progressive care unit admission criteria

This is probably a dumb question but how does PCU and intermediate care differ from stepdown? Palliative care consultations assist clinicians in managing complex pain, symptoms, comorbidities, patient/family communication and other issues. Number of productive hours worked by RN nursing staff (employee and with Number of Appropriate utilization of Intensive Care Unit (ICU) resources is an important issue as the nation struggles to contain health care expenditures. Performs within the legal framework of the nursing profession as defined by the Nurse Practice Act of the Commonwealth of Pennsylvania. Care for vascular patients pre/post-surgery including carotid endarterectomies and Fem-pops and other diseases/diagnosiss requiring close monitoring; such as sepsis, respiratory patients requiring BIPAP or High-flow oxygen, renal disease with/without HD, Neurological diagnosiss, patients withdrawing from substance abuse and OB emergencies. hbbd```b``M`2 21,191 Posts. What Is a Progressive Care Unit? Read our cookie policy. Nursing actions inherent in the concept of surveillance include maintaining vigilance for potential problems, 18 developing awareness of problems as they occur, and responding to problems when they occur. This unit cares primarily for cardiac patients in need of cardiac catheterizations, post STEMI/angioplasty, NSTEMI, post pacemaker insertion, CHF patients, Atrial Fibrillation or other cardiac arrhythmias and hyper/hypotensive patients, not meeting ICU admission criteria. Increased Level of Surveillance, Admission and Discharge Criteria, Synergy model, Comparison of core competencies for progressive care nursing between 2004 and 2009. For the sake of this article, we will use the term 'intermediate care unit' (IMCU) and assume . This unit cares primarily for cardiac patients in need of cardiac catheterizations, post STEMI/angioplasty, NSTEMI, post pacemaker insertion, CHF patient's, Atrial Fibrillation or other cardiac arrhythmia's and hyper/hypotensive patients, not meeting ICU admission criteria. 2.0 Aim Our hospitals, extended care facilities and clinics in Washington are nationally recognized for medical excellence. 24 In 2008, the AACN Certification Corporation completed a second study examining progressive care nursing practice. Specializes in NICU, PICU, Transport, L&D, Hospice. Job Summary: The Registered Nurse is a professional practitioner who assesses, manages, directs, and provides nursing care care activities during the patient's hospital stay and coordinates planning with other disciplines utilizing a patient/customer driven approach. They discussed that the goal of progressive care is to keep patients out of the ICU. Do you want to be a part of a family and not just another employee? The RN is responsible for administering and monitoring drips independently. Different hospital systems refer to these units by many different names: This results in confusion among patients, visitors, and even staff. Your job seeking activity is only visible to you. For example, an ICU may have more nurses on staff at all times to implement a 1-to-1 ratio of nurses to patients as patients are critically . Upon closer examination, however, the units are much more similar than they may initially appear. The policy question addressed by the chapter is whether there should be special regulations for special care units.On the one hand, the rapid Learn more atFacebook, Instagram, LinkedIn and Twitter. endstream endobj 56 0 obj <> endobj 57 0 obj <> endobj 58 0 obj <>stream hT[o0+~o*RHKWithJ/x)$(q%wCL=L~>P0$'#\H|CcB}uEtsF/QDo6b6L/Sct~=e-]LtkVD1[Bs]eF8Mw.EP,3&z1FM H0O&~1RIFRD@6N(Ms:{9Gjc .;"ui5$S`*kx? I thought the CDU was for more stable patients. Whether the types of patients served by the PCU are very alike or very different, the characteristics of the patients cared for in PCUs are generally very similar. These patients still need a high level of skilled nursing care and surveillance . Great fun when you have multiple drips going! As a PCU nurse, you'll treat patients with a variety of chronic health conditions or those recovering from surgeries. MO-SSM Health Saint Louis University Hospital 1201 Grand. In one hospital, the progressive care area may be called the PCU, but in another hospital, it may be called a variety of different names, for example, intermediate care unit. Blend critical care skills and patient interaction. they were careless people, tom and daisy; democrat obituaries for today; medical alert dog training; mychael knight cause of death; rever de quelqu'un qu'on a jamais vu islam; como calcular la longitud de una bobina; cavalier king charles rescue south wales; Create well-written care plans that meets your patient's health goals. 