Excerpt
Long term care (LTC) reality, in particular Nursing Homes (NHs) represent a very diversified and complex environment. The intrinsic heterogeneity, the demographic change of the population and of the national health system in recent years (increase chronicity, territorial absorption of patients, ageing population, etc…) affects the quality and safety levels of long-term care support services. The quality and safety of care in NH and LTC are less studied by scientific research and health policies compared to health services [
1]. To undertake pathways of systemic change it is necessary to know the reality of these contexts. Also taking that what we are going through is a period of inevitable and desired transformation and reorganization of LTC in Tuscany and Italy. First of all, it is necessary to reflect and analyze the needs of these realty and their staff, organizational level, resources and skills [
2]. The aim is to imple-ment most appropriate choices to respond to needs of people and families who live experience of life in NH. The emergency situation made it necessary to fight many problems and face managerial and structural changes, that at another time would have seemed insurmountable. The NHs, in particular, have seriously blamed the waves of Covid-19, remaining uncovered in terms of resources, staff and support of health services [
4]. LTC context is characterized by intrinsic fragility and the pandemic has highlighted it; NHs population is made up of frail patients, consequently exposed to greater risks and adverse events [
5]. The most common concern infections but also behavioral disorders, immobilization syndrome, emergencies management, therapy and drugs management, nutritional risk, polypharmaceuticals, escapes and the use of contain [
5]. We can find as many difficulties in quality assistance dimentions: development of desires, need for communication, relationship with family members, relations with community etc. … [
6]. Until a few yers ago this fragility was contained because the series of events was reduced and low traceable. In recent years, however, the LTC’s patients’ complexity has grown and risks proportionately. The safety of care is recognized as a fundamental right of human being and 24/2017 Italian law lays foundations for a redefinition of care paths and fields of application in the field of social and health services, making health professionals the guarantors of this right. Law 24 is aimed at all LTC organizations, requiring them to systematically define, analyze and prevent risks [
7]. The same is required by new Tuscany Regional accreditation system [
8], underlining the need to implement skills of professional healthcare. The epidemiological curve’s change has seen NHs destined to redefine the health system, moving care from the hospital to local area. In line with this inevitable change, staff of the NHs will be called to take roles with require greater professional judgment, organization and adequate resources. The question we should ask ourselves is: are the NHs ready? …
