birthday parties, celebrating holidays, book clubs, musical events, outdoor activities, discussion and social groups, exercise, arts and crafts, pet therapy, religious services and community outings. volunteer involvement is also an important part of nursing home activities given that volunteers can act as a link between the nursing home and the outside community. therapy occupational therapy one of the many services offered in a nursing home is occupational therapy. occupational therapy may be necessary following an injury or illness in order to regain skills and to receive support during any physical or cognitive changes. occupational therapy will focus on activities of daily living such as bathing, dressing, grooming. occupational therapy also assists with instrumental activities of daily living which include home and financial management, rest and sleep, education, work, play, leisure, and social participation. occupational therapists work to allow the person to safely and comfortably reintegrate into society by practicing public dining, transferring to different surfaces (chairs, beds, couches etc.), and will assess the need for any home modifications or safety equipment to ensure a proper and safe transition. when a cognitive and/or perceptual deficit is presented, therapists will work with the person by teaching strategies to maximize memory, sequencing and attention span length. physical therapy another important service found in a nursing home is physical therapy. physical therapy may be necessary following an injury, illness or surgery. physical therapy works with the person to help them regain strength, endurance, flexibility, balance and range of motion. physical therapy is also used as a way of preventing injuries and accidents by focusing on restoring mobility, increasing fitness levels, reducing pain and overall reaching a certain point of independence. there are many conditions that can benefit from receiving physical therapy in a nursing home, these conditions include arthritis, pain associated with cancer, dementia, alzheimer's, stroke and incontinence. speech language therapy speech-language pathology is another service found in a nursing home. speech language pathologists specialize in working with those who have a difficult time with language and/or speech, usually following an injury or an underlying diagnoses. the slp will evaluate the persons speech. if the person is having trouble with speech, this points to an issue with coordinating the movements and muscles used to produce speech. trouble with language points to the person having difficulty with understanding what they are hearing and seeing. the slp will also look at difficulty with swallowing food and will evaluate the person in order to figure out which part of the swallowing process is not working. some of the many speech disorders worked with by the slp are: phonology meaning the speech patterns used, apraxia meaning difficulty with coordinating the movements needed to make sounds, receptive language meaning difficulty understanding language, fluency meaning stuttering, expressive language meaning difficulty using language, and many other disorders. elder abuse elder abuse is more prevalent in hospitalized settings including nursing homes than in the general community. there are three major types of abuses reported in nursing homes: physical, emotional, and sexual abuse. physical abuse is the intention or action to hurt an elderly person resulting in scars and bruising. emotional abuse occurs when an employee makes verbal threats and continuously degrades the patient, resulting in the patient experiencing mood swings, anxiety, and depression. sexual abuse is when an elderly patient is being forced into unwanted sexual activity by an employee, resident or visitor, usually attempted and reported when the patient is sleeping, sick, or weak. nursing home neglect is similar to elder abuse. it is when employees begin to repeatedly ignore and leave a patient alone, neglect the patient's personal hygiene like bathing and brushing of teeth, provide the patient with an inadequate amount of food and water, or neglect to provide the patient with the correct amount of medication they require. one factor unique to elder abuse in nursing homes is that many nursing home contracts require residents to sign delegation clauses, giving up their right to trial by jury and instead using an arbitrator to settle disputes. by country canada main article: nursing home care in canada long-term care facilities exist under three major types: privately owned, non-profit/charitable, and municipal. regardless of their ownership, aspects of funding, admission criteria, and cost to the individuals are all regulated by their respective provincial governments. as medical care is publicly funded in canada, all long-term care facilities receive funding from provincial governments for the health care component of the residence – the nurses and personal support workers. residents pay daily rates for 'room and board' (accommodation and food) that are determined by the type of room chosen, either shared or private. provincial governments manage waiting lists for long-term care facilities. people who cannot afford to pay the monthly fees receive subsidies, and no one is refused due to inability to pay. united kingdom main article: nursing home care in the united kingdom in the united kingdom, care homes and care homes with nursing are regulated by different organisations in england, scotland, wales and northern ireland. to enter a care home, a candidate patient needs an assessment of needs and of their financial condition