19 Surveillance is a complex concept that incorporates both behavioral and cognitive components. Critical care services can be life-saving, but many patients admitted to intensive care units (ICUs) are too sick or, conversely, not sick enough to benefit. The progressive care unit (PCU) is considered a critical care unit, but it's also a step down unit. Most Common Skill. RESULTS: We reviewed 115 admissions to the Progressive Care Unit. Has 8 years experience. Examples of such patients include patients who require frequent neurological assessments, patients experiencing cardiac dysrhythmias, and patients receiving continuous intravenous infusions of medications such as nitroglycerine or insulin. On a related noted, Dr. Bay indicated that a Progressive Care Unit is a good place for new grads, I believe nurses need these skills. One such method of identifying characteristics of appropriate patients for each unit is through the AACN's Synergy Model for Patient Care. Increased Level of Surveillance, Admission and Discharge Criteria, Synergy model, Comparison of core competencies for progressive care nursing between 2004 and 2009. 19 In this case, patients are admitted to the PCU because the nurses possess additional competencies (knowledge and skills) not available in the medical-surgical unit. Terms and Conditions Since 1997, allnurses is trusted by nurses around the globe. About Lowell General Hospital: Lowell General Hospital is an independent, not-for-profit community hospital serving the Greater Lowell area and surrounding communities. PCU and step-down are the same type of floor. Peace Health-St. Joseph Hospital Bellingham, Washington, USA. In other words, synergy occurs when the needs of the patient are matched with the competencies of the nurse. 7 When compared with patients in the ICU, PCU patients can generally be described as having greater stability, a lower risk of a life-threatening event, less need for invasive monitoring, and a greater ability to participate in their care. Fax: (239) 343-3695. Ancient Letter Crossword, Three common soft skills for a coronary care unit nurse are critical-thinking skills, communication skills and compassion. Nurses in progressive care units draw on their critical care and critical thinking skills, but also enjoy being able to talk with their patients. I work on a 20 bed Step Down/Telemetry Unit. Has 31 years experience. Our members represent more than 60 professional nursing specialties. Abby, Kiara and Micah discuss working in the Progressive Care Unit at MultiCare Good Samaritan Hospital. Essential Functions. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. Data Element Name: ICU Admission or Transfer. %PDF-1.6 % 8 Many hospitals have espoused this level of care to bridge the gap between the intensive care unit (ICU) and the medical-surgical unit. for. RNs on this unit treat progressive care or intensive care burn patients. The purpose of this article was to describe and quantify these different formations and utilisation. The document can be viewed in the guidelines section of the SCCM website. Patients with progressive pneumonia or sepsis syndrome should be evaluated for admission to the ICU earlier rather than Validated DS M -5 diagnosis remains the principal diagnosis and the severity of the behavioral/emotional disturbance continues to meet the criteria for this level of care. ;ru:'hC4f*eGPNc0x ZL|4Gd\[?xWRL)9|0>)Q*;1Y8$>&2e%bz4WG1mbh4k@mln)`]-I!Z%|v 'j2,(?^yj^X}5] B'! z Patients will be admitted to the Progressive Care Unit upon request of an attending 1.0 Introduction . The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the extended prevalence of infection in intensive care study. Specializes in IMCU, Oncology. In other words, it is an intermediary level of hospital care. What drips do you take? POLICY: STATEMENT: The following criteria will be used by the medical and nursing staff in making decisions regarding the admission and/or . Wesley Healthcare owns and operates Wesley Medical Center, Wesley Woodlawn Hospital & ER, Wesley Childrens Hospital, Wesley West ER, Wesley Derby ER and multiple WesleyCare clinics. I now tell doctors that when they say they are sending someone to us for "closer monitoring" I tell them that our ratios are no different than the floor they are currently on. progressive care unit admission criteria July 1, 2022 progressive care unit admission criteria . 21 For example, if the unit manages patients who require long-term mechanical ventilation, then competencies regarding ventilators and weaning should be delineated and all staff should receive education and training to manage such patients. They also talked about nurse/patient ratios and Dr. Bay said, this should always be what the patient needs. 