QUALITY INDICATOR IN ELDERLY CARE HOMES (3)

% of residents who develop urinary tract infection (UTI)


Most urinary tract infections can be prevented by keeping the area clean, emptying the bladder regularly, and drinking enough fluid. Nursing home staff should make sure the resident has good hygiene.


Finding the cause and getting early treatment of a UTI can prevent the infection from spreading and becoming more serious or causing complications like delirium. It is important to find out whether the UTI is caused by a physical problem, like an enlarged prostate, so proper medical treatment can be given.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (2)

Percentage of residents who self-report

moderate to severe pain


Residents should be checked regularly by nursing home staff to see if they are having pain. Residents (or someone on their behalf) should let staff know if they are in pain so efforts can be made to find the cause and make the resident more comfortable.


If pain is not treated, a resident may not be able to perform daily routines, may become depressed, or have an overall poor quality of life. This percentage may include some residents who are getting or have been prescribed treatment for their pain, but who refuse pain medicines or choose to take less. Some residents may choose to accept a certain level of pain so they can stay more alert.

Alzheimer's - Degenerative age-related disease that impairs an individual's cognitive ability. Symptoms may include forgetfulness, wandering, and inability to recognize others. The disease is caused by neuron dysfunction and death in specific brain regions responsible for cognitive functions. Both genetic and environmental factors likely play a role in the development of Alzheimer's. A progressive disease that destroys cells in the brain and is the leading cause of dementia.


​Ambulatory - Describes ability to ambulate, walk around, not bedridden or hospitalized.


Assets - Money you have or property you own, such as cash, bank accounts, personal property, vehicles, real estate, and the cash surrender value of life insurance.


Assisted Living - A residential community with services that include meals, laundry, housekeeping, medication reminders, and assistance with activities of daily living. Generally regarded as one to two steps below nursing care. Might also be referred to as Residential Care Home.


Assisted living facilities consist of individual apartments, usually studio or one bedroom units, with some two bedroom apartments available. Each apartment has a bathroom equipped with walk in showers and grab bars, emergency call buttons, and often a small kitchenette. The facilities offer 3 meals a day, personal care (generally 45 minutes to 1 hour each day), activities, assistance with medications, homemaking, and scheduled transportation. Some have on site medical services, hair salons and fitness facilities.


Carer - Provides the most personal care to residents, including bathing, dressing, and toileting. Must be trained, tested, and certified to provide care in nursing homes. Carers work under the supervision of a Nurse.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (1)

Percentage of residents who experience

one or more falls with major injury


Each year, one in every three adults age 65 and older falls.

One third of falls among nursing home residents results in an injury. There are many things a facility can do to prevent falls and fall-related injuries.


Falls can cause moderate to severe injuries such as:

Bone fractures, Joint dislocations, Closed head injuries, Subdural hematoma, Altered consciousness.

ELDERLY CARE GLOSSARY OF TERMS

Activities of Daily Living (ADLs) - Everyday functions and activities that people usually do without help. These include dressing, eating, bathing, toileting, transferring and continence.


Acute Rehabilitation - Aggressive level of rehab, often up to 3 hours a day. Some elders start in acute rehab and then transfer to nursing facilities for continued, slower-paced rehabilitation.


Adult Day Care - Daily structured programs in a structured community setting with socialization activities and health-related and rehabilitation services for elders who may require supervision due to limited physical or cognitive abilities, and who may be physically or emotionally disabled and need a protective environment. This care is provided for during the day, the individual returning home for the evening. Programs provide meals, transportation, medication monitoring, administration, and social services. Enrolling an elder in an adult day care program can provide needed respite for caregivers.


Aging in Place - Concept which advocates allowing a resident to choose to remain in his/her living environment despite the physical and or mental decline that may occur with the aging process.

​​Cleanliness and infection control

Minimize risk of exposure to a health care associated infection arising from the operation and activity. Protection against identifiable risks of acquiring such infections by the effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of a health care associated infection. The provision of appropriate care for those affected by a health care associated infection; and the maintenance of appropriate standards of cleanliness and hygiene on the premises, equipment and reusable medical devices used, and materials to be used, which are at risk of being contaminated.


