When a resident is at the highest level of care, additional time and intensity of services may require an arrangement for outside supportive services such as home health care or private duty assistance.
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Five levels of care are identified according to the medical, functional and psychosocial status of the resident. These levels are determined by the Registered Nurse after completing a personal assessment. Because individuals vary widely in strengths and needs, it should be remembered that this is only an overview.
The resident is able to manage much of their own physical care most of the time. He/she may needs only guidance, reminding and cueing. The resident needs the basic services of three meals per day, housekeeping and laundry and activity program.
The resident needs increased guidance. Physical needs require some assistance. There may need to be some modification of diet. The resident may care for self, but need assistance with bathing and reminders in personal grooming.
The resident may be somewhat unsteady in walking, have incontinence episodes and need much more prompting in order to accomplish tasks. The resident regularly needs help with dressing and grooming. There may be behaviors at this level that need staff intervention.
Considerable assistance may be needed in transferring and ambulating. The resident needs to be regularly toileted or has challenging toileting habits. The resident needs total assistance with bathing, dressing and grooming, possibly several times a day. Confusion is pronounced; redirection required many times. Although can feed self, needs many reminders.
The resident may not be able to bear weight or help very little with transfers. He/she may need to depend on another for all mobility, all personal cares and all incontinent care. May not be able to eat without one-on-one assistance. Medication management may be complex and may involve injections. Nurse monitoring is needed more frequently.
When a resident is at the highest level of care (Level Five), additional time and intensity of services may require an arrangement for outside supportive services such as home health care or private duty assistant. It may become appropriate and cost-effective to pursue placement in a nursing facility. The facility RN will explore with the resident’s family, the best options for the welfare of the resident and the facility.