PART 1 How to run a nursing home?

Chapter 1: Current Status of Nursing Homes Around the World
1.
Definition of Nursing Homes (NHs)… … … … … … … … 4
2.
Japan… … … … … … … 6
3.
America… … … … … … … 9
4.
Netherlands … … … … 10
5.
Taiwan… … … … … … 10

Chapter 2 What is the Long-Term Care Insurance System for the Elderly?
1.
Why was the long-term care insurance system introduced in Korea? … … … … … … … … 12
2.
Who is eligible for the long-term care insurance system for the elderly? … … 13
3.
What benefits do recipients receive? … … … … … … … 15
4.
Long-term care finance and management system… … … … … … … 16

Chapter 3 Grading and Facility Admission Procedures
1.
Grade Determination Criteria (Article 7 of the Enforcement Decree of the Long-Term Care Insurance for the Elderly Act)… … … … … … … … … … 20
2.
Application and Procedure for Grading … … … … … … … … … … 21
3.
Eligible persons for admission to facilities (= geriatric medical welfare facilities = geriatric nursing facilities, geriatric nursing group homes)… … … 24
4.
Procedures for admission to the facility… … … … … … … … … 24

Chapter 4: Creating Fall-Safe Facilities
1.
Epidemiology of falls in the elderly… … … … … … … … … … … 26
2.
In what cases does a fall occur… … … … … … 26
3.
Complications of a fall… … 27
4.
Fall Risk Assessment Tools… … … … … … … 29
5.
Fall Intervention and Prevention 30

Chapter 5 Establishment Standards, Staffing Standards, and Operation Standards for Nursing Homes
1.
Legal Standards for Facilities (Enforcement Regulations of the Elderly Welfare Act [Appendix 4]) 38
2.
Personnel standards of the facility (Enforcement Regulations of the Elderly Welfare Act [Appendix 4])… … … … … … … … … … 50
3.
Facility Operation Standards (Elderly Welfare Act Enforcement Regulations [Appendix 5]) 51

Chapter 6: Preparing for Long-Term Care Facility Evaluation and Management
1.
Evaluation cycle… … … … 56
2.
Evaluation Procedures and Methods… … … … … … … … … … 57
3.
Evaluation results… … … … 57
4.
Preparation according to evaluation criteria… … … … … … … … … … 60
5.
Tips for Competing Against Each Evaluation Criteria Aiming for "Excellence"... ... 65
I.
Institutional Operations… … … 66
II.
Environment and Safety… 77
III.
Guarantee of beneficiary rights… … … … … … … … … … 92
IV.
Salary provision process 96
V.
Salary provision results… 113

PART 2 GUIDELINES FOR CONTRACTORS

Chapter 7: The Process and Role of Becoming a Contract Doctor
1.
The Role of Doctors in Geriatric Health and Welfare Facilities… … … … 120

Chapter 8 Q&A on the Contractual Doctor System (including how to claim contractual doctor fees)
1.
Admission facility… … … … … 134
2.
Medical institutions… … … … 142
3.
Q&A on improving the contract system (additional)… … … … … 149
4.
How to Claim Contractual Fees Explained with Pictures… … 152

Chapter 9 Understanding the Characteristics of the Elderly
1.
What are some common problems that arise as we age? … 168
2.
Clinical characteristics of elderly patients… … … … … … … … 170
3.
Atypical symptoms in elderly patients… … … … 171
4.
Social, economic, and cultural characteristics… … … … … … … … 173

Chapter 10 Geriatric syndrome is a common problem among nursing home residents.

1.
The main principle of geriatrics: Homeostasis declines in all organs due to aging = HOMEOSTENOSIS… … … … … … … … 176
2.
Definition of geriatric syndrome 176
3.
Common features of geriatric syndromes… … … … … … … 177
4.
Types of geriatric syndromes 177

Chapter 11 What is a Comprehensive Geriatric Assessment (CGA)?
I. Simple CGA using the DEEP-IN mnemonic technique… … … 181
1.
Delirium 181
2.
Dementia 182
3.
Depression… … … … … … … … … … 182
4.
Drugs… 183
5.
Hearing (Ears)… … 183
6.
Eyes… … 183
7.
Falls (Ph[f]alls)184
II.
Nursing Home CGA Tool (Author's Proposal)… … … … 185
1.
Explanation of the Comprehensive Geriatric Assessment (CGA) Tool for Nursing Homes… … … … … … … … … … 186
2.
Simple CGA tool… … … … … … … … … … … 188

