關(guān)于養(yǎng)老院的外文翻譯

1、<p><b>　　養(yǎng) 老 院</b></p><p>　　養(yǎng)老院分為療養(yǎng)院，專業(yè)護(hù)理組（首爾大學(xué)），護(hù)理院或療養(yǎng)院。這是一個需要護(hù)理和日常活動有不便的人居住的地方。居住在這里的居民包括身體或精神殘疾的老人和成年人，住在療養(yǎng)院的人如果發(fā)生意外或疾病也會被進(jìn)行物理治療。居民的法律權(quán)利取決于機(jī)構(gòu)的法律地位。</p><p><b>　　美 國&l

2、t;/b></p><p>　　在美國，一個“專業(yè)護(hù)理機(jī)構(gòu)”或“民營護(hù)理機(jī)構(gòu)”是指一個注冊參加并可以醫(yī)療保險(xiǎn)報(bào)銷的機(jī)構(gòu)。聯(lián)邦醫(yī)療保險(xiǎn)方案主要是為那些在工作時(shí)為社會保障和醫(yī)療保險(xiǎn)做出貢獻(xiàn)的老年人而設(shè)的，護(hù)理基金是指給予那些得到認(rèn)證并參與了醫(yī)療報(bào)銷的養(yǎng)老院的資金。聯(lián)邦醫(yī)療補(bǔ)助計(jì)劃是為每個國家提供醫(yī)療及相關(guān)服務(wù)，并為那些所謂的“窮人”實(shí)施的。所謂的“窮人”是指每個國家確定的給予老人，殘疾人或兒童醫(yī)療補(bǔ)助的資格（如

3、兒童的健康保險(xiǎn)計(jì)劃 -芯片和母嬰保健和食品方案）。</p><p>　　每個國家開辦的養(yǎng)老院，都受到國家法律和法規(guī)的保護(hù)。護(hù)養(yǎng)院可以選擇參加醫(yī)療保險(xiǎn)或醫(yī)療補(bǔ)助。如果他們通過一項(xiàng)調(diào)查（檢查），他們得到許可，也受到聯(lián)邦法律和法規(guī)的保護(hù)。全部或部分護(hù)理之家可參加醫(yī)療保險(xiǎn)或醫(yī)療補(bǔ)助。</p><p>　　在美國，護(hù)理安老院參加醫(yī)療保險(xiǎn)或醫(yī)療補(bǔ)助須有職業(yè)護(hù)士每天24小時(shí)值班。至少每天8小時(shí)，每周7天

4、，必須有一個注冊護(hù)士值班。護(hù)養(yǎng)院的管理由持牌護(hù)理之家管理員管理。不像美國護(hù)理沒有標(biāo)準(zhǔn)化的培訓(xùn)和管理人員發(fā)牌規(guī)定，但大多數(shù)州都要求有聯(lián)邦許可證，許多州，如加利福尼亞州有他們自己的系統(tǒng)管理員執(zhí)照。到2005年4月18日，美國共有16094家有許可的養(yǎng)老院，低于2002年12月12日，德爾的16516家。</p><p>　　有些國家已經(jīng)給能夠在社區(qū)生活但需要幫助的老人和其他成年人提供不同的照料。例如，康涅狄格安老院或

5、安老院是由公共衛(wèi)生國務(wù)院授權(quán)。這些安老院提供24小時(shí)監(jiān)管，提供了更多的“如家“的環(huán)境。許多人實(shí)際上已轉(zhuǎn)化為住房，提供一個住宅社區(qū)，促進(jìn)了獨(dú)立的生活方式和給予他人需要的某種形式的援助，以促進(jìn)更好的在社區(qū)生活</p><p><b>　　服 務(wù)</b></p><p>　　護(hù)理之家提供的服務(wù)包括護(hù)士，護(hù)理助手和助理服務(wù)，物理，職業(yè)及語言治療師，社會工作者及康樂助理和食宿

6、。大多數(shù)護(hù)理機(jī)構(gòu)提供的認(rèn)證服務(wù)是護(hù)士助理，而不是由技術(shù)人員擔(dān)任。平均每100個居民擁有40張病床和40個認(rèn)證的護(hù)士助理。注冊護(hù)士執(zhí)照的護(hù)士和數(shù)量均明顯低于每100個居民擁有和7張病床和每100個居民擁有13張病床。 </p><p>　　參加醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助的護(hù)養(yǎng)院都必須達(dá)到聯(lián)邦工作人員和服務(wù)質(zhì)量方面的要求才能為居民服務(wù)。2004年，16,100家護(hù)理機(jī)構(gòu)中，98.5％的護(hù)理機(jī)構(gòu)被證實(shí)參與全國范圍的醫(yī)療保險(xiǎn)，醫(yī)