Management of medicines

Ensure you have your medicines at the times you need them, and in a safe way. You will have information about the medicine being prescribed made available to you or others acting on your behalf. Those responsible will handle medicines safely, securely and appropriately, and ensure that medicines are prescribed and given safely, and follow published guidance about how to use medicines safely.


Safe and suitable premises

Safe and accessible surroundings that promote your wellbeing. Assurance that your personal property will be secured. Protection against the risks of unsafe or unsuitable premises by the design and layout of the premises being suitable for carrying out care activity. Appropriate measures being in place to ensure security of the premises. Premises and grounds being adequately maintained, compliance with legal requirements relating to the premises, Take account of any relevant design, technical and operational standards and manage all risks in relation to the premises.


Safety, availability and suitability of equipment

Prevent risk of harm from unsafe or unsuitable equipment (medical and non-medical equipment, furnishings or fittings). Ensure provision of equipment that is comfortable and meets your needs. Comply with regulations to make sure that equipment is suitable for purpose, is available when needed, is properly maintained and is used correctly and safely, and promotes independence.  Follow guidance about how to use medical devices safely.


Requirements relating to workers

Staff are fit, appropriately qualified and are physically and mentally able to do their job. Effective recruitment and selection procedures in place. Relevant checks performed when employing staff. Ensure that staff are registered and authorized by the relevant professional body where necessary. Report staff who are no longer fit to work in health and adult social care to the appropriate authorities.


Staffing

Sufficient numbers of appropriate staff. Compliance with regulations to make sure that there are sufficient staff with the right knowledge, experience, qualifications and skills to provide support.


Supporting Staff

Competent staff. Compliance with regulations to ensure that staff are properly supported to provide care and care. Staff are properly trained, supervised and appraised. Staff are supported to acquire further skills and qualifications that are relevant to the work they undertake. Provision of assessment and monitoring of the quality of service provision.


Complaints

Comments and complaints are listened to and acted on effectively. You will not be discriminated against for making a complaint. Compliance with the regulations and systems in place to deal with comments and complaints, including providing information about that system. Provide support to make comments and complaints. Consider fully, respond appropriately and resolve, where possible, any comments and complaints.


Records

You are protected from the risks of unsafe or inappropriate care. Accurate and appropriate records are maintained of care needs and how they should be met. Staff can take any action when a concern is identified. A system is in place to monitor care records on a monthly basis to ensure any areas of improvement can be identified and actioned. Quality assurance checks are carried out on the homes records and report on any recommendations for improvements to the records.

 

Non-Ambulatory - Inability to ambulate, walk around, and usually bedridden or hospitalized.


Not-for-Profit - Status of ownershipand/or operation characterized by government by community-based boards of trustees who are all volunteers. Board members donate their time and talents to ensure that a not-for-profit organization's approach to caring for older people responds to local needs. Not-for-profit homes and services turn any surplus income back into improving or expanding services for their clients or residents. Many not-for-profit organizations are often associated with religious denominations and charity groups. Not-for-profits may also interact with government agencies to further causes that serve the elderly.


Nursing Home - Residential facility licensed by the government that provides 24-hour nursing care, room and board, and activities for convalescent residents and those with chronic and/or long-term care illnesses. One step below hospital care.  Regular medical supervision and rehabilitation therapy are mandated to be available. May be referred to as Nursing Facility or Convalescent Home.


Occupational Therapist - A rehabilitation professional who teaches people to compensate for functional limitations as a result of an injury, illness or disability by learning skills and techniques needed to perform activities of daily living and optimize independence.


Occupational Therapy - Process to help  individuals relearn activities of daily living, generally administered by a licensed occupational therapist.


Personal Emergency Response System - In case of a fall or other medical emergency, this electronic device enables the user to contact help 24-hours-a-day simply by pressing a button. A number of private companies offer these systems.


