The Nurse’s Role in an Intermediate Care Facility (ICF)

• An Intermediate Care Facility (ICF) serves individuals with intellectual and developmental disabilities (IDD) in need of a long-term placement that provides nursing-related care. 
• Intermediate nursing services in an ICF setting include the observation, assessment, and treatment of an individual with either short-term or long-term illness or disability whose medical condition is stable, and the focus is on maintenance rather than rehabilitation.   
• Many do not fully the understand all the care that an ICF nurse provides, but the responsibilities and roles of the intermediate care facility nurse are extremely important, and they serve as the first line in determining the type of care, treatment, and placement for these specific and unique patients. 

What is an Intermediate Care Facility?

An Intermediate Care Facility (ICF) serves individuals with intellectual and developmental disabilities (IDD) in need of a long-term placement that provide nursing-related care.  

The care for each individual is under the direction of a physician and the staff working with these individuals typically provides basic care related to activities of daily living, administering medications, and working on individual goals to return to an independent environment, or for those that are unable to care for themselves due to a mental disability or a decline in health. 

Often, ICF settings become confused with skilled nursing facilities but are actually regarded as lower-level nursing facilities.   

The nurses that work in ICF settings have an important role to pursue as they typically work directly with the patients or oversee that nursing/medical care is being performed in a competent manner among unlicensed personnel.   

In considering the importance of the nurse in ICF settings, it is imperative to be mindful of the following: 

• What type of nursing care is provided in an intermediate care facility (ICF)?   
• How can nurses provide optimum holistic care to those in intermediate care facilities (ICF)? 
• What are the nursing responsibilities of the intermediate care facility (ICF) nurse?   

Nursing Care in an Intermediate Care Facility

Intermediate nursing services in an ICF setting include the observation, assessment, and treatment of an individual with either short-term or long-term illness or disability whose medical condition is fairly stable and the main focus is on maintenance rather than rehabilitation.   

The nurses in ICF settings may also be caring for patients who are not near full recovery yet, but still need medical and nursing supervision in order to reach full recovery.   

Medication management and administration are also an important aspect of care for patients in ICF and the nurse must ensure that accurate medications are being given and documented based on the facility’s guidelines.   

Often, unlicensed personnel are utilized in ICF settings and it is the nurse’s responsibility to work with them to ensure that the medication steps are being implemented and followed.

Optimal Holistic Care

As necessary and important as it is for nurses caring for those in intermediate care facilities to provide the best possible medical care, it is of equal importance to ensure that a holistic approach is used with the individual.   

Holistic encompasses the entire well-being of the individual and involves physical, social, environment, economic, spiritual, and psychological areas.   

Involving all of these areas when providing care is of utmost importance as it encompasses the entire wellbeing of the individual.   

Below are some benefits and weaknesses involving holistic care: 

Benefits: 

• Improved habits and lifestyle changes 
• Increased ability to withstand the onset of disease more easily 
• Improved natural healing abilities of the body 
• Prevention of various disorders and diseases 
• Reduced stress and anxiety levels 

Weaknesses: 

• Holistic disagreements may not identify any single cause for human behavior 
• Too many variables can be present which can make it difficult to analyze or understand which ones are accurate 
• Lacking in-depth information as there are so many varying variables involved 

More often in intermediate care facilities, the individuals have varying factors related to their health, behaviors, actions, and psychological wellbeing that often intertwine and affect each other.   

Intermediate care facility nurses must understand that these various factors are a normal part of caring for individuals in these specific facilities and must serve as a strong advocate for the patient in not only one area, but in many areas.

Nursing Responsibilities in an Intermediate Care Facility

The ICF nurse has such an important and integral role in the care of clients in ICF facilities.  Although some of the same responsibilities of a Registered Nurse are present as with any other facility, there are some differences.  It is also important for the ICF nurse to have a full understanding of intellectual and developmental disabilities along with medical disorders and to treat the client in a holistic manner as discussed earlier.   

The nurse must engage with other team members and caregivers to ascertain that all important medical and developmental areas of the patient’s care are included.   

The nurse must supervise other nursing staff such as licensed practical nurses (LPN) and oversee unlicensed personnel to assure that performance standards are being met and to ensure that regulatory standards are also being maintained.   

Typically, the nurse supervises a group home setting that consists of four to fifteen bed facilities that provide 24/7 services including both medical and physical areas of patient care.  Many times, the nurse oversees the progression or regression of these patients in order to ensure that ICF placement is still appropriate.   

If ICF placement is not appropriate, the nurse will need to determine if the patient has improved significantly and no longer needs ICF placement or if regression has occurred and may need another type of placement.  The nurse must possess keen observational and assessment skills in order to notice changes and to be proactive with the appropriate types of care.   

The Bottom Line

In considering the type of placement for an individual that may/may not be eligible for ICF facilities, the nurse serves as an integral component of this process and serves as the patient advocate throughout the entire process.

Many do not fully the understand all the care that an ICF nurse provides, but the responsibilities and roles of the intermediate care facility nurse are extremely important, and they serve as the first line in determining the type of care, treatment, and placement for these specific and unique patients.  An intermediate care facility nurse must possess a passion for this type of nursing as it is considered a unique and sometimes challenging specialty in nursing.   

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