7、療補(bǔ)助。 </p><p>　　醫(yī)療保險(xiǎn)包含了在20到100天之內(nèi)為那些需要熟練的護(hù)理或康復(fù)服務(wù)的護(hù)理受益人提供至少連續(xù)三天的貼身服務(wù)。該保險(xiǎn)不包括照顧只需要監(jiān)護(hù)的人。例如，當(dāng)一個人需要幫助洗澡，散步，或從床上移到椅子上是不包括在里面的。要獲得醫(yī)療保險(xiǎn)所指的專業(yè)護(hù)理，醫(yī)生必須證明受益人需要熟練的日常護(hù)理康復(fù)技術(shù)或其他相關(guān)的住院服務(wù)，而且這些服務(wù)，作為一個實(shí)際問題，必須在提供住院的基礎(chǔ)上。例如，中風(fēng)后住院和物理治療

8、，或在技術(shù)熟練的護(hù)理之下，受益人的傷口在手術(shù)后需要公布的受益者，可能是醫(yī)療保險(xiǎn)包含的護(hù)理資格。 </p><p>　　民營護(hù)理之家是指提供一個獨(dú)立的醫(yī)院服務(wù)為基礎(chǔ)的機(jī)構(gòu)。一個獨(dú)立的機(jī)構(gòu)是一般護(hù)理之家的一部分，涵蓋了通過醫(yī)療補(bǔ)助，通過長期護(hù)理保險(xiǎn)或醫(yī)療保險(xiǎn)服務(wù)，以及民營護(hù)理之家長期護(hù)理服務(wù)的一部分。一般來說，民營護(hù)理之家為患者所提供的醫(yī)療保險(xiǎn)彌補(bǔ)的只是一個獨(dú)立的護(hù)理之家常住人口總量的一小部分。 </p>

9、<p>　　醫(yī)療護(hù)理還包括那些需要監(jiān)護(hù)，并按要求提供的相應(yīng)等級的家庭護(hù)理。如護(hù)理之家居民的身體障礙或認(rèn)知障礙，需要24小時(shí)護(hù)理。以滿足一個國家的經(jīng)濟(jì)狀況調(diào)查的入息及資產(chǎn)審查。 </p><p>　　家庭護(hù)理費(fèi)用可以達(dá)到每月數(shù)千元。成本很高的護(hù)理往往都是一些消耗資源的護(hù)理。如果符合資格，涵蓋在醫(yī)療護(hù)理范圍內(nèi)的人可以繼續(xù)保留這些權(quán)利。然而，那些病人要求保護(hù)他們的畢生積蓄或資產(chǎn)。</p>&

10、lt;p>　　美國政府的管制和監(jiān)督</p><p>　　在美國所有護(hù)理院接收醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助的資金是受聯(lián)邦法規(guī)所規(guī)定的。負(fù)責(zé)療養(yǎng)院檢測的被稱為測量師，通常叫做情況檢測師。情況檢測師可察看遵守執(zhí)照（國家規(guī)定）認(rèn)證（醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助的規(guī)定）。 </p><p>　　“最小數(shù)據(jù)集”評估是美國聯(lián)邦政府規(guī)定的部分，它是指對參與了醫(yī)療保險(xiǎn)或醫(yī)療證明療養(yǎng)院的所有居民進(jìn)行全面評估的過程。最小數(shù)據(jù)

11、集的評估是一個篩選評估，在對每個居民的行為能力進(jìn)行全面評估的基礎(chǔ)上，幫助養(yǎng)老院工作人員識別并幫助居民達(dá)到健康的標(biāo)準(zhǔn)或應(yīng)付其他需求。 最小數(shù)據(jù)集會產(chǎn)生一種，用于償還所有醫(yī)療保險(xiǎn)，并在許多國家用來設(shè)置網(wǎng)絡(luò)檔案系統(tǒng)的報(bào)銷的“資源利用組” 。</p><p>　　對于美國護(hù)養(yǎng)院和網(wǎng)絡(luò)檔案系統(tǒng)服務(wù)中心，醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助有一個網(wǎng)站，這個網(wǎng)站允許用戶執(zhí)行監(jiān)督某些機(jī)構(gòu)指標(biāo)。網(wǎng)站內(nèi)容管理系統(tǒng)還出版了用于監(jiān)督的設(shè)施清單用來衡量護(hù)養(yǎng)

