Complexities of the Care Facility and Nursing Home - Essay Example

Introduction The ability to meet the needs of different individuals is one which is based on the work area which one is in and the responses which are included in the applications of the area. The environment, attitudes of those in the area and the responses from others who affiliate with a business all make a difference in how one responds to the different services or products offered. This report is based on personal experience of being in a work learning environment, specifically with the personal job I carry as a care manager of a nursing home. Through observations, first hand experience and affiliations with secondary research I have been able to look at different applications which are required for the care center and changes which need to be made. The main ideology which is a part of the conditions of the care home are based on the need to change the quality of life in the building through the staff, family and residents that are a part of the home. Observations of the Care Home The concepts which were in the care home were based on 20 weeks of observations and interactions which were taken with the residents and what was occurring within the region. The first four weeks were noted as basic observations, including looking at routines, environment and interactions between the individuals. It was noted during this time that the schedules and routine as well as the environment always remained the same. The standards were expected to be met in terms of when meals were served, what activities were available, times for visitors to come in and meeting the needs of residents in the area. The staff easily met these while ensuring that the residents were able to keep their basic needs as met through this main environmental setting which was associated with this. The environment followed the same routine, specifically by keeping everything orderly at all times without changing the care home unless a special event occurred. These were based on policies and standards as well as expectations upheld by managers and those in other positions. An interview was given during the first four weeks from this main observation, specifically in terms of why the environment and scheduling was this way. When speaking with the staff, there was a specific response based on the needs and attitudes of residents. Most had come from a way of life which was expected to uphold specific routines for comfort. If this basic comfort level were not kept, then it would cause difficulties and problems among the residents and would cause difficulties not only with the routine during the day, but would also continue as the residents developed a specific attitude and set of behaviors toward the routines or a specific staff. By ensuring that the routine were developed, it avoided problems which would occur with the family and would also provide continuous comfort and higher quality. This particular application was one which followed with the standards that allowed the care home to continue functioning with the specific needs while providing the proper routines to keep to the necessary standards. The initial interview and observations led to questions that were asked during weeks 5-8. The residents were expected to have a specific set of behaviors and attitudes which made the living more comfortable. This was combined with the need to have specific needs met while ensuring that the residents were able to receive what was needed according to policies. However, when observing the residents closely, it was noted that the attitudes and behaviors, while comfortable with the basic routines, did not have the right approach to the other residential needs. This was based on the inability to meet individual needs because of the amount of staff and the level of comfort available. At times, the residents would have behavioral problems or would feel neglected because of the staff inability to meet specific needs. This particular problem, while allowing the correct options for basic comfort, did not provide complete alternatives to those who were in the care home and which had specific needs. At times, I noticed that a resident would become depressed or would begin to alter the attitude which they held, most often spoken of by the staff as one of the residents having a bad day. With this observation, I interviewed several of the residents about the living conditions. During this interview, I asked about the basic treatment and care of the residents and their feelings toward the staff. A total of 20 of the healthier residents were interviewed with the basic attitudes and trends which were in the home. The residents all stated that they were happy with the comfort level, basic routines and care which were provided. However, 75% of the residents also stated that they were often unable to find the comfort that they would find in their home. The problem was based on a lack of resources and available materials. Often, staff would not be available and they would find themselves waiting for something which would have been easily taken care of if they were on their own. The majority of residents were not happy about staying in the care home and did not find it to be conducive to their needs and the ability to live comfortably. The term which was often heard during the interviews was that they stayed in the home because it was convenient to the family and they did not have another place to go. This particular attitude was one which then developed into many having a difficult time when remembering their time away from the home and the lost conveniences which were a part of the resources and comforts they would have had at the home. The observations from week 9 – 20 continued with the same observations. However, at this time I became more aware of what the residents did try to do with the attitudes, behaviors and resources given. The most common approach by the residents was to watch the TV or to remain in their rooms taking naps. The common attitude changed when there was a visitor, outing or activity. These highlights immediately changed the attitude of the residents while creating a different approach to the resident attitudes. It was also noted that during these times, the residential behaviors and attitudes were calmer and were more positive than other times. This particular change in behaviors and attitudes was specific to the type of activity which was conducted as well as who was visiting the individual. The positive attitude was heard directly when one would begin to brag to the other residents about a family visit or going out for a special trip that others were also invited to. The positive changes which were a part of the care center during these times immediately began to change the way in which many were looking at the different needs within the residential area. The final observations were followed by another series of interviews, all which created the same response to the individuals living in the nursing home. Each resident and staff which was interviewed had similar answers. The behaviors and attitudes were able to alter when one was given more activities, outings or was visited by the home. This was combined with several who stated they did not see their family as often and that this led to