A ROLE FOR THE PUBLIC HEALTH NURSE IN NURSING HOME CARE.

Abstract

IT is well known that the demand for nursing home continues to increase rapidly throughout the nation. At the present time there are some 9,700 skilled nursing care homes in the United States with a total of 307,681 beds. This is an increase of 48 per cent in the number of homes since 1954 and an even larger increase can be expected in the future.1 The availability of insurance and federal programs for payment of nursing home for older people will play a part in increasing the demand for such services. As the demand for nursing home has increased, there has been louder and more frequent criticism of the kind of patient given in these institutions. The proprietary home has been the main target of such censure. In an attempt to raise the standards of nursing home care, many health and welfare agencies around the country have developed teaching programs for nursing home personnel. In 1962 a unique opportunity for experimenting with a modification of classical patterns of nursing home occurred in New York City. At that time a new welfare medical program was inaugurated which involved the Health Insurance Plan of Greater New York in the of some 17,000 Department of Welfare clients. With the advent of this program, Montefiore Medical Group assumed the of Department of Welfare patients in one proprietary nursing home in the Bronx.2 The Medical Group chose this particular home because of its proximity to Montefiore Hospital, its small capacity of 28 patients, and because 26 of these 28 were Department of Welfare clients. The owners were informed that their home had been selected and their cooperation with project personnel was requested by the Department of Welfare. At the time this program began the patient population in the Nursing Home was composed of a group of 21 women and five men. Their ages ranged from 47 to 96 with a median age of 80. About half of these patients could be considered ambulatory. The variety of diseases represented was fairly characteristic of this age group; these included heart disease, visual defects, musculoskeletal defects and cerebral or generalized arteriosclerosis. The purpose of the project is to develop and institute a program to assist this nursing home in utilizing its facilities and staff to meet the needs of institutionalized, chronically-ill aged patients as effectively as possible. Our program is directed toward improving three aspects of patient in the nursing home: medical, nursing, and