Transcript Gerontology: Chapter 8 - University of Nebraska Medical Center

Gerontology: Chapter 8
The Continuum of Care
Independent Living:
 Older people may feel that by giving up
their home, they are giving up their freedom
& independence.
 They may feel emotionally attached to a
home that holds years of cherished
memories.
 They may like the neighborhood & not want
to leave friends.
 They may want to maintain a large house
for when family & friends visit.
 Many people, of all ages, either do not like
or are even fearful of change.
As health care professionals:
 We must respect competent older peoples’ wish
to remain in their own homes, even if we do not
believe that this is the best possible plan for
them.
 Garrett describes Violet. He concludes that
while safety is crucial, the home environment
should be of the person’s choosing if at all
possible. Home improvements to in-crease
safety may be a preferred alternative.
Lack of adequate income:
 American Housing
Survey reported (95):
a third of the nations’
elderly reported not
having enough money
left over after housing
expense for essentials
like food, clothing and
health care.
Reverse Mortgage Program:
 Borrowers use their home as collateral, &
the bank sets up either and annuity or a line
of credit to be used as needed until the
home is sold. This allows those with
inadequate monthly income, but substantial
home equity, to continue to reside in their
own homes. When the older person decides
to or needs to sell or he or she dies, the bank
then recovers the investment.
A Home!
 Apart from the spouse or life
partner, a home may be the
single most important factor in
the life of an elderly person.
 It is crucial that the home
environment foster a sense of
security & comfort. This is
especially important for the
remaining spouse after the death
of a long-time partner. This is
exactly when it may be difficult
for the one left (usually a
widow).
Elder decides to move with family:
 Nearly 1 in 5 elderly who are not living in a
group home reside in multigenerational
households. This arrangement may have a
cultural bias; studies have found that older
people of southern, central & eastern
Europe descent are more likely to reside
with family.
 In the US, research shows that most elderly
people prefer not to live with their children.
Single Room Occupancy (SRO)
 Usually widowed or unmarried. They are
inexpensive & may be located in familiar
neighborhoods. Rarely have a private
bathroom or kitchen. Considered by some to
be substandard housing.
Continuing Care Retirement
Communities: (CCRCs)
 The person pays an entrance fee and a
monthly fee, and in return gets a home, &
certain services. Homes are arranged in a
small community--may be free-standing
houses, condominiums, or apartments & can
include residential treatment facilities to
provide ongoing long-term care. Services
may range from none to comprehensive
health care services as needed.
Continuing Care Retirement
Communities: (CCRCs)
 Type A: Extensive
 Type B: Modified
contract
 Type C: Fee-forservice
Disadvantages of CCRC’s
 Cost is still out of reach for many elderly
 Financial risk – like an insurance policy
 Lack of uniform standards on regulations
 Do not accept all applicants
– 60% (incontinent)
– 90% (unable to perform one or more daily living tasks)
 May be tight-knit, made up of senior citizens
Congregate Housing:
 Includes independent living units, adult
congregate living facilities, rental retirement
housing, & senior retirement centers.
 Sometimes subsidized by state & federal
government programs.Generally do not offer
personal assistance or health services, although
resident may be eligible for home care services
through an outside agency. Often offer group
dining & socializing centers.
Assisted Living Centers:
Residential care:
 Bridging the gap between independent
living and 24-hour-a-day nursing care.
 Defined: a special combination of housing
& personalized health care (services)
designed to respond to the individual needs
of those who need help with activities of
daily living (ADLs). Care is provided in
such a way that promotes maximum
independence & dignity for each resident.
Board and Care Facilities:
 Tend to be located in
older, larger, single
family homes.
 Provide meals,
transportation, other
services, and
“protective oversight”
as needed.
Problems with assisted living
centers:
 Lack of adequate licensing, inspection,&
enforcement of these facilities may put
residents in danger of abuse or neglect.
Governmental agencies blame this
deficiency on limited financial resources.
 Lack of public funding, again causing this
vital resource to be financially out of reach
for many elderly people who need exactly
this type of arrangement.
More problems…..
 There is no training or education required
for residential care operators. Therefore
some caregivers may be ill equipped to care
for older people who have physical
problems, mental illness or dementia.
 The cost per month can vary from $20 to
more than $200 per day, with an average
cost of $72 per day(1995)--also charge an
initial deposit.
Home Health Care:
 Fastest growing
industry in the U.S.
 Expansion due to the
rise of managed care,
which focuses on
moving people out of
the more costly health
care settings, such as
hospitals, as quickly as
possible.
Home Health Care Agencies:
>9000 that are Medicare certified
 Offer therapies (occupational, physical)
 respiratory, speech, home health care aides,
social work intervention, psychological &
nutritional counseling & nursing care.
 Rehabilitation health care service providers
arrange for an acute level of rehabilitation in the
person’s home.
 In 1995, 10 million required home care services.
Impact of managed care.
Rehabilitation: process of
restoring someone - To their highest possible
level of functioning after
an injury or illness.
 A combination of
rehabilitation specialists,
nurses, & therapists, work
with patients or clients.
 Patients generally have 3+
hrs. therapy/ day x5
days/week
Long-Term Care
 Because of their
physical or cognitive
impairments, others
must assist them in
completing their daily
tasks.
 It is a 24 hr. day job.
 Caregiver needs
support in order to get
rest and relief.
Adult Day Care Programs
 Provides a break for
caregivers during the
day by offering health
& social services &
supervision for the
elderly person who is
not safe when left
alone.
Nursing Homes:
 Provide round-the-
clock care through the
use of paid caregivers,
nurses & CNAs.
 1.6 million in U.S.
reside in nursing
homes. 1 out of 3
people will become
nursing home resident
sometime in their life.
1987:Omnibus Budget
Reconciliation Act (OBRA)
 All nursing homes must have quality assurance