Physical Therapist - A rehabilitation professional who utilizes various therapies to help people maximize mobility, and restore strength and body movement after an illness or injury such as a stroke, fall, back injury, etc.


Physical Therapy - Process that includes individualized programs of exercise to improve physical mobility, often administered following a stroke, fall, or accident. Physical therapists plan and administer prescribed physical therapy treatment programs for residents to help restore their function and strength.

Geriatrician - A physician who specializes in the care of the elderly, primarily those who are frail and have complex medical and social problems.


Home Health Care - Provision of medical and nursing services in the individual's home by a licensed provider. Skilled services in the home including nursing, physical therapy, occupational therapy, speech therapy, and home health aids.


Hospice Care - Care and comfort measures provided to those with a terminal illness and their families- it can include medical, counseling, and social services. Hospice care addresses the physical, spiritual, emotional, psychological, social, financial and legal needs of the dying patient and his/her family. A concept that refers to enhancing the dying person's quality of life. Hospice care can be given in the home, a hospital, special hospice facility or a combination of both.


Independent Living - Multi-unit senior housing development that may provide supportive services such as meals, housekeeping, social activities, and transportation. Independent Living typically encourages socialization by provision of meals in a central dining area and scheduled social programs. May also be used to describe housing with few or no services (Senior Apartment). They often include some social work coverage, emergency call buttons inside the apartment, and bathrooms that include equipment such as grab bars.


Legal Guardian - A court appointed individual responsible for the financial and physical well being of a person deemed incompetent.


Living Will - A document that spells out one’s wishes for end of life care.


Long-Term Care - Provision of services to persons of any age who are afflicted with chronic health impairments.


Meals on Wheels - Meals on Wheels programs were developed to provide nutritious hot meals to seniors who are largely homebound. The meals are delivered for a nominal fee.


Medical Director - A staff medical director assumes overall responsibility for the formulation and implementation of all policies related to medical care. The medical director also coordinates with an individual's personal physician to ensure that the facility delivers the care that is prescribed. In some instances, the medical director may be a resident's primary physician.


Medications Management / Medication Administration - Formalized procedure with a written set of rules for the management of self-administered medicine, as in an assisted living setting. A program may include management of the timing and dosage for residents, and could include coordination with a resident's personal physician. The resident must take the medication him or herself. For instance, the facility can remind the resident that she needs to give herself the medicine injection, but the facility cannot perform the actual injection itself.

Consent to treatment and care

Where you are able, give valid consent to the examination, treatment, care and support you receive, understand and know how to change any decisions about, examination,  care and support that has been previously agreed, can be confident that your human rights are respected and taken into account.


Care and welfare Impartial access to care or available lodging or appropriate medical and personal care based on individual needs, without considering race, religion, gender, national origin or social class. Effective, safe and appropriate care and support that meets your needs and protects your rights. Reducing the risk of receiving unsafe or inappropriate care  and support by assessing needs, planning and delivering care and support, taking account of published research and guidance, making reasonable adjustments to reflect individual needs, values and diversity, having arrangements for dealing with foreseeable emergencies.


Meeting Nutritional Needs

Supporting adequate nutrition and hydration. Reduce the risk of poor nutrition and dehydration by encouraging and supporting adequate nutrition and hydration. Providing choices of food and drink to meet diverse needs, making sure food and drink is nutritionally balanced and supports your health.


Cooperating with other providers

Receive safe and coordinated care and support where more than one provider is involved. Cooperate with others involved in the  care and support when responsibility is shared or transferred to one or more services.  Share information in a confidential manner with all relevant services to enable  care and support needs. Work with other services to respond to emergency situations. Provide support to access other health and care services as you need.


Safeguarding from abuse

Protection from abuse, or the risk of abuse, and your human rights are respected and upheld.  Take action to identify and prevent abuse from happening. Respond appropriately when it is suspected that abuse has occurred or is at risk of occurring. Ensure that Government guidance about safeguarding people from abuse is accessible to all staff and put into practice. Make sure that the use of restraint is always appropriate, reasonable, proportionate and justifiable to that individual. Only use restraint in a way that respects dignity and protects human rights, and where possible respects the preferences of people. Understand how diversity, beliefs and values of people influence the identification, prevention and response to safeguarding concerns. Protect others from the negative effect of any behaviour.

