The identified federal and state regulations for long-term care can be found in part 483 of Standard and Certifications, which is Requirements for States and Long Term Care Facilities. The identified specific points are 42 CFR § 483.15, 42 CFR § 483.25, 42 CFR § 483.20, and 42 CFR § 483.75. 42 CFR § 483.15 is on promoting quality of life of every resident as well as discharge, transfer, and admission rights, whereas 42 CFR § 483.25 is on quality of care (“42 CFR § 483.15 – Admission, transfer, and discharge rights,” 2017). 42 CFR § 483.20 addresses the issues regarding resident assessment, where accuracy, comprehension, and standardization are emphasized (“42 CFR § 483.20 – Resident assessment,” 2016). Lastly, 42 CFR § 483.75 is on performance improvement and quality assurance, where program details, evaluation, feedback, and monitoring procedures are specified (“42 CFR § 483.75 – Quality assurance and performance improvement,” 2017). The benefit of these regulations is that they ensure that resident’s quality of care and safety, but their shortcoming is the lack of flexibility offered to nurse specialists.
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The discharging process is highly strenuous and multistage, which means that a significant amount of resources is spent to remove a resident. It directly affects the cost and quality of healthcare services through effective staff shortage, where the documentation aspect consumes the care time. There is a tight relationship between improved care and regulations, and the main reason is the fact that the latter can set minimum requirements through deliberate enforcement. From a socio-ecological point of view, everyday activity is understood as a person’s ability to cope with daily, routine actions, the ability to function in certain living conditions. Physical, mental, and social activity is a component of everyday processes, and it is greatly influenced by the state of health and existing diseases, as well as the economic situation of a person. Daily activities can reflect changes related to age and various life circumstances. Based on the ongoing changes in daily activities, it is possible to predict the duration of an active social life and the ability to live independently, especially in old age.
Long-term care facilities are subjected to strict external governmental control because it is long-term, and there is a potential for a power imbalance. The majority of the residents are older adults who are incapable of taking care of themselves. Therefore, nursing specialists possess a certain degree of power over the group, which means that proper and ethical work might be dismissed through an abusive attitude. The agencies must ensure that such an activity will not take place in nursing homes. In order to determine the amount and type of care and support required, systematization of the most frequently used methods of assessing daily activities and the need for consideration in the system of social and medical work institutions is presented. The unification of these methods allows the specialist to quickly determine the type of care and support required, material resources, and personnel labor costs.
Quality in long-term care can be measured by observing the structure, processes, and outcomes of a facility. Therefore, there are three main approaches to measure the given factor. Structural components can be assessed through elements, such as schedule and availability of essential items. Processes might include the overall procedure of care provision, and the outcome can be manifested in the general health and well-being of residents. The responsibility should be split between an independent government agent and an in-facility worker. Both should be held accountable at tracking the quality of care.
42 CFR § 483.20 – Resident assessment. (2016). Web.
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