them not feeling the same positive changes in the area. From this information, a series of interviews were held with families. All families which came in stated that they could see that their parents or relatives would have a positive feeling when they came in and would always tell them how good things were going in the care facility. The families also stated that the staff would ask them to come back as often as possible when giving updates about the attitudes and behaviors, as this directly affected the attitudes which were a part of the care facility. The families which came the most noted that the attitudes remained positive with those that were in the care facility. One family was interviewed which only came one time during the 20 weeks. This family noted they did not have as much time to visit and also found that the resident they visited was not holding a positive attitude. The responses from the resident became bitter and often attacked the families inability to come to the care home as much. It can be stated that activities and visits from family then has a direct influence on the responses and behaviors which occur within the care facility. From the 20 weeks of observations, it is noted that quality comes from multiple dimensions in order to meet the needs of those that are in the nursing home. This begins with the ability to create the right environment and procedures to ensure basic comfort. This is also inclusive of having the right resources and care areas to ensure that each of the individuals is able to have all needs met while having the extra comforts which they would find at home. The most important part of the quality of life; however, comes with the understanding of activities, outings, special events and the ability to meet with family. Keeping these connections is what allows the facility to be more than a basic care home, but instead to improve the quality of life that are a part of those who are going to the care home for the needs which are required. Creating this basic comfort and approaches is then the priority which needs to be considered to improve the quality of life for those going to the nursing homes as residents. Quality of Life in Care Homes The quality of life in care homes that was observed follows with secondary research and theoretical viewpoints which are designed to improve the quality of life in these environmental areas. Examining the past research which has developed the right quality to care homes can become a part of the innovations and implementation within the care homes, specifically to provide even more opportunities to the residents while beginning to enhance the different concepts in the home. The ability to not only change the basic concepts with the theories and observations, but also adding in innovation to the area can help to begin to change the approaches within the care home while adding in more components to the care homes and what is required for those who are going to the facility as a resident. The first association which needs to be implemented within the care homes is based on the challenges and opportunities noted with end – care homes. It is currently noted that over 20% of death occurs in care homes in the United States and is beginning to increase as more elders are placed in care homes at the end of life. It is also noted that there are critical factors which are becoming a part of care homes. This is inclusive of a lack of staff, the inability to have the right physician training, reimbursement issues and a lack of extra faculty, such as psychological assistance, for the residents and the families. Each of these gaps is not only problematic with residents who do not have difficult symptoms. The elders that are suffering from diseases and being terminally ill are often not able to receive the proper treatments and care. This may shorten their life span and does not allow them to have the proper assistance for specialized needs that are a part of the care home. From this study, there is noted challenges which are associated with the resources, specifically for basic health and care among both the families and residents (Ersek, Wilson, 2004). The lack of care that is noted from the resources missing in the care homes is one which is further defined with the noted needs of those in nursing homes. While the basic resources are provided, most have found that care homes require extra assistance that is not provided to the elderly. Through a current study (Reynolds et al, 2004), it was noted that the end of life care often did not match with the psychological needs, both with family and staff after one passed away. This was combined with the care facilities not having the necessary resources for advanced stages of the symptoms, specifically in terms of the physical and emotional symptoms which came with those who were dealing with end of life conditions. The lack of treatments and care for the advanced symptoms, including emotional, mental and physical treatments, were not able to be provided within the home and did not offer the correct treatment for pain. This was furthered with the different hygienic needs and emotional and spiritual care that was often not provided. The challenge presented through this study was to begin to change the facilities for well – equipped staff that were able to provide personal services that could guide with the emotional, spiritual and physical symptoms on different levels (Reynolds et al, 2004). The concept of quality of life within a care home is one which has been further studied with ways in which the symptoms and outcomes can be improved, without the necessary professionals available. A current study (Kerse, 2008), examined different programs and activities in a variety of care homes to determine if these improved the quality of life of residents in each of these areas. It was found that the activities made a difference with those who had regular or increased cognition while they were in the care home. However, the residents which had disability, cognitive impairment or depression had little to no effect over the activities which were provided. The psychological, emotional and mental symptoms which were associated with this began to change the treatment and levels of health while altering the outcomes. While it was noted that activities and other options may help to improve the quality of life, other resources are needed. These resources are dependent on offering assistance with the psychological, emotional and physical difficulties which are unique to care homes and the elderly that are in the specific environment (Kerse et al, 2008). The concept of coordination among the patients and adults combined with the care homes use of medicines and the needed approaches which were not often provided to the residents. In a current study (Barber et al, 2009), it was noted that basic care professionals and nurses were the care providers that were often responsible for all the needs of the elderly. This particular responsibility is one which caused the basic medications to be available but not other specific needs. Medical errors and other complexities were often associated with the residential needs while causing more errors in the primary care. It was found that the problems and errors increased with three times higher