STANDARDS OF SAFETY AND QUALITY IN ELDERLY CARE


Residential care homes and nursing homes have a legal responsibility to make sure they are meeting standards of quality and safety. These are standards everyone should expect and experience when they receive care.


Respecting and involvement

Understand the care and support choices available to you, can express your views, so far as you are able to do so, and are involved in making decisions about your care and support, have your privacy, dignity and independence respected, have your views and experiences taken into account in the way the service is provided and delivered.


Privacy

The right to refuse to speak to, or to see someone, including visitors and persons officially related to the hospital, but not involved directly in your care. The right to be examined in installations designed to ensure privacy, visual and auditory isolation. The right to request that a person of the same sex be present during certain parts of a medical examination or during care or procedures done by a professional of the opposite sex, as well as, the right not to remain exposed for more than is necessary for carrying out the procedure for which you were requested to undress. The right to expect such privacy during toileting or bathing and other activities of personal hygiene, except as needed for patient safety or assistance.


Confidentiality

The right to expect that every consultation or mention of your care is made discreetly and that there are no people present who are not directly involved in your care without your consent. The right to have your medical file read only by those directly involved in your care or those who supervise its quality, and by other persons only with your prior written authorization or that of your legal representative.  The right to expect that all communication and records pertaining to your care, including the provision for payment, is treated confidentially. The right to be provided with the isolation and protection that are considered necessary for your personal and biological safety.

Power of Attorney - The legal designation of someone to be responsible for your financial decisions at the point that you are no longer able to manage your own affairs.


Nurse - Graduate trained nurse who has passed board examinations and is licensed by the government to practice nursing. The Nurse plans for resident care by assessing resident needs, developing and monitoring care plans in conjunction with physicians, as well as executing highly technical, skilled nursing treatments.


Rehabilitation - Therapeutic care for persons requiring intensive physical, occupational, or speech therapy.


Respite Care - Temporary relief from duties for caregivers, ranging from several hours to days. May be provided in-home or in a residential care setting such as an assisted living facility or nursing home.


Retirement Community - Apartment units for elders in a community of independent but often aging-in-place elders. These communities are generally available for monthly rental. The apartments usually have full kitchens and emergency pull cords and provide housecleaning and 1 or 2 meals each day. There are activities in the building and outside trips.


Senior Apartment - Age-restricted multiunit housing with self-contained living units for older adults who are able to care for themselves. Usually no additional services such as meals or transportation are provided.


Senior Center - A community facility for the elderly. Senior centers provide a variety of activities for their members including any combination of recreational, educational, cultural or social events. Also, some centers offer nutritious meals and limited health care services.


Visiting Nurse/Home Health Agency - Certified agencies that are working under the orders of one’s doctor to provide nursing care and, potentially, physical, occupational, and speech therapy as well as home health aid services.

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QUALITY ELDERLY CARE

Information, Advice and Guidance on Elderly At Home Care, Senior Residential Care Homes, Nursing Homes, Geriatric and Hospice Care for Older Aged People in Trinidad and Tobago.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (5)

Percentage of residents who lose control of their bowels or bladder.​


Loss of bowel or bladder control is not a normal sign of aging and can often be successfully treated. Loss of bowel or bladder control can be caused by:

  • Physical problems (like constipation, muscle weakness, or a bladder infection)
  • Location problems (like the bathroom is too far away)
  • Reaction to medication
  • Limited ability to walk or move around
  • Diet and fluid intake
  • Toilet routine (timing trips to the bathroom)
  • Whether someone can provide assistance when needed
  • Certain medical conditions such as diabetes, dementia, spinal cord injury, or neurological disease may put a resident at higher risk of losing bowel and bladder control.

