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Caregiving

When a Loved One Needs Long-Term Care

Rehabilitation units are similarly designed for patients whose hospital stay has left them too weak to return home, or who need more time and physical therapy to regain their independence. A good example would be a patient with a hip fracture. Some rehabilitation units are located in a special area of the hospital, but more commonly they are separate facilities, or special units in a nursing home developed especially for this purpose. Patients must qualify for rehabilitation units by being deemed able to participate in aggressive therapy for a minimum of four hours a day, five days a week. Generally, the social worker or case manager at the hospital will make arrangements for transfer to a subacute or rehabilitation unit. The social worker or case manager will work with the family to consider their preferences, but often applications must be made to several facilities, and the patient must be transferred to the first bed available. If the patient does not improve enough to allow return home, or if the family is dissatisfied with the quality of care, then arrangements can be made for transfer to another facility.

Respite care units are special units, usually within nursing homes, that are specially designed to provide very short-term care for patients whose caregivers need a break. Medicare will cover respite care for one or two weeks per year.

Skilled-nursing facilities (SNF), nursing homes, and extended-care facilities are all names given to facilities that provide chronic care. Stays may be short, less than six months, for those patients in special units designed for subacute, rehabilitation, respite or terminal (hospice) care. Other patients generally stay longer than six months. Although only five percent of people over the age of 65 live in nursing homes, there is a 20 percent chance that someone who lives to 65 will spend some time in a nursing home before she dies. As the population has become older, and forces have moved to discharge patients more quickly from the hospital, the population of patients living in nursing homes has become older and sicker. Two-thirds of patients in nursing homes have some type of mental or cognitive impairment that limits their ability to live independently; the rest are physically impaired. Nursing homes provide 24-hour nursing care and supervision; most residents require some assistance with self-care functions like bathing, grooming, toileting, and eating. A healthcare team of physician, nursing staff, dietitian, pharmacist, physical and occupational therapist, and recreation therapist monitor a broad range of patient functions such as medical, psychological, nutritional, and functional status. Social and physical activities are planned to promote emotional and physical well-being.

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