Transcript CHAPTER FIVE Where People Live: Person

CHAPTER FIVE
Where People Live:
Person-Environment Interactions
What are your 5 most important belongings?
IMAGINE…you have been in a terrible car accident
and need medical care round the clock for an
indefinite amount of time.
You are going to be admitted to a local nursing home
and are allowed to bring 5 personal items with you (in
addition to clothes and toiletries).
Write down one item per notecard. Briefly explain
why the item is important to you.
Describing Person—Environment Interactions
Person—Environment interactions (Kurt
Lewin, 1936): behavior (B)is a function (f) of both
the person (P) and the environment (E)
B = f(P, E)
Describing Person—Environment Interactions
Competence is the theoretical upper limit
of a person’s capacity to function.
Environmental press: the physical,
interpersonal, or social demands that
environments put on people
Competence and Environmental Press
• Adaption Level: The
area where press
level is average for a
particular level of
competence
– Slight increases in
press tend to improve
performance (Zone of
Maximum
Performance Potential)
– Slight decreases in
press create a Zone of
Maximum Comfort:
people live happily
without environmental
demands
Everyday Competence
• Everyday competence is a person’s potential ability
to perform a wide range of activities considered
essential for independent living.
– Broader than Activities of Daily Living (ADLs) or
Instrumental Activities of Daily Living (IADLs)
– Necessary determinate for whether an elderly person
can take care of themselves
The Ecology of Aging
• Environmental Psychology: Seeks to understand
the dynamic relations between older adults and
the environments they inhabit
Home Modification
– Helps people deal with tasks of daily
living by modifying the environment
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Hook for car keys near the door
Hand rails in bathrooms
Door handles that are easier to grasp
Widening doorways
Lowering countertops
Wheelchair ramps
Adult Day Care
• Designed to provide support, companionship, and certain services
during the day
• Goal is to delay placement in more formal care setting.
• Three types of adult day care
1. Social services, meals, recreation, and minor health care
2. More intensive health care, therapy, for serious medical problems
3. Specialized care for dementia or developmental disabilities.
Congregate Housing
• Apartment complex for older adults
– Shared meals
– Affordable
• Residents must be capable of independent living and:
– not require continual medical care
– know where they are and oriented to time
– show no evidence of disruptive behavior
– able to make independent decisions
– be able to follow specific service plans
Assisted Living
• Provides a supportive living arrangement for people who
need assistance with personal care (bathing, taking
medication) but are not so physically or mentally impaired to
require 24-hour care.
• Has three essential attributes
1. As much like a single family house as possible
2. Emphasizes personal control, choice, dignity, and autonomy
3. Should meet routine services and special needs
Types of Nursing Homes
• Two levels of care are defined in federal regulations.
1. Skilled nursing care consisting of 24-hour care, including medical
and other health services
2. Intermediate care also 24-hour but at a lesser intensity
Percentage of Medicare enrollees age 65 and over residing in selected residential settings
by age, 2005
Who is Likely to Live in Nursing Homes?
• Health issues and
functional
impairment
– Average resident has
significant mental
and physical
problems
– One third of
residents have
mobility, eating or
incontinence
problems.
– 30 to 40% show signs
of clinical depression.
Personal Items to Bring to a Nursing Home*
• Any needed denture supplies and container
• Electric razor or razors, shaving and aftershave lotions
• Makeup, body powder
• Hair supplies, including comb, brush, shampoo
• Deodorant
• Facial tissues
• 9 full sets of undergarments and 2 washable sweaters
• 7 pairs of stockings or socks and 4 nightgowns or pajama sets
• 2 pairs of flat, non-skid shoes and 1 coat or jacket
• 2 pairs of washable, non-skid slippers and 1 robe
• 7 casual outfits and 2 belts
*Reproduced from the Emory Healthcare, Georgia website
(Affiliated with Emory University)
Items to bring to personalize the living quarters:
A bed, bedspread, pillow, dresser and bedside table are provided. Residents
can also bring other personal items, provided they are in very good condition
and do not overcrowd the room.
Suggested items to bring from home:
• Clothes hangers
• Blanket and personal pillow
• Pictures, photographs, favorite objects and lamps (residents are
encouraged to place their names on these and other objects)
• Wheelchair, walker or any other adaptive equipment
• Telephone
• Television set
• Small refrigerator
Which 5 items will you bring with you to the nursing home?
The competence-environmental press model
• Goal is to find the optimal level of environmental
support for people of low levels of competence
• In selecting a nursing home relatives should keep the
following in mind:
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Level of skilled nursing care
Be mindful if facility is primarily Medicare or Medicaid
Is the director and upper staff fully licensed?
Is the care plan put in place by professionals?
Ask questions about staff educational levels and staff
turnover.
Special Care Units
• For people with dementia
• Provide additional environmental
support and safety features to help
when the person’s competence level
continues to decline.
• Memory aids are built into the unit.
Person-centered planning:
What can be done to foster the sense of home?
• Include the relocating individual in the
selection of a specific nursing home
• Allow the relocating individual to direct
his/her own daily schedule and activities as
much as possible
• Learn about the new environment and try to
have positive experiences
• Define the home in terms of family and social
relationships rather than place, objects, or
total autonomy
• Establish a continuity between home and
nursing home
• Reminiscing about home may facilitate
adjustment
Major factors influencing resident satisfaction in nursing
homes
How Not to Communicate with Residents
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Patronizing speech (infantilization/baby talk)
Inappropriate use of first names
Terms of endearment—“Honey,” “Sweetie”
Assumption of greater impairment than may be the case
Cajoling to demand compliance
New Directions for Nursing Homes
• The Eden Alternative
– Includes pets and other
approaches that try to ease
transition between current
and former living situations.
– Link to Eden Alternative
Featurette
• Green House Project
– Homelike environment
– Encourages residents to
participate in their care
through helping with daily
tasks