NURSING HOME M

& Ni bun ca ngi Vit gi Nursing Home

-Bs Trn Cng Bo

C nhn c cu: sinh, lo, bnh, t. Bn giai on ny khng ai

c th trnh khi. Chun b ng ph vi bnh tt v tui gi ca
mnh v ca thn nhn mnh l iu ai cng c dp ngh ti, k c
chnh k vit bi ny l ti cng ang sp sa bc vo tui tht
thp c lai hi.
Anh bn thn ca ti, Bs. TNT t lu c ngh ti vit mt bi
v Vin Dng Lo (VDL) gip b con mnh c thm mt
cht khi nim v VDL v anh bit trong sut 27 nm qua ti
lin tc sn sc cho cc c gi ti cc vin dng lo, v cng
l Gim c Y T (Medical Director) ca nhiu VDL trong
vng. Nay ti mun chia x cng qy bn mt s kinh nghim v
hiu bit v VDL.
Trong Vit ng chng ta thng dng t Vin Dng Lo, nhng
trong Anh ng th c nhiu t khc nhau nh Nursing home,
Convalescent home, Rehabilitation and Nursing center, Skilled
nursing facility (SNF), Rest home Ni chung, VDL l mt ni
cho nhng ngi b yu km v th xc khng th t sn sc cho
mnh c trong cuc sng hng ngy. Th d nh khng th nu
nng, git gi, i ch nng hn na nh khng sc lm
nhng vic ti cn thit cho cuc sng nh n ung, i tiu, i
tiu hoc cn phi c thuc men ng lc m khng th t lm
c.
Khi ni ti VDL ngi ta thng ch ngh ti nhng ngi gi m
thi. Tht ra c nhiu ngi tr nhng v tt bnh khng th t
lo cho mnh c cn phi c s gip ca SNF (skilled nursing
facility).

Vy th no l VDL?
VDL l ni cung cp nhng dch v cn thit cho cuc sng hng
ngy cho nhng ngi khng kh nng lo cho chnh mnh. Ty
theo mc trm trng ca bnh tt m c nhng VDL khc
nhau:

1- Skilled Nursing Facility (SKF): l ni cung cp nhng dch v

cho nhng ngi b khuyt tt nng nh tai bin mch mu no
gy nn bn thn bt toi, hn m lu di, hon ton khng cn
kh nng ngay c trong vic n, nut, tiu, tiu Thng thng
ti SNF c hai phn: phc hi (rehabilitation) v sn sc sc khe
(nursing care). C nhng ngi sau khi c gii phu thay
xng khp hng (hip replacement), thay u gi (knee
replacement), hay m tim (bypass, thay valve tim) cn thi gian
tp dt phc hi (rehabilitation). Sau h c th v nh sinh
hot bnh thng cng gia nh.

2- Intermediate care facility (ICF): cung cp dch v cho nhng

ngi bnh nh tt nguyn, gi c nhng khng cn sn sc cao
cp (intensive care). Thng thng nhng ngi ny khng c
thn nhn lo cho mnh nn phi vo y cho n ngy cui
cng (custody care).

3- Assisted living facility (ALF): Thng thng nhng ngi

vo ALF vn cn kh nng t lo nhng nhu cu cn bn nh tm
ra, thay qun o, i tiu, i tiu mt mnh c. H ch cn gip
trong vic bp nc, theo di thuc men v chuyn ch i thm
bc s, nh th, cha chin hay mua sm lt vt. H vn cn phn
no c lp.

4- VDL cho nhng ngi qu l ln (Alzheimer facility): c

nhng bnh nhn b l ln nng, n ni khng nhn ra ngi thn
nh v, chng, con chu na. Khng bit t i vo bung tm,
phng v sinh lm nhng cng vic ti thiu. H khng bit h
u, d i lang thang v lc ng. Nu nh th phi c ngi
lo cho 24/24. Nhng VDL dnh ring cho nhng bnh nhn ny,
thng l locked facilty, ca ra vo c kha li bnh nhn
khng th i lc ra ngoi. Cch y kh lu c trng hp mt
bnh nhn i ra khi vin, lc ng, b xe la cn cht! T c
locked facilty. i khi cng c nhng bnh nhn c gn alarm
vo c chn. Nu bnh nhn i qua ca th alarm s bo ng v
nhn vin s kp thi mang v li.