amounts of errors. This is one which reduced the quality of life and was unable to create the correct amount of comfort for residents. The problem is one which led to more disabilities with the medicine not being provided and the lack of professional care being available to those which were in the care homes. The problem then moves beyond the basic comfort and into patients that don’t have the needs met because of a lack of professional training or available resources within the area (Barber et al, 2009). The question of needs within a care home then become the main ideology of theories and how the care should be treated among the elderly. The concept is one which links to the theories of care coordination that are required in care homes. The care coordination is one which allows the quality of health care to be matched with the specific psychological, emotional and physical needs. The programs are inclusive of patient education and monitoring, communication with physicians about specific needs and group interventions which may be available to residents. For instance, if a resident is depressed, a nurse has the ability to find a specific doctor to help to treat the resident. It was noted that the care coordination was able to lower the total number of costs in the health facility while offering more care and assistance to those who were in need of specialized support for their needs. The lower costs were specifically affected with the Medicare costs that came from emergency situations and the neglected issues which were not often available through the care homes. These were followed by the basic communication skills that were implemented and which provided for higher quality of life by the individual care that was available through the communication procedures that were implemented and used (Peikes, 2009). The concept of coordination among specific needs move into a multidimensional model of the needs of those in care homes. The multidimensional model is one which is inclusive of the holistic approaches which are required for those in care homes and which are needed in terms of moving into different areas of care. The dimensions are inclusive of physical, mental, emotional and spiritual needs that are specific for the elderly group that move into nursing homes. These dimensions are furthered with the activities, family associations and the psychological implications that are associated with the various areas of care. The multidimensional model suggests that there is the need to change care quality based on these different areas of assistance that are required for all residents. The requirements are one which is determined by the environment created as well as the communication, cost and viewpoints which are available. Including the staff and families in the care for those remaining in the home and creating a different approach to the care quality then is able to provide even more alternatives to assist those which are in care homes and which are in need of assistance at the various levels of care (Rantz, 2009). The main approach which needs to be taken is to redefine what it means to have care for the elderly. This is furthered with what the quality of life should be for the elderly and those who are living in the nursing homes. The interpretations of these definitions is what will determine the main changes which are required in the nursing homes and how this is able to begin to alter and change the approaches which are made in nursing homes. The quality of care is one which now needs to expand beyond providing a space for the elderly while having nurses readily available for specific needs. This needs to combine with more resources, access to specialized concepts and the ability to freely communicate with patients on the emotional, psychological and physical level. Expanding the needs of those who require care and being able to meet these beyond basic care then alters the quality of life and the health care which is available. This change is then able to build and develop a different approach to those who are in a care facility while beginning to alter the environment into one which is holistic in nature and is inviting of complete care and higher quality of life to the elderly that are in the specific homes (Norman, 2003). Innovations of a Care Home The concepts which are seen in the theories, studies and observations all point to the need to move toward more innovations that are able to match the needs of those within a care home. By doing this, there is the ability to revolutionize the ideas of care facilities and how these are a part of the elderly needs that are within a community. The main objective is to begin looking at the psychological, emotional and physical needs of residents beyond the main and regulatory approaches which are used. By doing this more, there is the ability to create and establish a stronger approach to the care facilities while beginning to change the work that is provided with those who are looking at the care home. The aim and goal of a defined program is to begin heightening the quality of life of the elderly while ensuring that the proper resources are available for those that are a part of the main care home facilities. The first implementation which is required in the nursing facility is the ability to begin using the multidimensional model for care. This is inclusive of the holistic viewpoint for psychological, emotional and physical needs being met. The first step to this is to begin to train the staff and others caring for the residents. The training will be based on the defined needs of residents and how to recognize what these are. The training continues with the ability to communicate with those who are in the facility so personal and specialized needs can be met with those that are in the facility. This basic training and development will be to establish different goals and understanding with those that are a part of the program. It is noted that, even though this will be a part of the changes within the care home, there may be some resistance to the program. The lack of time and the lower amount of staff remain problematic with the care home. Not being able to change this particular approach may cause some difficulty in meeting some of the needs until there is the ability to change the number of staff working. However, the alteration of communication and basic knowledge by the staff can begin to change the processes that are within the care facility. The next step used will be to connect a community that is a part of the care facility. Psychologists and others who have more information in terms of physical needs will be included in this. The lack of budget and inability to meet specific needs with these professionals may be problematic. Instead of hiring individuals, a network will be established between the care home and others who are interested in this specific area. The network will be inclusive of physical contacts which are associated with those who are a part of the facility. This will be combined with an online network that will be established between different offices with individuals committing specific times and spaces for communication and development within the care facility. This particular online network will be inclusive of a database of observations and