that
can provide a longer stay
In long&term care institutions if their patients re!uire more
than 5/ days of treatment, as is available in rehabilitation
facilities or nursing homes. Long&term care institutions treat
physical diseases or injuries that are debilitating and re!uire
prolonged medical intervention or physical therapy and
regular skilled nursing care. #ome long&term care facilities
are psychiatric institutions for the mentally ill ho cannot be
cared for at home.
c. Ownership of Hospitals.
Not-for-profit, or voluntary hospitals, are charitable
institutions that e3ist to serve the best interests of their
communities. A small number of private charitable hospitals
ere spearheaded by individuals.
roprietary, hospitals are oned by corporations and their
shareholders.
Nursing Homes
Nursing Home is the residence that is e!uipped and staffed to provide
care for people ith serious medical conditions. 6n -akistan this setting
has not been established as yet. Hoever e see this concept in practice
in 0#A. +hese Nursing Homes are designed to provide food, shelter, and
medical care for their residents, as ell as social, religious, civic,
creative, and intellectual activities. 4ost nursing home residents are
elderly7 the largest group is beteen 1$ and 89 years of age
Nursing&home residents are people ho have serious medical conditions
but are not sick enough to re!uire hospitali2ation.
+he level of care provided by a nursing home depends on the patient:s
medical needs.
"or e3ample, skilled nursing facilities provide medical care
;9 hours a day.
6ntermediate care facilities are appropriate for people ho
are seriously ill but ho do not re!uire around&the&clock
medical care.
6n addition to providing medical care, nursing homes help residents ith
basic daily activities such as eating, dressing, bathing, grooming, going to
the bathroom, and moving from place to place.
+hey also provide constant supervision for patients ith dementia, the
intellectual impairment caused by strokes or neurodegenerative diseases
such as Al2heimer:s disease.
4any nursing&home residents have a chronic illness such as heart failure,
diabetes, lung disease, or degenerative joint disease.
About to&thirds have dementia.
Staffing and dministration
Nursing assistants,
registered nurse, and a
physician oversees each resident:s medical care.
-hysical therapists and occupational therapists ork ith residents to
help them maintain physical strength, coordination, and as much
independence in daily activities as possible.
A variety of other staff members, including social orkers,
activity coordinators, cooks, and housekeepers,
administrator,
<egular inspections of nursing homes focus on !uality of care (including
hether care is adapted to the special needs of each individual*, residents:
satisfaction, staff si2e and training, and safety.
=ffering creative activities such as art and music, activities for a broader
range of interests, and programs aimed at specific populations such as
Al2heimer:s patients.
4any nursing homes create a co2y environment ith plants, pets, and
decor that is more like a home than a hospital.
Choosing a Nursing Home
Nursing home can be a stressful e3perience. #ome elderly people are
reluctant to enter nursing homes because to them, nursing homes
represent the end of life, a place to go to die.
"amily members often e3perience guilt and stress hen they can no
longer care for an aging loved one and must decide to place that person in
a nursing home.
As the population ages, more nursing homes ill be necessary.
Home Care
4ost of those receiving long&term care and most caregivers prefer a home
environment.
=lder people prefer their home over the unfamiliar proposition of living
in a care facility.
=ften the decision to stay in the home is dictated by funds available. 6t is
much less costly and more loving for a father or mother to move in to the
home of their son than to li!uidate assets and put reside in a nursing
home. %esides, taking care of our parents or spouses is an obligation most
of us feel very strongly about.
)8. +hose needing care feel comfortable and secure in familiar
surroundings and a home is usually the best setting for that support. %ut
despite the psychological advantage, a home may not alays be the best
place for those receiving care or for the caregiver.
The Plight of Caregivers
Caregivers face many challenges providing care at home. A ife caring
for her husband may risk injury trying to move him or help him bathe or
use the toilet. Another situation may be the challenge of keeping constant
surveillance on a spouse ith advanced dementia. =r a son may live
hundreds of >4 from his disabled parents and find himself constantly
traveling to and from home, trying to manage a job and his on family as
ell taking care of the parents.
#ome caregivers simply don:t have the time to atch over loved ones and
those needing care are sometimes neglected.
Another problem ith full&time care is the risk of burnout. Caregiving
can be very stressful and demanding. 6n the case of a healthy spouse or a
child living ith the disabled person at home, caregiving can be a ;9
hour, 1 day a eek commitment.
%ut even for the caregiver not living in the home, looking after a loved&
one or friend can consume all of the caregiver:s free time.
Problems with Home Care
;). "or many long&term care recipients the home is an ideal
environment. +hese people may be confined to the home but continue to
lead active lives engaging in church service, entertaining grandchildren,
riting histories, corresponding, pursuing hobbies or doing handork
activities. +heir care needs might not be that demanding and might include
occasional help ith house cleaning and shopping as ell as help ith
getting out of bed, dressing and bathing. 4ost of the time these people
don:t need the supervision of a ;9?1 caregiver. +here are, hoever, some
care situations that are not suitable for home care.
