2.6 Health Care Settings
Caregivers who provide assistance in activities of daily living (ADLs) work in a variety of settings. When an individual is no longer able to independently care for oneself, the level of care needed is what determines where they reside. For example, an individual who is able to perform most of their ADLs but needs assistance with meals and laundry may live in an assisted living facility, but someone who needs more assistance with daily ADLs may live in a nursing home. As you become more familiar with health care delivery, you will discover what type of setting will be the best fit for you. Some settings require licensure for nurse aides while others will provide training at the agency level. Table 2.6 outlines the different types of settings where health care can be delivered. Terms such as patients, clients, residents, and members are used interchangeably for people for whom nursing assistants provide care. In general, people receiving care in hospitals are referred to as “patients,” people who live long-term care facilities are referred to as “residents,” and people receiving outpatient care are often referred to as a “clients” or “members.”
Table 2.6 Health Care Settings
| Care Setting | Type of Care Provided | Typical Patient | Room Environment | What are Users Called? | Who Provides ADLs? |
|---|---|---|---|---|---|
| Hospital | 24-hour care is provided with access to physicians and other providers, RNs, speech therapists, physical therapists, occupational therapists, respiratory therapists, social workers, registered dietitians, and chaplains for spiritual care. Hospitals provide acute and specialty care for patients, as well as emergency and urgent care. Some hospitals provide home health and hospice services. Larger hospitals provide various types of labs and diagnostic tests on site. | Anyone with emergent or urgent health care concerns is appropriate to be served in the hospital setting. | Designed for short stays with sterile and clean environments. Rooms are typically made for one patient and contain multiple pieces of medical equipment to avoid HIPAA and infection control concerns. Many disposable or one-time use items are used to avoid cross-contamination. | Patients | Patient Care Assistants (PCAs) or Certified Nursing Assistants (CNAs); licensure is required. |
| Long-term Care (LTC) or Nursing Home (NH) | 24-hour skilled care is provided for people who are no longer eligible for hospital care but are unable to care for themselves at home. An RN is always on site. Residents may be admitted due to physical limitations in mobility, management of chronic conditions or medication, or both. | Typically, older adults with chronic conditions such as physical disabilities, heart disease, prior strokes, diabetes, history of major fractures, or are otherwise unsafe at home. | A long-term care facility, commonly referred to as nursing home or rehabilitation center, is where a person lives. The facility typically has both private and shared rooms, and residents are encouraged to have their own belongings. Rooms are accessible for various mobility needs but are more homelike than a hospital setting. | Residents | Certified Nursing Assistants (CNAs); licensure is required at facilities that are funded by Medicare and Medicaid. |
| Assisted Living | Care is provided that can be scheduled, such as medication assistance, grooming, showering, meal preparation, cleaning, and laundry. On-demand care, such as assistance with toileting or getting from one place to another, is not included. | Typically, residents are 65 years or older and are more independent than in other LTC facilities. They are medically stable but need some oversight for safety and home maintenance. As their assistance needs change, they can be moved to a different area if necessary. | Each room is like an apartment with a small kitchen and entry doors that lock. | Residents | Daily Living Assistants (DLAs) or CNAs; licensure is not required. |
| Group Home/Adult Family Home | Provides daily care and maintenance with mostly an oversight on safety. | Typically, adults with developmental disabilities or moderate dementia, or those recovering from substance use disorders. | Residents have a bedroom and access to the whole house. Each state provides a maximum capacity per house, but group homes typically have 4-6 residents. | Residents or clients | Daily Living Assistants (DLAs) or CNAs; licensure is not required. |
| Home Health | Any assistance (nursing or ADLs) provided in someone’s home. | Can be short-term assistance for things like wound care or IV therapy or long-term assistance with medication management, cleaning, shopping, etc. | Care is provided in the client’s home. | Patient, client, or member | Daily Living Assistants (DLAs) or CNAs; licensure is not required. |
| Hospice | Assistance provided for palliative or end-of-life care. | Those who are terminally ill and/or have a life expectancy of six months or less. | Care is available 24 hours, 7 days a week in a resident’s home, LTC facility, or hospital unit. | Patient, client, or member | Daily Living Assistants (DLAs) or CNAs; licensure is not required. |