problems with the elderly and residents at the care facility. The proper professionals then have the ability to observe and diagnose specific patients or to offer basic guidelines for care and treatment. If necessary, the doctor can come to the care facility. However, the online network will be established to continue to further knowledge at a lower budget while ensuring that each of the staff members are able to provide more assistance to those who are in need of psychological, emotional or physical help. The online network established will be furthered with the ability to have more programs at the care home facility. Currently, there are few activities available. These come from volunteers who are only able to come to the facility at different times but don’t have the necessary procedures to those who are a part of the network. To change this, there is the need to alter the care home facility so more activities are available. Finding more volunteers, putting together programs for the residents and establishing more entertainment and connections to others may help to alter the specific needs of the residents while changing and placing those that are within the care facility. By doing this, there is the ability to begin altering the needs of those that are in the facility while establishing a different approach to the psychological and emotional needs of residents. As this continues, it will build a positive environment, especially to others that are in the facility but are suffering from psychological and emotional problems within the area. By doing this, there is the ability to alter the associations which are made in the residency while assisting with the care and quality of life that is associated with the residential programs. Limitations to Innovation While there are several possibilities for the care home to offer higher quality of life, there are also questions that are a part of the innovative techniques. Offering training and development, expanding to a collaborative network and pushing for activities also has some limits with the facility. The first is the budget that is available to begin adding in new programs and to offer specific needs. Currently, there is a limitation with the staff as well as resources, specifically because of the budget that is within the facility. The care home will need to find grants and other alternatives that are associated with the facility, specifically to create and alter a different approach to the needs of those in the home. This limitation will need to be looked at over time with specific amounts of time designated to each phase of the project so the budget can be met to improve the quality of life that is within the care home. The second limitation that is a part of the care facility is based on the staff and the resources which may be available. Theoretically, the multi-dimensional viewpoint of establishing a network and moving forward with the needs of residents is ideal. However, it is not necessarily associated with the ability to easily create the changes within the facility because of the lower amount of staff and the expectations which are a part of the program. The structure, process and outcomes which are a part of the collaborative structure will need to be firmly established while creating a different approach to the resident, staff and family members. The environment, processes of care, expectations for the staff and other concepts will need to be implemented at a different level for the holistic care to be made available. This will need to be combined with the expectations for resident outcomes. This is inclusive of how the staff and others want the residential attitudes to be as well as how this can be promoted. Ensuring that the collaboration is constructive in understanding the change in the structure and process of the care home is one of the areas which will need to have continuous attention, monitoring and change for the innovation to work within the care home (Thompson, Gessert, 2005). The main approach which will determine the limits or the approaches to change is based on the perceptions and the ability to alter the perceptions which are a part of the care home. There are several care homes which are now being defined as smart homes. The smart homes are inclusive of the holistic and collaborative approach for care homes, specifically with the involvement of residents, families and others working in the facility. The smart home combines this with devices for both entertainment and to meet the specific needs of those within the facility. This is combined to data collection and processing. The smart home is then able to provide a foundation for those working in the home, specific to the online collaboration area that is a part of the care home online network which is to be established (Chan et al, 2009). However, for the smart home implementation and online network to be established within the care home, there needs to be training, education and a lack of resistance to the changes being made. This will help to cut costs of staffing and will provide more options for collaboration. However, the resistance is one which is based on the misunderstandings of the change and how this may create alterations in the staffing and expectations. Ensuring that the changes into a smart home are established with a firm foundation then becomes essential to the overall changes within the care home. Conclusion The concepts associated with the nursing home and care facility also require better quality of life and establishment of different features. When looking at both secondary research and observations from a care home, it is noted that there are basic needs which are met. However, the lack of staff, budget and other complexities often don’t provide complete quality of life. This is dependent on the lack of psychological and emotional assistance that cannot be met as well as the inability to care for more complex cases within the care home. The ability to change this is one which is dependent on establishing multidimensional models for the assistance of those looking at the care of the home. This is combined with the need to look at the facilities and to alter this with the care of life which needs to be made available to those who are in the care home. Combining this with the staff, residents and family and ensuring that the correct collaboration takes place through various means can provide improved quality of life while ensuring that all individuals receive the personal attention required while in the home. References Barber, ND, DP Aldred, DK Raynor. (2009). “Care Homes’ Use of Medicines Study: Prevalence, Causes and Potential Harm of Medication Errors in Care Homes for Elderly People.” Quality and Safety Control 32 (1). 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(2009). “Nursing Home Care Quality: A Multidimensional Theoretical Model Integrating the Views of Consumers and Providers.” Journal of Nursing Care Quality 14 (1). Reynolds, Kimberly, Martha Henderson, Alan Schulman, Laura Hanson. (2004). “Needs of the Dying in Nursing Homes.” Journal of Palliative Medicine 5 (6). Thompson, Sarah, Charles Gessert. (2005). “End of Life in Nursing Homes: Connections Between the Structure, Process, and Outcomes.” Journal of Palliative Medicine 8 (3). Read More