Colleges of Nursing. (1998). Essentials of baccalaureate education for professional nursing practice. Washington, DC: Author. 28. Involve, educate, and when appropriate, supervise family, friends, and assistive personnel in implementing best practices for older adults. 29. Ensure quality of care commensurate with older adults’ vulnerability and frequency and intensity of care needs. 30. Promote the desirability of quality end-of-life care for older adults, including pain and symptom management, as essential, desirable, and integral components of nursing practice. SOURCE: American Association of Colleges of Nursing and the John A. Hartford Institute for Geriatric Nursing. (2000). Older adults: Recommended baccalaureate competencies and curricular guidelines for geriatric nursing care. Washington, DC: Author. TABLE 1-2 (continued) 55805_CH01_0001_0025.qxd 2/19/09 1:01 PM Page 16 Continuum of Care 17 subacute care or transitional care, and long-term care facilities (LTCFs). Regardless of the setting, rehabilitation is accomplished through the work of an interdisciplinary team that includes nurses, therapists, and physicians as well as other professional staff. The goals of rehabilitation are to maximize independence, promote maximal function, prevent complications, and promote quality of life within each person’s strengths and limitations. The level of intensity of acute rehabilitation is greater than for subacute or long-term care. For older adults to qualify for rehabilitation in the acute care hospital, they must be able to tolerate at least 3 hours of therapy per day. The interdisciplinary team will work together to set up mutually established goals with the patient. Inpatient rehabilitation in the acute setting is beneficial to help persons recovering from or adapting to such conditions as stroke, head trauma, neurological diseases, amputation, orthopedic surgery, and spinal cord injury. Home Health Care Independent-living older adults requiring a longer period of observation or care from nurses may be candidates for home health care services. Home health care is designed for those who are homebound due to severity of illness or immobility. Visiting nurse associations (VNAs) have long been known for their positive reputation in providing home health care. For reimbursement of allowable expenses, home health care services must be ordered by a physician and the person must be considered homebound. There has been record growth in the number of home health agencies in the past FIGURE 1-1 The “web” of health care for older adults. Inpatient subacute unit Home Inpatient rehabilitation unit Long-term care facility (Nursing home) ACUTE CARE HOSPITAL –Long-term transitional –General –Chronic –Transitional –PT –OT –Speech therapy –Social services –Nursing care –Ancillary services –OP therapies –Home health care –Adult day care –Vocational rehab –Hospice –Skilled –Intermediate –Assisted living –Residential –Group homes –Hospice –Subacute SOURCE: Easton, K. L., 1999, Gerontological Rehabilitation Nursing, p. 14. Philadelphia: W.B. Saunders. Used with permission. 55805_CH01_0001_0025.qxd 2/19/09 1:01 PM Page 17 18 Chapter 1: Introduction to Gerontological Nursing decade. People’s desire to be cared for in familiar surroundings by their families, versus an institution, has fueled the need for more agencies. Although physical, occupational, and speech therapies may be obtained through home care, as well as home health aide services, a nurse must open the case file and the individual must warrant some type of nursing services to qualify. The majority of home health care patients are elderly with a variety of nursing needs, such as wound care, intravenous therapy, management of newly diagnosed diabetes, and tube feedings. Long-Term Care Facility Traditionally referred to as nursing homes, longterm care facilities (LTCFs) provide support to persons of any age who have lost some or all of their capacity for self-care due to illness, disability, or dementia. Though not acutely ill, residents of LTCFs, like hospitalized patients, require 24-hour nursing care (SeniorHousingNet, 2008). Registered nurses working in long-term care provide care planning and