Chapter 12 Precautions when prescribing medication to the elderly
1.
Major Preventable Adverse Drug Events (ADEs) in the Elderly… … 192
2.
Problematic drug prescriptions in the elderly (polypharmacy)192
3.
Common causes of side effects from polypharmacy in the elderly… … … … … … … … … … … 192
4.
Drugs with Common Side Effects in the Elderly (US Survey)… … … … … … … … … 192
5.
Results of polypharmacy 192
6.
List of medications that should be administered cautiously in the elderly… 193
7.
Prescription status in nursing homes for the elderly in Korea… … … … … 196
8.
How to search for drug side effects… … … … … … … … … … 197
9.
Recommendations for Prescribing Medication to the Elderly… … … … … … … 198

Chapter 13: Guidelines for Writing a Physician's Opinion for Long-Term Care Insurance for the Elderly
1.
Why is a doctor's opinion required for long-term care insurance for the elderly? 200
2.
Request for issuance of medical opinion… … … … … … … … … … … 200
3.
Internet access for issuing medical opinions… … … … 201
4.
How to claim the cost of issuing a medical opinion… … … … … … … 202
5.
Medical opinion form (Form No. 2, Appendix to the Enforcement Regulations of the Long-Term Care Insurance Act for the Elderly)… … … … 202
6.
Opinion on the disease that directly causes disability204
7.
Documents issued by doctors for dementia special grade (grade 5) patients… … … … … … … 207
8.
Medical opinion revision form… … … … … … … … … 207

Chapter 14: Guidelines for Writing a Death Certificate (Autopsy Report)… … … 213

PART 3: Managing Common Diseases and Symptoms in Nursing Homes

Chapter 15: Management of Hypertension in Nursing Homes
1.
Characteristics of blood pressure in the elderly… 224
2.
Blood pressure target for the elderly… 225
3.
How to Deal with a Hypertensive Crisis… … … … … … … 225
4.
Should Blood Pressure Be Strictly Controlled in the Elderly? (Introduction to the American Medical Association Paper)… … 226

Chapter 16 What to do when a resident of a nursing home has a fever?
1.
Definition of Fever 232
2.
Why do fevers occur in infectious diseases? … … … … … … … 232
3.
Types of fever: Guessing the cause based on the type of fever… … … … … … … … … … 232
4.
How to deal with a fever… … … … … … … 234

Chapter 17: Managing Diabetes and Hypoglycemia in Nursing Homes
1.
Goals of Diabetes Management in the Elderly… … … … … … … … … 238
2.
Diet… … … … 238
3.
Exercise therapy… … … … 238
4.
Principles of taking diabetes medications… … … … … … … … … 238
5.
Characteristics of Different Types of Diabetes Drugs… … … … … … … 239
6.
Insulin injection therapy… 240
7.
Combination therapy (oral medication + insulin)… … … … … … … 241
8.
Glycemic Control Goals for Elderly Diabetes… … … … … … … … 242
9.
The blood sugar control goals for nursing home patients are… … … … 242

Chapter 18: Managing Patients with Degenerative Arthritis in Nursing Homes
1.
Distribution of osteoarthritis in the elderly… … … … … … … … 248
2.
Characteristics of joint pain… … 248
3.
Knee osteoarthritis… … 248
4.
Treatment of Osteoarthritis… 248

Chapter 19: Common Skin Diseases Seen in Nursing Homes
1.
Prevalent diseases by site of local skin lesion… … … … … 252
2.
Characteristics and Treatments of Common Skin Diseases in the Elderly… 253

Chapter 20: Managing Patients with Respiratory Distress in Nursing Homes
1.
Shortness of breath… … … … 272
2.
Mechanisms of dyspnea in chronic obstructive pulmonary disease (COPD)… … … … … … … … … 272
3.
Managing Dyspnea in Nursing Homes… … … … … 272

Chapter 21 Depression: How to Deal with a Depressed or Apathetic Resident
1.
There are many depressed residents in nursing homes.… … … 276
2.
Two Types of Geriatric Depression… … … … … … … … 276
3.
Methods of Obtaining a Medical History of Depression… … … … … … … … … 276
4.
A simple screening test for depression… … … … … … … … … … … 276
5.
Diagnosis of Geriatric Depression… … … … … … … … … 277
6.
Characteristics of Geriatric Depression278
7.
Situations that may trigger or identify geriatric depression… … 279
8.
Drugs that cause depression… … … … … … … … 279
9. Mental and psychological support using the BATHE technique… 280

Chapter 22 Sleep Disorders: How to Deal with Residents Who Have Trouble Sleeping
1.
Why can't old people sleep? … … … … … … … … … … 282
2.
Causes of Sleep Disorders282
3.
Why Sleep Disorders Are So Prevalent in Nursing Home Residents… … … … … … … … 283
4.
Nonpharmacological treatments for sleep disorders in older adults… … … 284