164 Articles 7 The initial competencies regarding continuous medication administration addressed nontitrated vasoactive agents, 24 whereas the revised competencies address titration of vasoactive medications. In addition, the revised competencies address management of chest tubes, insulin infusions, procedural sedation, stroke patients, behavioral emergencies, and complex wounds. Registered Nurse and Educator BScN (UHS Lahore) specialized in CCU(CON-NHMC) and Biostatistics Environmental Design (PIMS). Neurology Nurse Responsibilities, MO-SSM Health Saint Louis University Hospital 1201 Grand. Progressive hypotension and acidosis despite fluid resuscitation and antibiotics; trial of BiPAP Frequent nursing needs, mental status change, -qY";Zf08mp>vh>`1>}'9D$fCTU[["e\mFB6x/"fO37b|?|j ABhcW+qXRM )g9{{_eS|9 [ _tL+8s()]0BxjeKMBZ!Kt>#99lw^[X$KVJ"ERIa/@) w A~ou/BIh1lcz-_/;N1~x3S)Z1I\^@7qmFhR1Bs~K1lKJL-'rP!n9rLJ*%4*Z*~] 8oub\fZVk 4}MW*pM4#[-GiqRbPKnhLTy&OKs9;LN+iSU+YqGL7Hy[ Valid BLS and ACLS required, PCCN or CVRN certifications preferred, Clinical Advancement Program which provides advancement opportunities and financial rewards, Shared governance: Nurses are encouraged to participate in our unit based councils or one of the many other council opportunities. . Found inside Page 449Criteria. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 55 0 obj <> endobj workplace factors that affect the ability of nurses to provide patient care efficiently and safely. Great co-workers and management. To unlock your profile and take advantage of all features on CareerBuilder.com, you need first to upload or build a resume, ***$10,000 Sign on bonus for RNs with 2+ years of experience!***. 10 Generally, PCU patients do not require the more sophisticated technologies found in an ICU. This is an offshift position: 32 . We are not an agent or representative of any employer. Each characteristic is rated on a continuum of 1 (minimal) to 5 (high). Progressive Care nursing is nursing of patients that don't meet ICU criteria but need a higher level of care than a medical-surgical unit. Gourmet Choice Gift Basket. Key words: progressive patient care, intermediate care, intensity of care, patient-centered hospital e12915-1 ORIGINAL ARTICLES Epidemiology Biostatistics and Public Health - 2018, Volume 15, Number 4 Assessment is the key and this is a nice bridge to an ICU.. determine if an outpatient should be transitioned to an inpatient stay due to care needed. These units are often used to bridge the gap between intensive care units and medical-surgical units . Usually these are patients who have been transferred from the ICU as their condition has stabilized and they no longer require the ICU level of technology. The PCU is a less intensive care environment for those patients who do not meet the criteria for admission to the Intensive Care Unit, where patients may require a breathing machine and frequent . 12 When compared with patients in the medical-surgical unit, patients in the PCU are generally considered to have an increased risk of their condition becoming unstable or of experiencing a life-threatening event. Has 31 years experience. Inappropriate nurse staffing is a persistent and major barrier to delivering optimal patient care and one of the most dangerous threats to patient safety. 15 These patients have complex needs for nursing care and require care on a long-term basis. Key words: Healthcare, critical care, patient ow, queueing, uid an alysis, diffusion analysis, state-space collapse 1. If you find this opportunity compelling, we encourage you to apply. SCRANTON, Pa. - A new Progressive Care Unit (PCU) featuring private rooms and a modern, evidence-based design is now open at Geisinger Community Medical Center and specializes in caring for the complex needs of trauma, medical and surgical patients. Progressive neuromuscular . Patients with the following conditions are candidates for admission to the General Intensive Care Unit: . Learn more. Consumer Experience Specialist I - AdventHealth Centralized Scheduling - Tampa, FL. This job was posted on Wed Nov 24 2021 and expired on Sun Dec 12 2021. This tool details the policy used to ensure the appropriate utilization and resources of the intensive care unit and staff, including specific admission, transfer, and discharge criteria. HWn#7}W*`e$lbM! The most common early symptom is difficulty in remembering recent events. Progressive Care Unit This is a 40bed unit located on the 8th floor of the Dally Tower. Enter the email address you signed up with and we'll