12、院的經(jīng)營情況。美國政府責(zé)任辦公室已發(fā)現(xiàn)養(yǎng)老院視察的數(shù)目問題嚴(yán)重已經(jīng)對目前的居民造成了危險(xiǎn)。美國政府責(zé)任辦公室的結(jié)論是，雖然合作醫(yī)療監(jiān)督有所改善，但在護(hù)理安老院的監(jiān)督方面仍有薄弱環(huán)節(jié)。2008年9月發(fā)表的一份報(bào)告發(fā)現(xiàn)，2007年，超過90％的家庭護(hù)理存在聯(lián)邦衛(wèi)生和安全的隱患，約有17％的家庭護(hù)理有缺陷，這種缺陷造成了患者的實(shí)際損害或即時(shí)危害。 </p><p>　　養(yǎng)老行業(yè)被認(rèn)為是國家兩個最重要的行業(yè)之一，（另一個

13、是核電工業(yè)）。 </p><p>　　醫(yī)療保險(xiǎn)和醫(yī)療補(bǔ)助調(diào)查</p><p>　　適用護(hù)養(yǎng)院和網(wǎng)絡(luò)檔案系統(tǒng)的聯(lián)邦監(jiān)管和檢查（測量）運(yùn)用研究于1965年創(chuàng)建的醫(yī)療服務(wù)質(zhì)量模型。該模型包含護(hù)理團(tuán)隊(duì)，護(hù)理程序和結(jié)果的概念。</p><p><b>　　護(hù)理團(tuán)隊(duì)</b></p><p>　　調(diào)查發(fā)現(xiàn)，醫(yī)療結(jié)構(gòu)是養(yǎng)老院的資源，這包

14、括工作人員，他們的知識和技能，政策，程序，記錄，設(shè)備等，護(hù)理團(tuán)隊(duì)是測量組織關(guān)懷的工具。</p><p><b>　　護(hù)理程序</b></p><p>　　在實(shí)際中，護(hù)理程序是養(yǎng)老院的資本。調(diào)查過程表明每個居民需要適當(dāng)性，及時(shí)性的服務(wù)。護(hù)理程序是由5種腦力和體力活動所組成的：測量，規(guī)劃，執(zhí)行（代），評估和傳播。 這些活動必須是完整的，并共同執(zhí)行的。遺憾的是這些過程都以任

15、務(wù)而不是以居民為中心。一個有責(zé)任的護(hù)士在發(fā)現(xiàn)傷口的時(shí)候可以有序的進(jìn)行換藥并就行傷口評估。養(yǎng)老中心的護(hù)士早就知道治療會導(dǎo)致居民的痛苦和術(shù)前的痛苦。在治療中，她（或他）將與居民交談，并以此來分散他們的注意力從而達(dá)到減少居民痛苦的目的。與那些處在特殊情況下的居民討論各種問題，可以大大的提高他們的舒適感。在這種特定的情況下，護(hù)士也能夠做好縱向跟進(jìn)，這保證了更持久的實(shí)施效果。</p><p><b>　　結(jié) 果

16、</b></p><p>　　在醫(yī)療服務(wù)質(zhì)量模式中，結(jié)果被假定為醫(yī)療程序的結(jié)果，醫(yī)療程序被假定為需要的醫(yī)療團(tuán)隊(duì)。一個結(jié)果可能是一個間接地支持照顧居民的結(jié)果。一種間接治療或設(shè)施治療結(jié)果主要用于監(jiān)督和糾正或培訓(xùn)員工，改變員工的知識和技能。工作人員應(yīng)用這些新技術(shù)的過程是一個產(chǎn)生更好居住效果的過程。失敗的結(jié)果可能被歸類為物理結(jié)果（死亡，疾病，殘疾或功能障礙）和心理結(jié)果（不適，不滿）。 結(jié)果通常是指居民的健康狀

17、況，福利，病人滿意度等，這種結(jié)果通常是用來提高護(hù)理人員的護(hù)理經(jīng)驗(yàn)。</p><p><b>　　消費(fèi)者選擇</b></p><p>　　目前的趨勢是向他們提供滿足重要人士所需要的支持和長期的生活安排。事實(shí)上，在美國，作為一個真正選擇制度改革的研究結(jié)果顯示很多人住在社區(qū)是都能夠回自己的家。 私人護(hù)理機(jī)構(gòu)可以提供能夠陪護(hù)的私人護(hù)士。 </p><p&g