NHNG DCH V C CUNG CP TI VDL

iu ny ty theo tng vin. Tuy nhin nhng dch v sau y l

cn thit:
1- Phng ng.
2-n ung
3-Theo di thuc men
4-Nhng iu ti thiu hng ngy nh tm ra, thay qun o, v
sinh c nhn
5-24/24 lo cho nhng trng hp bnh khn cp.
6-Sinh hot hng ngy nh gii tr, tn gio
7- Vt l tr liu. Dch v ny rt quan trng gip ngi bnh
c th phc hi cng nhiu cng tt. Trong vt l tr liu c nhiu
dch v khc nhau:
a- Tp dt (physical therapy): nh tp i, tp ln xung cu
thang, tp t vo ging ng hay ra khi ging mt cch an ton,
khng vp ng
b- Speech therapy: tp ni, tp nut khi n ung C nhng
bnh nhn b stroke, khng th ni hay n c, cn c tp
phc hi chc nng ny.
c- Occupational therapy: Tp mang giy, b tt (v) Tp s
dng bp gaz, bp in cho an ton trnh b tai nn.

AI TR TIN CHO VDL?

C nhiu ngun ti tr khc nhau:

1-Medicare
2-Medicaid ( California l Medi-Cal).
3-Bo him t, c nhiu ngi mua sn bo him cho VDL.
4-Tin dnh ca ngi bnh (personal funds).
MEDICARE l do qy lin bang, ch tr ti a 100 ngy cho
nhng bnh nhn cn tp dt phc hi chc nng ti mt
Skilled Nursing Facility (SNF). Thng nhng bnh nhn b
stroke, gy xng cn dch v ny. Medicare KHNG TR cho
custody care.
MEDICAID l do qy lin bang v tiu bang. Qy ny tr nhiu
hay t l ty tng tiu bang. Medicaid tr cho dch v y t v
custody care.
BO HIM T th tuy theo tng trng hp s c nhng quyn
li khc nhau, nhng thng rt hn ch.
Hin nay ngi ta c lng trn nc M c khong 1.4 triu
ngi sng trong 15,800 VDL. Cc VDL ny t di s kim
sot ca b y t, c bit l do Center for Medicare & Medicaid
Services (CMS) gim st. Hng nm cc VDL u phi tri qua
mt cuc kim tra rt gt gao (survey) ca CMS. VDL no khng
ng tiu chun th c th b ng ca! Mc ch kim tra ca
CMS l bo m cho cc bnh nhn ti VDL c sn sc an
ton, y vi cht lng cao. ng thi trnh nhng trng
hp b b b (negligence) hay bo hnh (abuse) v th xc ln tinh
thn. Ti mi VDL u c lu tr h s kim tra cho cng chng
xem. Bt c ai cng c th xem kt qu ca cc cuc kim tra
ny. Tt c cc VDL u phi c cc bin php bo m s sn
sc cho bnh nhn theo ng tiu chun. Nu khng s b pht
tin, v c nhng trng hp b ng ca.

Trn y ti trnh by s qua v nhng im chnh ca VDL.

Tuy nhin, nh qu bn tng nghe v bit, c nhiu khc bit
gia nhng VDL. Theo ti nhn xt th quan nim chung ca mi
ngi l khng mun vo VDL. Chng ta tng nghe nhng
chuyn khng tt th nhiu, m nhng chuyn tt th t. Ting
lnh n gn, ting d n xa, l cu ngn ng ngi mnh vn
ni t xa xa n nay. Ti c khng bit bao nhiu l bi vit
v vic con ci bt hiu, b b m, ng b vo VDL ri khng
oi hoi ti. Ti cng thy nhiu trng hp cc c vo VDL
mt thi gian ri khng mun v nh vi con chu na! Trn i
ny khng c g l tuyt i c, trong ci hay c ci d, v trong
ci d li c th tm ra ci hay. Vy chng ta rt ta c kinh
nghim g trong vn ny? Ti ch xin nu ln nhng nhn xt
ch quan ca ring ti m thi. C th qu v khng ng ht,
nhng nu rt ta c t nhiu kin xy dng th cng tt
thi.