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

programs.
Facilities must provide enough staff for residents to
attain (& maintain) the highest functional level
possible.
Registered nurses must be available 8 hrs a day 7 days
a week.
Aides must be certified.
All new residents must have a clear & individualized
plan of care.
Assessment forms must be filled out within 4 days.
OBRA
 Restraints are to be used minimally & only
under doctors’ orders.
 There is a residents’ bill of rights, which
includes their right to refuse any medication
or treatment.
 If not followed, they can lose their
Medicare/Medicaid certification.
Housing & Health Connection:
 Independence
 Empowerment
 Social & emotional
support
 Purposeful activity
 Accessibility
Independence:
 Some view as living
comfortably without
needing regular
assistance from
anyone else, others
viewed it as living in
one’s own apartment
or home, & the ability
to make one’s own
decisions.
Empowerment:
 Closely related to
independence. It
relates not only to
older people’s ability
but also to the
privilege of making
choices that affect
their own lives.
Older person wanted to make
choices about, their own lives- The type of environment in which they live
(housing in general).
 Where they would go if they needed
additional care (continuity of care).
 Control over their day-to-day lives
(reflecting their personal view of
independence).
Social Support Theory:
 Theory that those who are lacking
adequate social support systems are
more susceptible to disease because of a
decrease in functioning of the body’s
immune system. During tense times, the
love & support of other people can
decrease stress & may also help to
increase a person’s sense of control.
Reminiscence Sessions:
 Can give the person the opportunity to
speak about their personal history &
experiences. Elderly people often enjoy
talking about their past & processing their
feelings through this sort of life review.
 Intergenerational, social interaction
programs also valuable, especially if
grandparents live away from grandchildren.
Purposeful Activity:
 Lack of participation
leads not only to
physical but also
cognitive & emotional
decline. It can lead to
premature physical
death and premature
death of the spirit.
Accessibility:
 A supportive environment
fosters comfort, safety &
ease of movement.
 Environmental design falls
into 2 categories:
 Building new,
accommodating structures
 Adapting existing
structures
Adaptation & Compensation:
 Raised toilet seats & grab bars
 tacking down or eliminating
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scatter rugs
better lighting
shower seats
no excess furniture
smoke alarms
resetting water heater to 120F
removing door thresholds
move items within reach
Physical Therapy:
 Transfer into & out of the tub or shower safely
 Use a walker or cane to accommodate for decreased
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balance
Use safer techniques when using kitchen appliances
Use new, more effective techniques for completing daily
activities
Use joint protection & energy conservation techniques
Compensate for the physical changes of aging (eyesight,
memory, hearing)