18、t;　　在考慮為那些不能獨(dú)立生活的人安排生活時(shí)，潛在客戶認(rèn)為多看看養(yǎng)老院和輔助生活設(shè)施記住每個人并能獨(dú)立照顧自己是非常重要的。許多家庭選擇選擇養(yǎng)老院都是選擇那種充滿愛心的，每天只要戴在養(yǎng)老院幾個小時(shí)的養(yǎng)老院。 </p><p>　　從2002年開始，醫(yī)療補(bǔ)助就建立了一個在線比較網(wǎng)站，旨在促進(jìn)養(yǎng)老院之間的良性競爭。</p><p><b>　　趨 勢</b></

19、p><p>　　在美國，一些養(yǎng)老院已經(jīng)開始改變他們的管理模式和組織結(jié)構(gòu)，旨在創(chuàng)造一個更加以居民為中心的環(huán)境，所以他們更注重“家庭式”或“醫(yī)院一樣”的養(yǎng)老院，這些家庭共用一個廚房和客廳。護(hù)理人員的任務(wù)是照顧好其中的一個“家庭”。白天，當(dāng)他們醒來時(shí)，當(dāng)他們吃飯時(shí)，當(dāng)他們想做什么時(shí)。工作人員可以為他們服務(wù)。他們也有機(jī)會獲得更多的陪伴，如寵物的陪伴。運(yùn)用這種管理模式的機(jī)構(gòu)將它稱為“文化轉(zhuǎn)向”或“文化變革”，例如長期照護(hù)，這種

20、護(hù)理之家，被稱為“溫室”。</p><p><b>　　面向任務(wù)的護(hù)理</b></p><p>　　任務(wù)導(dǎo)向的護(hù)理是指給護(hù)士分配具體的任務(wù)，一個護(hù)士負(fù)責(zé)一個特定的病房。如果居民遇到特殊情況，那么，在一段時(shí)間內(nèi)會有很多護(hù)士照顧她。如果居民遇到問題，護(hù)理人員隨機(jī)安排，護(hù)士被要求與居民建立密切的關(guān)系、美國的護(hù)士資格培訓(xùn)是任務(wù)導(dǎo)向。在有營業(yè)資格的護(hù)士之家，它的主要從業(yè)者是有職

21、業(yè)資格的護(hù)士。經(jīng)過認(rèn)證的護(hù)理之家是病人的主要照顧者。職業(yè)資格學(xué)院的培訓(xùn)要求培訓(xùn)時(shí)間和實(shí)際工作時(shí)間總共要達(dá)到75小時(shí)以上，并且必須通過口頭或書面測試。因此，美國的養(yǎng)老院，對護(hù)理者的培訓(xùn)是一項(xiàng)責(zé)任。</p><p><b>　　居民護(hù)理</b></p><p>　　以居民為主的護(hù)理，是指護(hù)士被分配到特定的患者并有能力與病人建立良好的關(guān)系。在一個機(jī)構(gòu)中，就像大多數(shù)家庭一樣，

22、患者都被治療了。采用居民為主的護(hù)理，可以使護(hù)士與每個病人都更熟悉，照顧他們的特殊需求，無論是情緒上的還是醫(yī)療上的。與此相反，以機(jī)構(gòu)護(hù)理為中心的護(hù)理院。其重點(diǎn)是工作人員的便利和效率。在這里工作人員只是執(zhí)行任務(wù)，而不是通過與居民互動而達(dá)到理想的居住成果。凡駐地為中心的工作人員都知道你的名字，機(jī)構(gòu)工作人員通過房間號碼識別，診斷，例如幫助那些有需要的居民進(jìn)食。</p><p><b>　　科學(xué)發(fā)現(xiàn)</b&

23、gt;</p><p>　　根據(jù)不同的調(diào)查結(jié)果顯示，住在以居住為主的護(hù)理院，可以得到高質(zhì)量的服務(wù)。護(hù)理人員被要求要多關(guān)注一下病人，并與他們多相處。大量的問題都是在初級護(hù)理檢查之后才發(fā)現(xiàn)的。在護(hù)理人員長時(shí)間的照顧病患之后，會慢慢的發(fā)現(xiàn)很多病患應(yīng)注意的問題。一旦體驗(yàn)過這種模式的護(hù)理，護(hù)士往往會更喜歡以居住中心這種模式。雖然居民為導(dǎo)向的護(hù)理不能夠延長生命，但是他們可以通過與人們交流來消除許多寂寞和不滿的感受。</