email you a reset link. endstream endobj 954 0 obj <>stream Progressive care units PCU. And are PCU patients really in CDU areas? Gotsman and Schrire introduced the concept of SDUs in 1968. Discharge criteria are also provided. To establish standards for admission and discharge that meet the requirements of Medicare and render appropriate care to the individual and completion of appropriate assessments and care plans. Guidelines for developing admission and discharge criteria were also proposed (12). I have great interest in nursing research. On the surface, PCUs may appear to vary widely. Demonstrates consistent adherence to HIPAA guidelines. The nurse to patient ration . Abstract The goal to consistently mobilize the mechanically ventilated patient to decrease the risk or progression of delirium is the primary focus of my project. And sheath pulls. Report this job. AACN Scope and Standards for Progressive and Critical Care Nursing Practice. 26 In 2008, for the first time, a PCU was recognized through the Beacon award for the high-quality patient care it provided. Methods. Geisinger is committed to making better health easier for the more than 1 million people it serves. 8 Another difference is the name of the unit. Intensive care unit professionals have experience in critical care and its proportionality, collegial decision-making, withholding or withdrawal of treatment deemed futile, and communication with patients' relatives. 0 criteria in Sec . Assess and document sepsis screening q 4 hours with assessment We use cookies on this site to help us bring you a suitably polished experience. Age, care coordination, transitional care, and discharge planning are all captured through the clinical documentation of the bedside nurse and translated from the EHR to CCODA system. Progressive pleural/peritoneal or pericardial effusions; Failure . Updated: Oct 3, 2020 5 The guidelines provide a list of examples of patients by body system (eg, cardiac, pulmonary) that would and would not be appropriate for admission to the PCU. The PCU is a place where specialty-educated and trained nurses combine the knowledge and skills of assessment, surveillance, and provision of complex nursing care to provide high-quality patient care. The recommendations of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) on the personnel, capacity, equipment and structure of these units are intended to provide the framework for the setting up and operation of intermediate care units in collaboration with experts on both an evidence-based and an . The term "progressive care unit" (also called step-down unit, intermediate care unit, transitional care unit, or telemetry unit) may be used in varying ways in different facilities. Are you looking for a work environment where diversity and inclusion thrive? endstream endobj 951 0 obj <>/Metadata 87 0 R/Outlines 126 0 R/Pages 948 0 R/StructTreeRoot 137 0 R/Type/Catalog>> endobj 952 0 obj <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 953 0 obj <>stream I agree 100% that if you aren't ready for ICU but don't want a typical M/S floor then a PCU/Step-down is a great place to start. Thomas Jefferson University Hospitals Surveillance is a critical element of patient safety. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. 3. ]^{pf\g%%j ~&gPiFd issues R/T criteria, patient flow, assessment, reassessment 3) Establish a measure for data collection R/T admission & D/C in PCU Do: 0 Burn ICU/Progressive Floor The Burn Center has an 18 -bed adult unit with six ICU beds and 12 progressive care beds. "We had expected the changeover to be more gradual, but it happened within a week," Pratt said. Many hospitals contain both a CCU for critically ill patients and units called either an "intermediate care unit", "progressive care unit", "telemetry floor" or "step down unit" for patients who are not as crtically ill. y],Kq\8^;$H35x3CBW>$IBbxVv9Z8e%zgLh5lW~ "{KKD$ZK"YltU+XFi This type of nursing can be found in step down units, telemetry floors, and even the emergency department. By Suhail Rafidi. AdventHealth Tampa. About Geisinger The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. Lensa, Inc. - Lensa is a job search engine. Although progressive care units today may seem to provide care for a wide variety of patients . Therefore, an intermediate care level . Found inside Page 16criterion which , effective October 1 , 1979 , was 115 percent of average group costs . We want you to apply now! Majority of PCU patients have a medical diagnosis and include COPD exacerbation, DKA, CHF, alcohol/opioid withdrawal, drug overdose . The ratio can be 1:4 on a PCU even in California. I have also done MA In Philosophy (PU Lahore) and recently joined E-Commerce training. Submit your application today and find out what it truly means to be a part of a team. A process for implementation, monitoring and performance review of Found inside Page 954MINIMUM ESSENTIALS , CAPABILITIES AND LIMITATIONS OF CARDIOVASCULAR CARE UNITS IN SMALLER HOSPITALS " Should my hospital have a with acute , intermediate and convalescent progressive care , feasible in practically any hospital . . 