;;. =ne is here a couple or individual have either cognitive or
physical disabilities that confine them to a bed or chair all day in one
room. 6f the caregiver can spend only minimal time in the morning and
evening and ill be absent the rest of the day, those receiving care
literally become imprisoned by their environment. +hey receive little or
no social stimulus and may spend day after day just sleeping or atching
television. +hey typically get no e3ercise other than moving to or from
the bathroom and often they suffer from poor nutrition and dehydration
due to lack of ade!uate food and fluid intake. Drinking and eating are
deliberately avoided to lessen trips to the bathroom or to avoid soiling a
diaper. 4alnutrition and dehydration often result in poor mental
reasoning or stupor, thus contributing to the daily routine of only sitting,
sleeping and enduring the +@. +his is not a noble ay to finish out one:s
life. And e are doing these people an injustice by keeping them
imprisoned in this manner at home. +hey should either be in a good adult
daycare center or in the more stimulating environment of an assisted
living facility.
;5. +he other situation here the use of home care should be eighed
against other alternatives is here a caregiver is in over his or her head
and either doesn:t recogni2e it or on:t admit it. +he care is just too
difficult to handle beyond a period of a month or more. #hort&term the
caregiver can handle it. Long&term, help is needed. +o make matters
orse, some overloaded caregivers on:t ask for help. 6f the person
receiving care is cognitive, he or she is probably aare of the caregiver:s
plight but may contribute to the problem by trying to support the
caregiver:s role. %oth may not kno there are other alternatives.
Problems That !ay Prevent Home Care from "eing an Option
;9. Caregivers face many challenges providing care at home. A ife
caring for her husband may risk injury trying to move him or help him
bathe or use the toilet. Another situation may be the challenge of keeping
constant surveillance on a spouse ith advanced dementia. =r a son may
live $// miles from his disabled parents and find himself constantly
traveling to and from his home, trying to manage a job and his on
family as ell taking care of the parents. #ome caregivers simply donAt
have the time to atch over loved ones and those needing care are
sometimes neglected.
;$. +he problems ith maintaining home care are mainly due to the
inade!uacies or lack of resources ith informal caregivers, but they may
also be caused by incompetent formal caregivers. +hese problems center
on five issuesB
a. 6nade!uate care provided to a loved one
b. Lack of training for caregivers
c. Lack of social stimulation for care recipients
d. 6nformal caregivers unable to handle the challenge
e. Depression and physical ailments from caregiver burnout
Lac# of Training for Caregivers
;.. +here is really no e3cuse for caregivers not to have training in the
physical and emotional needs of their care recipient. Help is available
from the local area agency on aging and in most cases ill cost nothing.
Here are some issues caregivers need to consider
a. -roper techni!ues for lifting and moving to avoid injuries
b. -roper use of bedpans and sanitation
c. Cays to prevent bedsores
d. Ho to deal ith incontinence
e. Ho to provide proper skin care
f. Ho to maintain personal hygiene ith a disabled person
g. 0se of devices, modifications and systems to help ith
disability
h. Ho to maintain good oral hygiene and oral health
j. Ho to avoid yeast infections in older omen
k. Ho to provide emotional and spiritual comfort
l. >noledge and training on fall prevention
m. Ho to prevent falls
n. Ho to provide proper nutrition
o. Ho to provide foot care and hygiene especially ith
diabetic patients
Telehomecare and $emote Patient !onitoring
;1. +elehomecare is a more effective ay to deliver home care under
certain circumstances. #ince it is a rapidly developing field, it:s difficult
to define all telehomecare applications. 6t usually involves to&ay
electronic communication beteen the patient and the formal caregiver
such as a nurse or doctor. Communication can occur ith to&ay radio,
telephone or as is usually the case, to&ay interactive video using a
computer and phone lines or satellite donlink. +his electronic face&to&
face home visit also re!uires some means for the care provider & ho
might be hundreds of miles aay & to access patient vital signs and
receive patient&initiated medical tests. +he patient or her in&home
informal caregiver has been trained to use electronic monitoring or test
e!uipment that sends the relevant video snapshots or numeric data via
phone line, or radio ave to the formal caregiver.
;8. +elehomecare is not only more cost&effective but also in many
cases it provides a higher !uality of care. Here are some of the ays
telehomecare is proving to be beneficialB
a. <educing number of visits to the emergency rooms.
b. <educing unnecessary visits to physician:s offices.
c. Avoiding unnecessary costly visits by health providers.
d. -roviding education of the patient in early symptom
management.
e. 4onitoring vital signs on a ;9&hour basis, therefore
providing a potential for early intervention and?or prevention
of repeat hospitali2ation.