24、p><p>　　輪流看護(hù)是指讓所有人享受到同等的服務(wù)。有了這個特定的系統(tǒng)，養(yǎng)老院會為居住在這里的人負(fù)責(zé)。然而，這一系統(tǒng)的執(zhí)行可能會引起問題，那些被分配照顧居民的護(hù)士和護(hù)理者會與居民們產(chǎn)生良好的感情。當(dāng)他們被調(diào)走或者離開時(shí)，他們會舍不得。 </p><p>　　各種研究結(jié)果表明，為了完成任務(wù)而去照顧居民會引起居民的不滿。在許多情況下，向居民透露信息會讓他們變的慌亂，因此決定不透露所有信息。 患者

25、通常抱怨有寂寞和流離失所的感覺</p><p>　　“居民轉(zhuǎn)讓是指輪流著照顧居民，而不是一個護(hù)士照顧一個特定的居民。 因?yàn)橐粋€看護(hù)身上的負(fù)擔(dān)可能很重，所以很多看護(hù)不能用一個居民的感情和物質(zhì)方面的經(jīng)驗(yàn)來定義居民的信息，這些信息可能是錯誤的或者是沒有事實(shí)根據(jù)的，因?yàn)楹芏嗟目醋o(hù)輪流照顧一個居民。</p><p><b>　　應(yīng)急處理</b></p><p

26、>　　在看護(hù)病人的時(shí)候遇到緊急情況往往是令人生畏的任務(wù)，它包括著事件很容易失去控制和沒有緩和的時(shí)間。（目前）只有一些可以運(yùn)用的應(yīng)急方案或操作標(biāo)準(zhǔn)程序。幸好，還是有很多作家出版了關(guān)于這些話題的評論性文章。</p><p><b>　　英 國</b></p><p>　　2002年，英國的護(hù)理院因?yàn)橛刑囟ǖ木幼…h(huán)境和護(hù)理人員好和總所周知。在英國護(hù)理院及護(hù)理安老院是

27、由英格蘭，蘇格蘭，威爾士和北愛爾蘭的不同組織組成的。 進(jìn)入一家養(yǎng)老院，你需要當(dāng)?shù)厥凶h會對您的財(cái)務(wù)狀進(jìn)行評估。您可能還必須通過護(hù)士對你的評估，看你是否需要被護(hù)理。</p><p>　　在英國，2009年四月，資金下降底線是13500英鎊，在這個水平上，所有的從退休金，補(bǔ)償金，救濟(jì)金和其他除了個人花費(fèi)的津貼（當(dāng)前是 21.9英鎊）以外的經(jīng)濟(jì)來源，都將用于支付房子看護(hù)。當(dāng)?shù)氐恼?wù)為提供被占據(jù)房間不比當(dāng)?shù)爻B(tài)的房間貴這件

28、事做出了持續(xù)的貢獻(xiàn)。目前，拿漢普夏郡打個比方，如果居民支出多于這個平均數(shù)字，政府就不會支付任何東西，一個三口之家必須做出貢獻(xiàn)或者施舍，否則居民就搬到一個更便宜的房子里去。在低收入居民和高收入居民之間的居民，領(lǐng)著帶有很少的私人花費(fèi)津貼的工資。他們得到每周大約是250英鎊的工資，處在高收入和低收入居民之間。政府會支付多余的部分，國民和原來的情況一樣。這是因?yàn)檎业揭粋€在政委會限定下能夠使用政委會的資金而且避免日后搬走房子是很完美的。超過醫(yī)藥費(fèi)

29、23,000英鎊的病人們，在看護(hù)病房需要支付全額費(fèi)用，直到他們的財(cái)產(chǎn)跌至最低限度。那些需要額外看護(hù)的病人們估計(jì)這些費(fèi)用（漢普夏郡看護(hù)在2009年是483英鎊）并且通過國際健康服務(wù)接受另外的財(cái)政支持 (103.80英鎊)，這就是所謂的儲備看護(hù)。</p><p>　　作為衛(wèi)生署網(wǎng)站上詳細(xì)的多學(xué)科的評估過程。國民保健服務(wù)的資金已全部用于保證給居民提供的護(hù)理符合醫(yī)療保健的標(biāo)準(zhǔn)并負(fù)全部責(zé)任是確定的。 </p>

