2.3 Members of the Health Care Team and Nursing Home Structure

As illustrated in Figure 2.1^[1] below, the resident and their family members are at the center of holistic care. We know from Chapter 1 that holistic care includes physical, emotional, social, and spiritual well-being. A holistic approach focuses on a person’s wellness and not just their physical illness or condition. Each member of the health care team provides holistic care to achieve the best possible health outcomes for clients and improve their quality of life. Responsibilities of the health care team members are as follows:

• Physicians and health care providers diagnose conditions and prescribe medications and treatments.
• Nursing service members include registered nurses (RNs), licensed practical nurses/vocational nurses (LPNs/VNs), certified medical technicians (CMTs), and nursing assistants (RNAs, LNAs, CNAs). The nursing team implements nursing care plans based on the nursing process and provider orders. The nursing supervisor/charge nurse/unit manager supports the nursing staff and may assist in providing resident care or treatments. Staff/Floor nurses provide nursing care to residents. Nursing assistants perform assigned or delegated nursing tasks such as assisting with ADLs and reporting any changes in a resident’s condition.
• Social Services, such as social workers and case managers, assist with emotional and personal problems, benefit coordination, and any discharge or transfer needs to other facilities.
• Therapists, such as physical therapy (PT), occupational therapy (OT), and speech therapy (ST), assist residents in recovering from an illness to return to and maintain function. Therapy roles are further outlined in Chapter 9.

Each department and member of the health care team is essential for quality resident care. Although there are a variety of certifications, skills, and abilities present within the health care team, each component is a valued resource. Your part in the team as a nursing assistant is to understand team member roles and responsibilities, coordinate with the appropriate team members when needed, and respect and support each team member’s efforts. You should expect the same treatment from other health care team members regardless of their educational background, title, or job duties.

While the health care team provides care for residents in the nursing home, other departments and individuals oversee business and non-health care operations for the facility. A nursing assistant should have an understanding of the non-medical aspects necessary to meet resident needs.

Non-health care responsibilities of team members in a nursing home include the following:

• Administrator: Oversees federal and state regulation compliance and manages non-medical aspects of the facility, such as finance.
• Medical Director: Consults on medical aspects of care, such as infection control and quality of care.
• Director of Nursing (DON): Manages all aspects of nursing staffing, policies, and procedures.
• Assistant DON: Assists with managing nursing staff and implementing policies and procedures.
• Staff Development Coordinator (SDC): Trains nursing employees and provides continuing education.
• Minimum Data Set (MDS) Coordinator: Assesses resident needs and reports to CMS for reimbursement.
• Business Office: Oversees billing and other financial aspects.
• Housekeeping and Maintenance: Maintains the facility and equipment and keeps the environment clean and safe.
• Activities Director: Oversees any activities staff members provide and plans events for resident enjoyment related to hobbies or interests.
• Dietary Director: Oversees dietary staff to deliver nutritional and fluid needs of residents.

See Figure 2.2^[2] for an illustration of the general structure of a LTC facility.