PART 4 ​​GUIDELINES FOR NURSING AND CARE PROVIDERS

Chapter 23: Inpatient Nursing Checkup and Guardian Information
1.
Information obtained by directly observing the residents… … … … … … 288
2.
Information from guardians… … … … … … … … 288
3.
Things to explain to your guardian… … … … … … 289
4.
Case Study of Initial Nursing Assessment Tools and Guidance for Residents… … 289

Chapter 24 Things to Check When Nursing Team Rounding
1.
Things to check during regular rounds… … … … … … 296
2.
Things to check when doing night rounds… … … … … … … … … … 300
3.
Care after rounding… … … … … … … … … 301

Chapter 25: Guidelines for Writing Nursing Records in Nursing Homes
1. TPR chart (clinical observation record)… … … … … … … 304
2.
Hospital Test Results Record 304
3.
Meal… … … … … … … 304
4.
Excretory function… … … … 304
5.
Sleep state… … … … 305
6.
Activities of daily living (ADL)… … … … … … … … … … 305
7.
Whether physical therapy or occupational therapy is performed and what type of therapy is used… … … 305
8.
Health related issues… … 305
9.
Presence and frequency of behavioral and psychological symptoms due to dementia306
10.
Record your observations of nonverbal expressions as they are… … … … … … … … … … 306
11.
Record after performing nursing duties… … … … … … … … … … … 306
12.
Bedsore condition… … … … 306
13.
Nursing records according to the operating regulations of contracted medical institutions and contracted physicians… … … … … … … 306

Chapter 26 Assessment and Management of Malnutrition and Dehydration
1.
Why is malnutrition so common in the elderly? … … … … … … 312
2.
Characteristics of malnutrition in the elderly… … … … … … … … … … … 312
3.
Those at high risk of malnutrition… … … … … … … … 313
4.
Identifying Malnourished Elderly … … … … … … … … … … 314
5.
Access to malnourished elderly people… … … … … … … … 316
6.
Approaching a dehydrated patient… … 317

Chapter 27: Medication Management and the 5R Principles in Nursing Homes
1.
Storing Medications Safely… … … … … … … … … … 324
2.
Administering Drugs Safely… … … … … … … … … … 324

Chapter 28 Oral Care
1.
Oral problems common in the elderly… … … 328
2.
Practice of Oral Care for Residents… … … … … … … … … 329

Chapter 29 Bedsore Management
1.
Why do bedsores form? 336
2.
Under what conditions are bedsores likely to develop? … … … … … … 336
3.
In which areas do bedsores most commonly develop? … … … … … … 336
4.
Stages of bedsores… … … 337
5.
Prevention and Management of Pressure Ulcers339

Chapter 30 The Role of the Caregiver: Safely Caring for Residents
1.
Basic Qualifications as a Nursing Assistant… … … … … … … … … 349
2.
Hygiene concept… … … … 350
3.
Training on how to write a care log… … … … … … … … … … … 350
4.
Managing the Inmates' Items352
5.
Bed decoration… … … 352
6.
Assistance with oral medication administration… … … … … … … … … … … 353
7.
Preventing Bedsores… … … … 353
8.
Preventing stiffness in arms and legs… … … … … … … … … … … 354
9.
Positioning a patient who is unable to move while lying down… … … … … … 355
10.
Moving a bedridden patient… … 355
11.
Assistance in getting out of bed… … … … … … 356
12.
Steps for getting a wheelchair out of bed356
13.
Meal assistance… … … … 357
14.
Bowel and urinary assistance… 360
15.
Assistance with personal hygiene of residents … … … … … … … … … 362
16.
If you observe any of the following abnormalities, report them to the nurse immediately: … … … … … … … 363
17.
For residents using body protection devices, things to periodically observe… … … … 363
18.
Fall Prevention… … … 364
19.
Stretching exercises for caregivers… … … … … 364

PART 5 What is dementia and how can we care for it?

Chapter 31: The ABC Approach to Dementia
1.
Diagnostic criteria for dementia (dementia formula)… … … … … … … 370
2.
Diseases that cause dementia371
3.
The ABCs of Dementia?… … 371
4.
Dementia screening test… … 374
5.
Activities of Daily Living (ADL) Measurement Tool: K-ADL… … … … … 382

Chapter 32 Delirium: Must be distinguished from dementia.

1.
How to Screen for Delirium with Just One Question… … … 388
2.
How to Diagnose Delirium… … … … … … … … … … … 389
3.
Who is more likely to experience delirium? … … … … … 390
4.
Types of Delirium 390
5.
Causes of Delirium… … … 392
6.
Prevention and Management of Delirium Patients… … … … … … 393
8.
Preventing Delirium in Residential Elderly… … … … … 394
9.
Delirium vs. Dementia vs. Delusion… … … … … … … … … … … 394
10.
Conclusion… … … … … … 396

Chapter 33 My feelings are conveyed even to dementia patients.