30、<p>　　英國的成人護(hù)理安老院是受護(hù)理質(zhì)量委員會所管的，這取代了社會的監(jiān)管。英國的成人護(hù)理安老院至少每3年要被檢查一次。在威爾士，威爾士照管標(biāo)準(zhǔn)監(jiān)察局負(fù)有監(jiān)督的責(zé)任，在蘇格蘭，蘇格蘭委員會的護(hù)理法規(guī)和北愛爾蘭的法規(guī)質(zhì)量促進(jìn)了北愛爾蘭委員會的法律監(jiān)管力度。 </p><p>　　2010年5月，聯(lián)合政府宣布成立一個獨(dú)立的委員會負(fù)責(zé)資助長期護(hù)理，這是由12個月份的人口老齡化醫(yī)療融資報(bào)告造成的。護(hù)理質(zhì)量委

31、員會本身也重新實(shí)施了登記過程，2010年十月竣工，這將導(dǎo)致2011年四月新的管理形式的產(chǎn)生。</p><p>　　資料來源：Nursing home [EB/OL].http://en.wikipedia.org/wiki/Nursing_home，2010.6</p><p><b>　　外文原文：</b></p><p>　　Nursing

32、 home</p><p>　　From Wikipedia, the free encyclopedia</p><p>　　A nursing home, convalescent home, Skilled Nursing Unit (SNU), care home or rest home provides a type of care of residents: it is a

33、place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living[citation needed]. Residents include the elderly and younger adults with physical or mental

34、 disabilities. Residents in a skilled nursing facility may also receive physical, occupational, and other rehabilitative therapies following an acci</p><p>　　United States</p><p>　　In the United

35、 States, a "Skilled Nursing Facility" or "SNF" is a nursing home certified to participate in, and be reimbursed by Medicare. Medicare is the federal program primarily for the aged who contributed to S

36、ocial Security and Medicare while they were employed. A "Nursing Facility" or "NF" is a nursing home certified to participate in, and be reimbursed by Medicaid. Medicaid is the federal program impleme

37、nted with each State to provide health care and related services to those who are "poor</p><p>　　In the United States, each State "licenses" its nursing homes, making them subject to the State

38、's laws and regulations. Nursing homes may choose to participate in Medicare and/or Medicaid. If they pass a survey (inspection), they are "certified" and are also subject to federal laws and regulations. A

39、ll or part of a nursing home may participate in Medicare and/or Medicaid。</p><p>　　In the United States, nursing homes which participate in Medicare and/or Medicaid are required to have licensed practical nu

40、rses (LPNs) (in some States designated "vocational nurses" or "LVNs") on duty 24 hours a day. For at least 8 hours per day, 7 days per week, there must be a registered nurse on duty. Nursing homes are

41、 managed by a Licensed Nursing Home Administrator. Unlike U.S. nursing there are no standardized training and licensing requirements for administrators, though most states requ</p><p>　　There are states that

42、 have other levels of care offered to elderly and other adults who need assistance and are able to live in the community. For instance, Connecticut has Residential Care Homes or RCH that are licensed by the State Departm

43、ent of Public Health. These homes provide 24-hour supervision and typically offer a more "home-like" environment. Many are actually large homes that have been converted to dwellings that offer a residential com

44、munity that promotes an independent lifestyle and</p><p><b>　　Services</b></p><p>　　Services provided in nursing homes include services of nurses, nursing aides and assistants; physi

45、cal, occupational and speech therapists; social workers and recreational assistants; and room and board. Most care in nursing facilities is provided by certified nursing assistants, not by skilled personnel. In 2004, the

46、re were, on average, 40 certified nursing assistants per 100 resident beds. The number of registered nurses and licensed practical nurses were significantly lower at 7 per 100 reside</p><p>　　Nursing homes t

47、hat participate in the Medicare and Medicaid programs are subject to federal requirements regarding staffing and quality of care for residents.[2] In 2004, 98.5% of the 16,100 nursing facilities nationwide were certified

48、 to participate in Medicare, Medicaid, or both.</p><p>　　Medicare covers nursing home services for 20 to 100 days for beneficiaries who require skilled nursing care or rehabilitation services following a hos

49、pitalization of at least three consecutive days. The program does not cover nursing care if only custodial care is needed — for example, when a person needs assistance with bathing, walking, or transferring from a bed to

