Home admission

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Preservation of identity and individual customs. Home residents in the costume of their region of origin

The home admission ( nursing home , old people's home ) is a critical and unique point in life for the elderly who move there. In the technical jargon of professional care, the term is used to describe the most holistic care possible for an old or disabled person on the day of the move and the first few days in a community facility after someone had lived in a private household up to that point . In professional care for the elderly , moving from your own apartment to a nursing home (etc.) is an event that can be planned and prepared well. Holistic care means both the basic physical needs as well as the psychological and social components of a person in need of care, for which they are dependent on outside help.

On the frequency: 612,000 people were permanently cared for in nursing homes in 2003. With an assumed duration (realistic size according to Bickel) of the stay in the home of an average of 12 months (length of stay) this would mean that approx. 300,000 older people move into the home every year and have to be admitted there. In contrast to inpatient hospital admission , this term is primarily not about completing the admission formalities, but about the necessary care measures, a package of measures. For most nursing home customers, home admission is the last move in their lives following (unsuccessful) hospital treatment for an acute illness because an independent lifestyle is no longer guaranteed either alone or by family members (dependence on long-term care).

Individual concern

The elderly are more vulnerable than usual in several respects due to their acute illness. Moving into a nursing home as the “last stop” in their life confronts them with the thought of their own death . Until then, a hospital patient could hope for healing and restoration of his strength. While there are many practical things to be regulated, there are massive doubts about the meaning of life . Moving into the home signals to the elderly that their strengths are limited. In addition, it may also indicate intellectual or emotional inability to take care of yourself. As a psychologically normal reaction, but the consequences are fatal, it can lead to hopelessness, psychosomatic complaints or withdrawal. The nursing staff must expect this and respond specifically to it.

In addition, this situation can lead to complex conflicts with close relatives , who in turn experience this situation with feelings of guilt . Therefore, some react extremely aggressively . Much more common, however, is a reduction in contact with the newly relocated family member. Therefore, their integration through targeted addressing is a social care goal during this period (in contrast to the physically or psychologically oriented care goals of the person to be cared for).

Preparing the move

With prohabitation that is offered specifically due to the good utilization of the homes only a few facilities, the cost offer for one or more nights is to know the candidate home meant. This would make it much easier to move soon afterwards, because fears of the threshold can be practically put aside. At least participation in the home election should also be ensured in the hospital before a decision is made.

The short-term care , an offer from the power spectrum of care insurance, actually serves the temporary stationary full-day care for dependent older people with an absence of other caregivers. It should also avoid or shorten the hospital stay, and ensure follow-up care after a serious illness. In individual cases, short-term care can also serve to get to know the conditions in the nursing home better in order to facilitate the (soon) necessary admission to home.

Many old people's and nursing homes offer information checklists, guidelines or forms for home admission in their brochures, which can also be found in large numbers on the Internet. This is not only about the formalities to be dealt with, but also about the different options from home to home for setting up a private nursing room. In the best case scenario, this room furnishing can take place before the actual day of the move, so that the new environment offers important mementos and conveniences of the previous apartment on the first day ( residential ecology, territoriality ).

In 2006, the Discharge Management Expert Standard was developed by the German Network for Quality Development in Nursing (DNQP), which, on the part of the clinic , is intended to promote and control the admission process in the home.

Heitmann presents a model project that was completed at the end of 2006: "Reference models for the quality-assured further development of fully inpatient care", in which such standards are developed for the facility.

Maintenance measures on the day of the move and immediately afterwards

The term home admission primarily describes the measures taken by the nursing staff in the nursing home: determination of vital signs , collection of the most comprehensive information possible about the previous daily life of the new guest, continuation of necessary medical treatments and support with everyday activities (ATL) where necessary. From this, a systematic care plan should be developed as a guideline for all parties involved in the following days . Of course, the people in the new environment are also to be introduced.

Interface between acute medicine and long-term care

From a sociological point of view, it is the interface between acute medicine and long-term care . This transition can fail or succeed. Neither home nor hospital should be experienced as a “ total institution ”. From the perspective of the donor institution hospital it comes to the completion of medical treatment and for the nursing home the beginning of a long-term care, to life care will last. This phase of life will now be manageable less medically than psychosocially .

The hospital sees its task in either good discharge management or so-called care transfer . This is a consulting system developed in the 1990s and the associated forms. Originally more part of hospital social work , it is now more understood as nursing case management .

For the nursing staff at the receiving institution, this time is often characterized by a lack of information. Because even the incomplete transfer of information by the previous care institution can influence the communication between the elderly and the nursing staff in the new environment. Therefore, various admission interviews are held in order to reconcile everyday habits, life story, care needs and individual wishes. If existing data from a geriatric hospital department (from the geriatric assessment ) is supplied, not only does it save duplication of work, it also enables the continuous tracking of care goals that have already been achieved. Long-term success control (also called evaluation in rehabilitation and care today ) is made easier. The old person's motivation to participate in life in the new institution must be systematically promoted.

The professional nurses are also in the midst of diverse interrelationships with relatives (almost; mostly) without knowledge of the family situation that has arisen over many years. Further contact, communication , can be difficult if the first meeting is not well prepared on both sides.