from their local council. the candidate may also have an assessment by a nurse, should the patient require nursing care. the cost of a care home is means tested in england. care homes for adults in the uk are regulated by care quality commission, which replaced the commission for social care inspection, and each care home is inspected at least every three years. in wales the care standards inspectorate for wales has responsibility for oversight, in scotland social care and social work improvement scotland otherwise known as the care inspectorate, and in northern ireland the regulation and quality improvement authority in northern ireland. in 2002, nursing homes became known as care homes with nursing, and residential homes became known as care homes. as of april 2009, the lower capital limit is £13,500. at this level, all income from pensions, savings, benefits and other sources, except a "personal expenses allowance" (currently £21.90), goes towards paying the care home fees. the local council pays the remaining contribution provided the room occupied is not more expensive than the local council's normal rate. the nhs has full responsibility for funding the whole placement if the resident is in a care home with nursing that meets the criteria for nhs continuing health care. this is identified by a multidisciplinary assessment process. in may 2010, a coalition government announced the formation of an independent commission on the funding of long-term care, which was due to report within a 12-month time frame on the financing of care for an ageing population. it delivered its recommendations on monday 4 july 2011. the care quality commission have themselves implemented a re-registration process, completed in october 2010, which will result in a new form of regulation being outlined in april 2011. in 2020 it emerged that some uk care home residents had blanket do not attempt resuscitation (dnacpr) orders applied during the covid-19 pandemic. these decisions were made without discussion with the patients involved, and the practice is being investigated by the care quality commission. united states main article: nursing home care in the united states in the united states, there are three main types of nursing facilities (nfs). an intermediate care facility (icf) is a health care facility for individuals who are disabled, elderly, or non-acutely ill, usually providing less intensive care than that offered at a hospital or skilled nursing facility. typically an icf is privately paid by the individual or by the individual's family. an individual's private health insurance and/or a third party service like a hospice company may cover the cost. board and care homes are special facilities designed to provide those who require assisted living services both living quarters and proper care. often referred to as residential care homes, these facilities can either be located in a small residential home or a large modern facility. in fact, a large majority of board and care homes are designed to accommodate fewer than 6 people. board and care homes are typically staffed by licensed professionals, including nurses, doctors and other medical professionals. these facilities are highly regulated in order to ensure that the best possible care is being provided for the residents. board and care homes offer residents 24-hour assistance, making them a highly popular choice for those in need of regular assistance. assisted living residences or assisted living facilities (alfs) are housing facilities for people with disabilities. these facilities provide supervision or assistance with activities of daily living (adls); alfs are an eldercare alternative on the continuum of care for people, for whom independent living is not appropriate but who do not need the 24-hour medical care provided by a nursing home and are too young to live in a retirement home. assisted living is a philosophy of care and services promoting independence and dignity. a skilled nursing facility (snf) is a nursing home certified to participate in, and be reimbursed by medicare. medicare is the federal program primarily for the aged (65+) who contributed to social security and medicare while they were employed. medicaid is the federal program implemented with each state to provide health care and related services to those who are below the poverty line. each state defines poverty and therefore medicaid eligibility. those eligible for medicaid may be low-income parents, children (including those in state children's health insurance programs (schips) and maternal-child wellness and food programs), seniors, and people with disabilities. the centers for medicare and medicaid services is the component of the u.s. department of health and human services (dhhs) that oversees medicare and medicaid. a large portion of medicare and medicaid dollars is used each year to cover nursing home care and services for the elderly and disabled. state governments oversee the licensing of nursing homes. in addition, states have a contract with cms to monitor those nursing homes that want to be eligible to provide care to medicare and medicaid beneficiaries. congress established minimum requirements for nursing homes that want to provide services under medicare and medicaid. these requirements are broadly outlined in the social security act, which also entrusts the secretary of health and human services with the responsibility of monitoring and enforcing these requirements. cms is also charged with the responsibility of working out the details of the law and how it will be implemented, which it does by writing regulations and manuals.