50、 a chair. To be eligible for Medicare-covered skilled nursing facility (SNF) care, a physician must certify that the beneficiary n</p><p>　　SNF services may be offered in a free-standing or hospital-based fa

51、cility. A freestanding facility is generally part of a nursing home that covers Medicare SNF services as well as long-term care services for people who pay out-of-pocket, through Medicaid, or through a long-term care ins

52、urance policy. Generally, Medicare SNF patients make up just a small portion of the total resident population of a free-standing nursing home.</p><p>　　Medicare also covers nursing home care for certain pers

53、ons who require custodial care, meet a state's means-tested income and asset tests, and require the level-of-care offered in a nursing home. Nursing home residents have physical or cognitive impairments and require 2

54、4-hour care.</p><p>　　The cost of staying in a Nursing home can cost several thousand per month or more.[3] Some deplete their resources on the often high cost of care. If eligible, Medicaid will cover conti

55、nued stays in nursing home for these individuals for life. However, they require that the patient be "spent down" to a low asset level first by either depleting their life savings or asset-protecting them, ofte

56、n using an elder law attorney.</p><p>　　U.S. Government regulations and oversight</p><p>　　All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to fed

57、eral regulations. People who inspect nursing homes are called surveyors or, most commonly, state surveyors. State surveyors may inspect for compliance with licensure (State regulations) and/or certification (Medicare and

58、 Medicaid regulations).</p><p>　　The "Mininimum Data Set" assessment (MDS) is part of the U.S. federally mandated process for comprehensive assessment of all residents in Medicare or Medicaid certi

59、fied nursing homes. The MDS assessment is a screening assessment that forms the basis of a comprehensive assessment of each resident's functional capabilities and helps nursing home staffs identify and help residents

60、 meet or cope with health and other needs. The MDS also yields "Resource Utilization Groups" (RUGS) which are used for a</p><p>　　For United States SNFs and NFs, the Centers for Medicare and Medica

61、id Services has a website which allows users to see how well facilities perform in certain metrics (see "Nursing Home Compare Tool" in the external link section below). CMS also publishes a list of Special Focu

62、s Facilities - nursing homes with "a history of serious quality issues."[4][5] The US Government Accountability Office (GAO), however, has found that state nursing home inspections understate the number of seri

63、ous nursing h</p><p>　　SNFs and NFs are subject to federal regulations and also strict state regulations. The nursing home industry is considered one of the two most heavily regulated industries in the Unite

64、d States (the other being the nuclear power industry).[9]</p><p>　　Medicare and Medicaid surveys</p><p>　　Federal regulation and inspection (surveying) of SNFs and NFs applies a model of health

65、care quality created for research by Avedis Donabedian in 1965. The model uses the concepts of structure, process and outcome.</p><p><b>　　Structure</b></p><p>　　For surveying, struc

66、ture is the nursing home's resources. That includes staff, their knowledge and skills, policies, procedures, records, equipment, buildings, etc. Structure surveying looks at the instrumentalities of care and their or

67、ganization.</p><p><b>　　Process</b></p><p>　　Process is the nursing home's resources in action. Process surveying looks at the appropriateness, timeliness and quality of care and

68、 services in relation to each resident's needs. Process can be organized into 5 kinds of intellectual and physical activities: assessing, planning, implementing (acting), evaluating, and communicating. These activiti

69、es must be integrated and often occur together. Unfortunately these processes can be task or resident-centered. A task nurse implements a physician ord</p><p><b>　　Outcome</b></p><p>

70、;　　In Donabedian's model, outcome is assumed to result from processes and processes are assumed to require structures. An outcome may be a facility outcome which indirectly supports direct resident care. An example o

71、f an indirect or facility outcome would be supervising and correcting or training staff That changes staff knowledge and skills. Staff applying those new skills is a process which should yield better resident outcomes. R

72、esident outcomes may be classified as physical (death, disease, dis</p><p>　　Consumer choices</p><p>　　Current trends are to provide people with significant needs for long term supports and serv

73、ices with a variety of living arrangements. Indeed, research in the U.S. as a result of the Real Choice Systems Change Grants, shows that many people are able to return to their own homes in the community. Private nursin

74、g agencies may be able to provide live-in nurses to stay and work with patients in their own homes.</p><p>　　When considering living arrangements for those who are unable to live by themselves, potential cus

75、tomers consider it to be important to carefully look at many nursing homes and assisted living facilities as well as retirement homes, keeping in mind the person's abilities to take care of themselves independently.