Clarification of financial issues

The financial questions, especially the financing of the home costs , should actually be clarified before the move. Since this may have been made more difficult by a hospital stay, some things need to be discussed with relatives only after the move. Another important open question is often the receipt of social assistance benefits .

The rule that long-term care insurance follows health insurance means that it is first checked whether the health insurance benefits can still be claimed. It also says that the long-term care insurance is organized by the statutory health insurance providers . All insured persons who are members of a health insurance company are also legally insured for long-term care and receive part of the benefits from there in the event that they are expected to be in need of care for more than six months. People insured with private health insurers have to take out compulsory private long-term care insurance there, which occurs if necessary. The need for care (criteria) according to long-term care insurance is only determined by the expert from the medical service of the health insurance upon request. The receiving home can help the elderly to prepare for the assessment appointment.

Issues of capacity and the scope of legal assistance often there are also still unresolved.

Relationships in the care situation

There are special social relationships in elderly care. This can be due to the knowledge advantage of therapists, the interpretive sovereignty of the individual or different expectations of mutual roles , financial dependencies, etc. a. lie. A relatively frequent problem is the role reversal of the “caring daughters” towards “caring tutelage” of the older person who has become dependent (vice versa, this also applies to the treating physicians or the less caring men). Some theories of nursing specifically address social relationships in the nursing situation.

The high proportion of interpersonal communication in care can lead to conflicts between relatives that have their roots in the shared past. In addition, there are always cases of personal inadequacies or even criminal goals, which are reflected in neglect, abuse or, in extreme cases, killings.

With primary nursing a personally-oriented organization of care is meant in the home (a care system in contrast to the " Function maintenance "). A nurse coordinates the activities and knowledge of those involved. This care system, favored by the Kuratorium Deutsche Altershilfe, is intended to prevent the loss of information and trust in the still new relationship “old people in the home” and the care staff who take turns through shift work. In some ways it corresponds to the naming of a sponsor for the newcomer, which is established in many homes .

See also

literature

  • Erwin Böhm : Is it Monday or December today? Experience with transitional care. 1992, ISBN 3-88414-062-0 .
  • German network for quality development in nursing (ed.): Expert standard discharge management in nursing, development - consent - implementation. 2004, ISBN 3-00-010559-X , excerpt (PDF).
  • Dieter Heitmann: Help with moving into the home. In: The nurse's sister . Issue 4, 2007, pp. 354-357.
  • Marly Joosten: The transition from hospital to outpatient care and care for the elderly. From the gap to the bridge. (Quality management in nursing). Thieme, Stuttgart, ISBN 3-13-121051-6 .
  • Bernd Klinger: In the residual waste of a life not lived - Grandma comes into the home - If unpleasant questions arise while clearing out the parents' apartment. In: Süddeutsche Zeitung . December 9, 2000.
  • Ursula Koch-Straube: Foreign World Nursing Home; An ethnological study. 2nd Edition. Huber, Bern 2002, ISBN 3-456-83888-3 .
  • Sabine Kühnert: The relationship between the relatives of residents and employees in the nursing home: a study of forms of encounter, especially conflicts and cooperation. Lang, Frankfurt am Main 1991, ISBN 3-631-43556-8 .
  • Andreas Kruse , Hans-Werner Wahl : Aging and living in the home (= applied geriatric studies. Volume 12). 1994, ISBN 978-3-456-82498-7 .
  • Bernhard Mann : Structure of offers for old people's homes - using the example of a large city ( Nuremberg ) In: Current Gerontology. Thieme, Stuttgart / New York 1982, pp. 176-179.
  • Bernhard Mann: Entry into old people's home and social strategies. In: Bernhard Claußen , Karlheinz Filipp, Klaus Wasmund: Materials for social science research. (MaSoFo) Volume 3. Frankfurt am Main 1987, ISBN 3-89228-117-3 .
  • Margot Sieger, Wilfried Kunstmann: Continuity of care through care transfer. Mabuse, Frankfurt am Main, ISBN 3-935964-29-3 .
  • Chr Sowinski: The challenge of transition management: It is important to avoid “revolving door effects”. In: Pro Age. (kda) 1/2007, pp. 26-28.
  • C. Thiele: Moving to the retirement home - experiences of seniors and relatives. In: Journal of Gerontology and Geriatrics. 35, 6, 2002. pp. 556-564.
  • On keeping animals in homes:
    Marianne Gäng, Dennis C. Turner (Ed.): Living with animals in old age. 2nd Edition. Reinhardt, Munich 2005, ISBN 3-497-01757-4 .

Movies

  • Nicola Graef: There are only old people there - mother moves into a retirement home - report . Editing: Harald Lüders and Beate Thorn. Camera: Alexander Rott. ZDF , 2005, 30 min.

Web links

Individual evidence

  1. ↑ Dieter Heitmann contrasts with help for moving into a home. In: The nurse's sister . Edition 4, 2007, pp. 354–357: “The tasks associated with moving into the home, the allocation of which to the respective occupational groups has grown over the years and is hardly based on considerations of the needs of the elderly moving in. ... while the challenges associated with this from the residents' point of view are often treated as secondary. "