13 Chronic critical illness is a syndrome that has been observed in patients with respiratory failure that requires prolonged mechanical ventilation. Nurses working in progressive care units all must have certain basic competencies. Assess body system affected by infection if known source. Moreover, the criteria for admission to the NICU have not been well defined, and some surgeons believe that routine ANCCs Magnet designation is the highest and most prestigious credential a healthcare organization can achieve for nursing excellence and quality patient care. His Eyes Water When He Looks At Me, Listed on 2023-03-03. UHS Past Solved Papers Biochemistry for BScN Generic & Post-RN, Health Assessment Bates MCQs With Answer and Book Reference. 1:3 ratio is a nice ideal but is it reality? Outside of Maryland (toll free) 410-464-6713 Request an Appointment Medical Concierge Services, International Patients +1-410-502-7683 Request an Appointment Medical Concierge Services. Typically progressive care patients have cardiac diagnoses ranging from post-stent placement, post-cardiac cath, heart attack, congestive . Examples of these types of patients include patients who require electrocardiographic monitoring, continuous pulse oximetry, or continuous blood pressure monitoring via an arterial catheter. The most common admission source was the ER (97%). The initial competencies addressed weaning and long-term mechanical ventilation, 24 but this competency is no longer part of the revised 2009 competencies. On average, for ICU patients with lower illness severity, we found that availability of step-down unit care was associated with an absolute decrease in the likelihood of hospital readmission within 30 days of 3.9% (95% CI, 3.6-4.1%). Criteria for ICU admission and discharge should be explicitly described. 1-612-816-8773. Clear and comprehensive admission criteria help ensure that the right patient is placed in the right bed and is cared for by the right nurse. It is the highest level of recognition an organization can receive for providing the very best quality in patient care. Although some PCUs are designed to be specialized and focus on caring for a specific population of patients (eg, cardiac patients, respiratory patients, or stroke patients), other PCUs are designed to be eclectic and focus on caring for a wide assortment of patients. This report provides admission and discharge guidelines for intermediate pediatric care. The nurse to patient ration is 1: 3-4. Guidelines for developing admission and discharge policies for the pediatric intensive care unit. 974 0 obj <>/Filter/FlateDecode/ID[]/Index[950 40]/Info 949 0 R/Length 118/Prev 337970/Root 951 0 R/Size 990/Type/XRef/W[1 3 1]>>stream We have the latest state-of-the-art technology and a full range of medical and surgical services for patients, from newborns to seniors. Progressive Care Nursing - Interview with Linda Bay. Progressive care units are increasingly common in hospitals in the United States. I saw some very sick people with some unique conditions. 23 Analysis of the data led to the identification of the knowledge and skills necessary for registered nurses to practice in progressive care settings. COVID-19: We are vaccinating patients ages 12+. Medical-surgical nursing vs progressive care nursing (ICU Step-down): What are the differences between these two areas?Many students will be graduating this . Admission to the BBU is determined after an outpatient evaluation in the BBU tub room. 9. 989 0 obj <>stream Alternative names for progressive care units, Comparison of core competencies for progressive care nursing between 2004 and 2009. Every nurse should be provided with specialty education and training to achieve a set of core competencies that is unique to the PCU. ]GKam5t>b4OJjcjW`{, :C&x$+ vDba{Kso#y y4jJ~:{z@MRlxIFjw,s)Pkj[[^S uhj#5[qG_u9,EE7#E~&8u12QjEnZnPaLKZzIS$-oQ.9`fgb/8LH@:jVF;!RK*}}:]h7PP ?fb:P`d):O medical / surgical inpatient units & intensive care nursing units novemer 2 211. medical / surgical inpatient units & intensive care nursing units. To limit costs, these patients are often transferred to long-term acute care facilities. They have decided to off-set this increase in patient loads by increasing the number of CNAs on the floor. @NWk1*iTSns!v95y>7NTj3qplT9`Q0(`h`` S@1:%s;b5BYYXkXbvN|k:=/sb The other patients commonly seen in the PCU are patients who require a high level of surveillance. Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, Our DEI Council, Steering Committees and Employee Resource Groups, Geisinger Health Foundation impact report. . 11 Thus patients may be candidates for the PCU if the intensity of nursing care required exceeds the ability of the medical-surgical units. If the unit manages patients or equipment not covered by the core competencies, additional competencies should be developed and incorporated into the unit's education plan. Introduction Step Down Units (SDUs) provide an intermediate level of care between the Intensive Care Units (ICUs) and the general medical-surgical wards. $iwH-U/+(N&"JCrfo^wnfu{fpc2kTPR%"z~ff67o/`/tTBYQUv %&,7UUBnR oIeYf0IxNZz5QJH)9w)$?wPXt3Ius"`d90(w0;mw Medical Specialist, Healthcare Nursing, Critical Care. Cardiovascular Progressive Care Unit (Zayed 10 W) Comprehensive Transplant Unit (Zayed 9 W) MPCU - Medical Step-down (Nelson 5) PCCU - Progressive Cardiac Care Unit Step-down (Bloomberg 5 S) Urology, Thoracic (Zayed 11 W) Intramural Administrative Management Bran Learn more. Johns Hopkins Hospital is not only one of Americas Best Hospital, but it is also a great place to work!Learn more about our new facilities. If evaluation criteria not met: admission to progressive care unit or critical care unit Instituting a requirement for a telemetry order rather than assuming telemetry as a standard of care on the progressive care units will further reduce telemetry use. PCU provides specialized care and monitoring based on the admission criteria and patient care ratios. Anaesthesist 17 : 237 , Jul 68 ( Ger ) G. Minerva Anest 33 : 597-8 , Aug 67 ( Ita ) Ohio Med J 64 : 1368-9 , Dec 68 ( Organization of an intensive care unit Im trying to get some feedback on what other progressive care/tele floors use as far as cardiac drip policies. It does have multiple PCU's and the PCU is staffed with the mandated telemetry ratio of 1:4 unless you have a vented patient, then you will have a 1:3 assignment. #jF/a-2Z1\f ]rfI@.\fd`U[ To use our website, you must agree with the Nursing. All rights reserved. Tuition Reimbursement/Assistance Programs, 401k (100% annual match 3%-9% of pay based on years of service). Choosing a specialty can be a daunting task and we made it easier. I interviewed at a couple of other hospitals near me which do 4:1 and they even took on sicker patients than we do at my current hospital. Objective: To present guidelines for writing admission and discharge policies for adult intermediate care units. Progressive care refers to care provided to hospital patients who need more monitoring and assessment than patients on the surgical/medical floor but whose conditions aren't so unstable that they need to be in the ICU. Found inside Page 954MINIMUM ESSENTIALS , CAPABILITIES AND LIMITATIONS OF CARDIOVASCULAR CARE UNITS IN SMALLER HOSPITALS Should my hospital have a with acute , intermediate and contalescent progressive care , feasible in practically any hospital . Admission Criteria for Acute, Progressive and Intensive Care Units System Acute Care / General Care Telemetry Transitional Intensive Care Vital Signs Stability within acceptable range of tolerance for the patients and/or generally evidenced by: Systolic BP equal to or greater than 80 and equal to or less than 200 mmHg Has 15 years experience. Results A total of 8816 admissions were included in the study. 6b8=0 . Only 2% of hospitals have attained a 3rd Magnet designation. These patients generally fall into 2 categories; patients who require an increased intensity of nursing care and/or patients who require an increased level of surveillance. 7 The initial competencies addressed hemodynamic monitoring, 24 whereas the revised version now specifies arterial pressure monitoring and non-invasive hemodynamic pressure monitoring. Collected For: CAH-04, PICU-03, PN-3a, Definition: Documentation that the patient was admitted or transferred to the intensive care unit (ICU) at this hospital. Exciting opportunity in , for Veterans Affairs, Veterans Health Administration as a Registered Nurse (RN) - Progressive Care Unit (ICU Step Down) existing special care units, the lack of standards to assist families, nursing home surveyors, and others in evaluating the units, and widespread allegations that some special care units provide nothing special for their residents, six States have developed regula-tions for special care units, and other States are in the process of doing so.

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