76、While certainly not a residential option, many families choose to have their elderly loved one spend several hours per day at an adult daycare center.</p><p>　　Beginning in 2002, Medicare began hosting an on

77、line comparison site intended to foster quality improving competition between nursing homes.</p><p><b>　　Trend</b></p><p>　　In the U.S. a few nursing homes are beginning to change th

78、e way they are managed and organized to create a more resident-centered environment, so they are more "home-like" and less institutional or "hospital-like." In these homes, units are replaced with a s

79、mall set of rooms surrounding a common kitchen and living room. The staff giving care is assigned to one of these "households." Residents have far more choices about when they awake, when they eat and what they

80、 want to do during the day. They</p><p>　　Task-oriented care</p><p>　　Task oriented care is where nurses are assigned specific tasks to perform for numerous residents on a specific ward. Residen

81、ts in this particular situation are exposed to multiple nurses at any given time. Because of the random disbursement of tasks, nurses are declined the ability to develop more in depth relations with any particular reside

82、nt. Licensed (vocational) nurse training in the United States is task oriented. The primary care giver in a certified nursing home is a "Certified Nurses Ai</p><p>　　Resident-oriented care</p>&l

83、t;p>　　Resident oriented care is where nurses are assigned to particular patients and have the ability to develop relationships with individual patients. Patients are treated more as family, as opposed to random patien

84、ts in an institution. Using resident-oriented care, nurses are able to become familiar with each patient and cater more to their specific needs, whether they be emotional or medical. In contrast, institutional care is in

85、stitution-centered. The focus is staff convenience and efficiency. St</p><p>　　Scientific findings</p><p>　　According to various findings residents who receive resident-oriented care experience

86、a higher quality of life, in respect to attention and time spent with patients and the number of fault reports after the introduction of Primary Nursing. Once they experience it, nurses often prefer resident-oriented set

87、tings, too. Although resident-oriented nursing does not lengthen life, nursing home residents are able to connect with someone, which allows them to dispel many feelings of loneliness and discon</p><p>　　&qu

88、ot;Resident assignment" refers to the extent to which residents are allocated to the same nurse. With this particular system one person is responsible for the entire admission period of the resident. However, this s

89、ystem can cause difficulties for the nurse or care-giver should one of the residents they are assigned to pass away or move to a different facility, as the nurse/caregiver may become attached to the resident(s) they are

90、caring for.</p><p>　　Various findings suggest that task-oriented care produces less satisfied residents. In many cases, residents are disoriented and unsure of who to disclose information to and as a result

91、decide not to share information at all. Patients usually complain of loneliness and feelings of displacement.</p><p>　　"Resident assignment" is allocated to numerous nurses as opposed to one person

92、 carrying the responsibility of one resident. Because the load on one nurse can become so great, various nurses are unable to identify with gradual emotional and physical changes experienced by one particular resident. R

93、esident information has the ability to get misplaced or undocumented because of the numerous amounts of nurses that deal with one resident.[citation needed].</p><p>　　Emergency management</p><p>

94、;　　Dealing with an emergency in nursing home is always a formidable task which involves the damage control and mitigation of the event. Not many written plans or standard operating procedures are available publicly, exce

95、pt for a few [9]. However, there are published academic reviews about the topic written by many authors [10], [11], [12].</p><p>　　United Kingdom </p><p>　　In 2002 nursing homes became known as

96、care homes with nursing and residential homes became known as care homes [13]. </p><p>　　In the United Kingdom care homes and care homes with nursing are regulated by different organisations in England, Scot

97、land, Wales and Northern Ireland. To enter a care home, you need an assessment of needs and of your financial condition from your local council. You may also have an assessment by a nurse, should you require nursing care

98、. The cost of a care home is means tested in England.</p><p>　　As of April 2009 in England, the lower capital limit is £13,500. At this level, all income from pensions, savings, benefits and other sourc

99、es, except a "personal expenses allowance" (currently £21.90), will go to paying the care home fees. The local council pays the remaining contribution provided the room occupied is not more expensive than

100、the local council's normal rate, currently £364.48 for Hampshire for example. If the resident is paying more than this the council will not pay anything and</p><p>　　The NHS has full responsibility

101、for funding the whole placement if the resident in a care home with nursing meets the criteria for NHS continuing Health Care. This is identified by a multi-disciplinary assessment process as detailed on the DOH website.