Finding the cause and treating a problem with bowel or bladder control is important for many reasons. Physically, it can help prevent infections and pressure ulcers. Mentally, treatment can help the well being of the resident by restoring dignity and social interaction.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (6)

% of residents who received an antipsycotic medication.​


Antipsychotic drugs are an important treatment for patients with certain mental health conditions.


However, the FDA has warned that antipsychotic medications are associated with an increased risk of death when used in elderly patients with dementia and the medications have side effects.


Therefore, these medications must be used appropriately. Interventions that do not involve medications should be used first if possible and the continued use of antipsychotics should be carefully monitored.


Consumers should ask nursing homes about their approach to managing behavior.


Interventions that do not require medications, such as higher staffing ratios, many and varied activities, and consistent assignment, have been shown to be successful in many cases.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (4)

Percentage of residents who lose too much weight.​


A loss of 5% or more of body weight in one month is usually considered unhealthy (for example, a 140 pound person should not lose more than 7 pounds in one month).

Too much weight loss can make a person weak, change how medicine works in the body, or put the resident at risk for pressure ulcers.


Too much weight loss may mean that the resident is ill, refuses to eat, is depressed, or has a medical problem that makes eating difficult (like weakness caused by a stroke).  It could also mean that the resident is not being fed properly, their medical care is not being properly managed, or that the nursing home's nutrition program is poor.


To help prevent unhealthy weight loss, it is important that the resident's diet is balanced and nutritious, and that staff spend enough time feeding people who can't feed themselves.


Sometimes it may be necessary for a person to lose weight for medical reasons. In these cases, the medical staff may plan in advance for the resident to lose weight on a special weight loss program, but the person should not lose more than 5% of body weight in one month.

Companion - Someone who provides social contact. A companion might just visit at home or go out with an elder. Usually no personal care is rendered.


Conservator - An individual who volunteers or is appointed by the court to manage the affairs or finances of another person.


Convalescent Home - See Nursing Home.


Dementia - Progressive neurological, cognitive, or medical disorder that affects memory, judgment, and cognitive powers. Dementia is not a disease itself but rather a group of symptoms caused by one or several disease processes.


Developmental Disability (DD) - Affliction characterized by chronic physical and mental disabilities, which may include: cerebral palsy, retardation, thyroid problems, seizures, quadriplegia.


Durable Medical Equipment (DME) - Durable Medical Equipment is medically necessary equipment that a physician prescribes for use in the beneficiary’s home such as walkers, wheelchairs, and hospital beds. In order to be considered durable medical equipment, the equipment must be able to with-stand repeated use, serve a medical purpose and be appropriate for use in the home. “Home” is one’s house, apartment, relative’s home, a home for the aged, or some other type of institution that a beneficiary resides (i.e. a hospital or nursing home).


Elder - Someone who is at least 60 years of age. An elder is also known as senior, senior citizen, aged, or elderly.


Elder Abuse - Acts or omissions resulting in serious physical or emotional injury to an adult age 60 or over. This includes Physical abuse, Emotional abuse (harassment, threats, verbal abuse), Sexual abuse, Financial exploitation and Caregiver neglect. Social Services investigate and intervene in cases where there is evidence that an elder has been neglected, abused or financially exploited by someone in a domestic setting. It is empowered to take steps that ensure that elder victims of physical and emotional abuse, neglect, and financial exploitation receive protective and supportive services.

QUALITY INDICATOR IN AN ELDERLY CARE HOME (7)

% of residents who have depressive symptoms.​


Depression is a medical problem of the brain that can affect how you think, feel, and behave.


Signs of depression may include fatigue, a loss of interest in normal activities, poor appetite, and problems with concentration and sleeping.


Feeling depressed can lessen your quality of life and lead to other health problems.


Nursing home residents are at a high risk for developing depression and anxiety for many reasons, such as loss of a spouse, family members or friends, chronic pain and illness, difficulty adjusting to the nursing home, and frustration with memory loss.


Identifying depression can be difficult in residents because the signs may be confused with the normal aging process, a side effect of medication, or the result of a medical condition.


Proper treatment may include medication, therapy, or an increase in social support.