;D. Although electronic monitoring of patients is also a function of
telehomecare, it is also becoming a primary source of supplemental home
care service not alays involving the use of a home health agency. +his
area of assistance focuses more on the use of devices that arn of
problems ith homebound people ho are often ithout caregivers for
certain periods of the day. +his may include ;9&hour vital sign
monitoring, video surveillance, emergency signaling systems or E-#
locator devices for andering care recipients. +o find products and
services go to <emote -atient F +elehomecare.
Hospice
5/. %ntroduction. Hospice care is a package of services and programs
provided to terminally&ill individuals and?or their caregivers and families.
Hospice beneficiaries must be under the care of a physician. Hospice is a
centrally&administered program of palliative care (i.e. services hich do
not cure illnesses, but produce the greatest degree of relief from the
symptoms of a terminal illness* and supportive care.
6ncluded are physical, psychological, spiritual and sociological cares,
hich is available ;9 hours a day, 1 days a eek.
Hospice services include bereavement & assistance to the family and
caregivers after the death of the hospice patient.
Hospice vs Nursing HomeB 6n terms of monitoring her vital signs and
handling 6@s G the round&the&clock nursing care that the skilled&nursing
facility benefit is designed to provide G maybe so. %ut for treating end&
of&life symptoms like pain and shortness of breath, for providing spiritual
support for her and her family, for palliative care that helps her through
the ultimate transition H hospice is the acknoledged e3pert.
dult &ay Care
5$. Adult day care is a daytime program of nursing care, rehabilitation
therapies, supervision, and sociali2ation that enables frail, often elderly,
people to remain in the community.
%y attending adult day care, people ho are functionally disabled and?or
moderately ill but not in need of tenty&four&hour nursing care can
remain in their homes at night ith their families and friends hile
receiving the care that they need during the day.
+he goal is to foster the ma3imum possible health and independence in
functioning for each client as ell as the optimum combination of care&
giving and respite for each family.
5.. +he services adult day care programs provide includeB nursing,
activities of daily living assistance, personal care, meals, recreation,
nutrition counseling, social services, physical therapy, occupational
therapy, medical assessment and treatment, family counseling, and
transportation.
#ome adult day care centers provide all of these services7 the remainder
provides select services
9/. #eem to offer an ideal alternative to caregivers by providing a
daytime care environment outside of the home. =ne ould think that a
program here a loved one could be nurtured, stimulated and provided
medical care ould be a elcome relief for the caregiver and the care&
recipient.
+he care&recipient ould receive supervision and possibly some limited
care hile the caregiver ould have a break from the routine of daily
caregiving. +his could give the caregiver needed time for herself and
some peace and !uiet to relieve the stress of caregiving.
ssisted Living
9$. Assisted living fills a gap beteen home care and nursing homes.
Iears ago, before assisted living, a person needing care ent to a nursing
home even though the care didn:t alays merit the intensive supervision
and control of a nursing home. +he fairly ne alternative of assisted
living provides a more homelike environment for people needing or
anticipating help ith activities of daily living or incidental activities of
daily living but for hich ;9&hour nursing care is not a necessity. 6nstead
of the hospital environment or a nursing home, Assisted Living "acility
(AL"* looks more like apartment buildings ith private rooms or suites
and locked doors. 6nstead of a nurse desk, there is a help desk. And
instead of a hospital&like lounge area and sterile cafeteria, assisted living
has gathering areas ith couches, fireplaces, gardens, atriums, etc.
Central dining areas look more like ban!uet rooms and often offer
entertainment during or after mealtimes. 4eaningful activities and chats
ith neighbors in pleasant surroundings, keep residents active and
stimulated.
9.. +here can be a variety of other assisted living facilities, some of
them being converted homes, others converted hospitals, some dedicated
areas in independent retirement communities and others dedicated
hospital ings. +here can be many differently living arrangements that
could be called assisted living. %ut at a minimum the essence of all of
these facilities is to provide an assistive environment to individuals or
couples ho for either medical reasons or to gain freedom from being
tied to maintaining a home prefer instead to have someone else do the
cooking, cleaning and gardening.
-rior to assisted living, many people had to reside in nursing homes but
didn:t need the level of care provided. Iet there ere fe options for
other living arrangements. Cith assisted living, these people no have
the choice of a more home like environment at loer cost than of a
nursing home.
Not all residents of AL"s need care or assistance. 4any are there because
they ant a simpler lifestyle ithout the orry of maintaining a home
and they seek the companionship of other people their on age. +hey
also may have chosen assisted living over an independent retirement
community because they may need some minor help ith 6nstrumental
Activities of Daily Living such as taking medications but they anticipate
a time hen they may need the more intensive care available ith an
AL".