NHNG BNH C TH DO VDL GY RA

1- Lo lng (anxiety): Trong thng 9/2011 nhng nh nghin cu

hi kin ca 378 bnh nhn trn 60 tui nm VDL ti thnh ph
Rochester, New York. Kt qa l c trn 27.3% tr li l h b
bnh lo lng, t va n nng. Nu khng c cha tr s a
n bnh trm cm (depression). Nn nh l 378 bnh nhn ny l
ngi M chnh cng, sinh ra v ln ln ti M. Chng ta hy
tng tng ngi Vit mnh khng bit rnh ting Anh, khng
am tng phong tc, tp qun th s kh khn s nhiu nh th
no! Cn mt vn na l thc n, chng ta quen nc mm,
tht kho, lm sao m c th nut hamburger, sandwich ngy
ny qua ngy khc! Cc vn ny cng lm bnh lo lng, trm
cm nng thm !

2- Phn ng ca thuc (adverse drug reactions): Trong thng

1/2012 ngi ta theo di cc bnh nhn ti VDL, kt qa l t nht
40% cc bnh nhn dng trn 9 loi thuc khc nhau. Ung cng
nhiu thuc th phn ng cng nhiu. C ba loi phn ng khc
nhau:
a- Phn ng ph (side effects): th d nh ung aspirin lm
bao t kh chu, thuc cao mu lm to bn Loi ny thng
xy ra, khng cn phi ngng thuc.
b- Drug interference (tm dch l thuc i tc vi nhau): c
nhiu loi thuc ung chung vi nhau s lm tng hoc gim sc
tc dng. Th d thuc long mu coumadin m ung chung vi
thuc tim nh amiodarone s lm d chy mu. C nhng thc n
hay nc ung dng chung vi thuc cng nh hng n thuc.
Th d ung nc bi hay nho vi mt vi loi thuc cng s
tng sc tc dng ca thuc, d gy ng c.
c- D ng vi thuc (allergic reaction): Loi ny nguy him
hn, thng lm da ni m ay, , nga. Nu nng th c th cht
c nh phn ng vi penicillin chng hn. Nu b d ng th
phi ngng thuc ngay.

3- Ng t (fall): Ngi gi rt d b t ng gy nn nhiu bin

chng quan trng nh chy mu trong u (intracranial bleeding),
gy xng (nh gy c xng i, tay). Khi gi qu hoc c
nhng bnh nh hng n s di chuyn, khng cn i li vng
vng, nhanh nhn nh lc tr nn d vp, t ng.
4- Da b l lot (decubitus ulcers): Nhng ngi b lit ging,
khng sc t mnh xoay tr trn ging, rt d b l lot da
gy nn nhiu bin chng tai hi.
5- Nhim trng (infection): nh sng phi, nhim trng ng
tiunht l nhng ngi cn phi dng my mc nh my th
(respirator), ng thng tiu (Folley catheter)

6- Thiu dinh dng, thiu nc (malnutrition, dehydration):

cc c gi th trung tm kht (thirst center) trong no khng cn
nhy cm na, nn nhiu khi c th cn nc m khng thy kht
khng ung nn b thiu nc. Ci cm gic ngon ming"
(appetite) cng gim i nn khng mun n nhiu gy nn tnh
trng thiu dinh dng.

VY C NN VO VDL KHNG?

Vic ny th ty trng hp. Theo ti:

1- Nu cn c th nh c m vn an ton th nh tt hn.
Nu ti chnh cho php, th d mnh khng kh nng lo cho
mnh, mnh vn c th mn ngi bn thi gian (part time)
n lo cho mnh vi gi mi ngy, gip n ung, tm ra, dn dp
trong nh, thuc men, ch i bc s
2- Nu khng th nh c, m ti chnh cho php th c th
nhng assisted living facilities. y thng h ch nhn tin
(personal funds) ch khng nhn medicare & medicaid. Ti y
th s sn sc s tt hn.
3- Group homes (nh t): C nhng ngi nhn sn sc cho
chng 4-6 ngi mi nh. H cng lo vic n ung, ch , thuc
men, ch i bc sThng th r hn ty tng group.
4- Nu chng ng ng phi vo VDL th phi lm sao c
c s sn sc tt nht?
a- Lm sao la chn VDL:
- Vo internet xem ranking ca VDL (tng t nh cc tim
n c xp loi A, B, C)
- Mi VDL u phi c cun s phc trnh v cc cuc kim tra
(survey) do b y t lm hng nm. Trong b y t s nu ln
nhng khuyt im m h tm thy. Cun s ny c khu
cng cng (public area) trong khun vin ca VDL. Hi
receptionist th h s ch cho.
- Hi kin thn nhn nhng ngi c thn nhn ang nm ti
.
- Quan st bn trong v ngoi ca VDL: xem c sch s, khng
mi hi, nc tiu. Theo di cch i x, sn sc ca nhn vin
vi bnh nhn.
- Nu c th th tm mt VDL c nhiu ngi Vit ang c
nhn vin ni ting Vit, c thc n Vit, c chng trnh gii tr
theo kiu Vit.
b- Nu quyt nh chn VDL cho ngi thn ri th phi
lm g sau ?
Chun b t tng khng nhng cho bnh nhn m cn
cho c chnh mnh v mi ngi trong gia nh c c s
chp nhn (acceptance) cng nhiu cng tt.
Thm ving thng xuyn: Nu nh ng con chu th
khng nn n tht ng mt ln ri sau nhiu ngy khng c
ai n. Nu c, nht l trong vi thng u, lun phin nhau ti,
 mi ngy mt ln mt vi ngi. Lm lch trnh ai i thm ngy
no, gi no
Nn lm mt cun s thng tin (communication book)
cnh ging. Trong cun s ny mi khi ai n thm th vit
ngy gi, tn ngi n thm, v nhn xt xem bnh nhn c vn
g cn lu , gii quyt. Nu khng c vn g th cng nn
vit vo l khng c hoc cho nhn xt v vui, bun, than th ca
bnh nhn
Cui tun hay ngy l: nn c ngi vo hoc mang bnh
nhn v nh na bui c sng vi khng kh gia nh d
ngn ngi, hay a ra khi VDL lm u, tc hoc ti tim n
cho khuy kha
Nn sp xp bnh nhn c sch bo, bng nhc bng
ting Vit cho bnh nhn gii tr.
Cho d c nhng bnh nhn b hn m bt tnh lu di,
nhng khi n thm hy c th thm bn tai h nhng li yu
thng, nhng k nim c. Nm tay, xoa du t tnh thng
yu. Tuy h khng c th cm thy c 100% nhng chc chn
h vn cn mt cht nhn thc, lm h hnh phc hn, mc d
mnh khng nhn thy. bn u ging nhng bng nhc, cu
kinh m khi cn khe h thch nghe.
Mt iu cht m theo kinh nghim ca ti, rt c hiu
qa: i x tt nhng nghim tc vi nhn vin ca VDL:
i x tt: lch s, nh nhng, khng thiu nhng li cm n cho
nhng nhn vin phc v tt. Thnh thong mua mt vi mn qu
nh cho h (ti xin nhn mnh nh thi ng nn coi y l
hi l) nh n, thc ung by t lng bit n ca mnh.
Mnh tt vi h th h s quan tm n mnh nhiu hn. Ngi
mnh vn ni: C qua c li mi toi lng nhau).
Tuy nhin i x tt khng c ngha l mnh chp nhn nhng sai
tri ca h. Th d mnh bo co nhng thay i v sc khe
ca bnh nhn cho h m khng ai quan tm gii quyt th mnh
phi lch s nu ra lin. Nu cn th gp ngay nhng ngi c
trch nhim nh charge nurse, nursing director v ngay c gim
c ca VDL c gii quyt. Nn nh l phi lch s, nh
nhn nhng cng quyt th h s n phc mnh. Ti thy
nhiu trng hp t yu cu mt cch rt kh quan.
Trn y l nhng kinh nghim ca ti xin chia s vi qu bn. D
nhin l khng hon ton y tt c nhng g qu bn mong
mun, nhng hy vng cng p ng c phn no nhng u t,
lo lng cho ngi thn ca qu bn.

Bs. Trn Cng Bo

nguon: http://vietlifestyles.com/vien