oversight of numerous residents, often directing and coordinating the care via licensed practical nurses and certified nursing assistants or other unlicensed assistive personnel (UAP). Nurses working in long-term care will be challenged to maintain the functional and nutritional status of residents, while preventing complications of impaired mobility such as pressure ulcers and falls. Dementia care is often a substantial part of the nursing care provided, as is managing residents’ health conditions and medication regimens. Long-term care facilities often house specialty care units such as skilled nursing units and Alzheimer’s care units, described in the next section. Skilled Nursing Facilities Skilled nursing facilities (SNFs), sometimes called subacute or transitional care, are for those patients requiring more intensive nursing care than provided in long-term care and are usually found as specially designated units within long-term care facilities or occasionally within hospitals (SeniorOutlook.com, 2008). SNF patients are often transferred from the hospital to continue their recovery from an acute episode and often require continued therapy (physical, occupational, and/or speech). Frequent patient assessments are needed for a limited time period for stabilization or completion of a treatment regimen. “Typical individuals seen in subacute care are those needing assistance as a result of non-healing wounds, chronic ventilator dependence, renal problems, intravenous therapy, and coma management and those with complex medical and/or rehabilitative needs, including pediatrics, orthopedics, and neurological. These units are designed to promote optimum outcomes in the least expensive cost setting” (Easton, 1999, p. 15). Good assessment and communication skills are needed to care for these complex patients. The skilled care nurse should have knowledge of transfer techniques, prevention and assessment of swallowing problems, bowel and bladder management, and nutrition. The gerontological nurse working in skilled care must have expertise in preventing the hazards of immobility such as pressure ulcers and contractures. Gerontological nurses working in this setting would benefit from having a critical care background and rehabilitation experience as well. Alzheimer’s Care A growing trend in LTCFs is to offer dedicated units for the care of persons with Alzheimer’s disease and other dementing illnesses. Because of the high rate of Alzheimer’s with advanced age, there is a growing need for units that provide nursing care for elders in the various stages of dementia. Often, family members can care for their loved ones at home during the early stages. However, due to impaired judgment that may pose safety issues, during middle and late stage dementia the older adult cannot be left alone. As memory loss progresses, home caregivers often feel overwhelmed and unable to provide the required care. The goal of dementia care is to preserve the functional status of the demented person via supportive care that fosters self-worth and socialization even within the context of diminishing cognitive capacity. Alzheimer’s units can be a great benefit to the community by having gerontological nursing staff with expertise in the management of this challenging disease. Nurses can help family members understand disease progression and assure them that their loved one is being well cared for even to the end of this ultimately fatal disease. 55805_CH01_0001_0025.qxd 2/19/09 1:01 PM Page 18 Continuum of Care 19 Hospice Gerontological nurses may also choose to work in hospice, caring for dying persons and their families. Although many patients in hospice are not elderly, the majority of the dying are older. The concept of hospice is centered on holistic, interdisciplinary care that helps the dying person “live until they die.” (See Chapter 24 for further discussion.) A number of team members who specialize in thanatology and palliative care work together to provide quality care for patients in their last months, weeks, days, and hours of life. Pain management and comfort care are the standards upon which treatment is based. Nurses and physicians work closely with social workers, chaplains, psychologists, and other hospice professionals to