1.
When I change, the patient changes.… … … … … … … … 400
2.
Acts that protect the dignity of dementia patients vs. acts that undermine dignity… … … … 401
3.
Points to Understanding Dementia Patients… … … … … 402
4.
Communication Point 402
5.
Humanitude Techniques … … … … … … 403

Chapter 34: Behavioral and Psychological Symptoms of Dementia - Coping Without Medication
1. BPSD may not necessarily be a problem caused by memory or cognitive impairment. … … … 409
2. Why is BPSD clinically important? … … … … … 409
3. Characteristics of each symptom of BPSD… … … … … … … … … 409
4. Non-pharmacological treatments for BPSD ☞ A cooperative relationship with medication only when necessary… 412
5.
Examples of specific coping strategies for situations that make employees feel uncomfortable 415

Chapter 35 Tips for Running Activity Programs for Residents
1.
Activity Program… … … 422
2.
Art therapy… … … … 424
3.
Music therapy… … … … 426
4.
Exercise therapy… … … … 427
5.
Occupational therapy… … … … 427
6.
Cognitive therapy… … … … 428
7.
Gardening techniques… … … … 431
8.
Aromatherapy… … … 432
9.
Animal Assisted Therapy (AAT)… … … … … … … … … … … 433
10.
Programs with children… … … … … … … 435
11.
Emotional support activities… 435
12.
Reminiscence therapy… … … … 436
13.
Examples of writing program records… … … … … … 438

Chapter 36: Evidence-Based Lifestyle Tips for Dementia Prevention
1.
Jininsa Daecheonmyeong GO! Life Rules… … … … … … … … 442
2.
Get enough sleep!… 443
3.
Live like nuns!… … … … … … … … … … 444

PART 6 How to Deal with Critically Ill Patients

Chapter 37 Tube Management in Nursing Homes (Gastric Tubes, Urinary Catheters, Colostomy Tubes, and Endotracheal Tubes)
1.
L-tube management… … … … … … … … … … … 450
2. PEG (Percutaneous Endoscopic Subgastrostomy) Management… … … … … … 453
3.
Foley catheter… … … … … … … … … … 455
4.
Artificial anus… … … … 457
5.
Tracheal catheter (T-tube) 458

Chapter 38 What if the urine bag turns purple?
1.
What is Purple Urine Syndrome (PUS)? … … … … … … 464
2.
Risk factors and incidence of purple urine syndrome… … … 465
3. Bacteria associated with PUS… … … … … … … … … … … 465
4. Clinical Significance and Countermeasures of PUS… … … … … 466

Chapter 39 When should you go to the hospital?
1.
Find out the guardian's wishes from the time of admission!… … … 470
2.
Make it clear that nursing homes are not hospitals… … … 470
3.
Determining the timing of hospital visits for patients with common conditions in nursing homes… … … … … 472

Chapter 40 How to Respond to Various Emergencies
1.
Primary response methods for each problem situation … … … … … … … … … … 478
2. CPR (Cardio-Pulmonary-Resuscitation)… … … … … … 481

Chapter 41 How to Care for Terminally Ill Patients and Their Families?
1.
Emotional support (therapeutic conversation)… … … … … … … … 488
2.
Pain Common in Terminal Cancer … … … … … … … … … … … 488
3.
Types of terminal illnesses other than terminal cancer… … … … … … 490
4.
Symptom management of terminal illness… … … … … … … … … … 490
5.
Decisions about life-sustaining treatment: Writing an advance directive for life-sustaining treatment… … … … … … … … … 493
6.
Bereavement Care for Bereaved Family… … … … … … … 494

Operating Regulations Case Study… 497
Index … 543

As of 2021, Korea is in a transitional period from an aging society to a super-aged society. Nursing homes have become a vital place for seniors in need of physical and mental support. Therefore, guidelines for providing quality care services have become essential.


Meanwhile, the COVID-19 pandemic that began in early 2020 has served as an opportunity to strengthen awareness of the importance of systematic operation and safety management, including infection control, in nursing homes where vulnerable elderly people live in close proximity.
As a result, nursing homes have evolved from being mere residential spaces to providing professional care services, and the level of staff involved must also match this.

The Nursing Home Guidelines are designed to provide practical assistance to nursing home staff.
I hope that this book will convey the author's and publisher's sincere desire to be of help to nursing home staff and those interested in geriatric care. I also hope that this book will serve as a guide for staff and contract doctors working in geriatric care facilities across the country.