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YEAR 4 OLDER PEOPLE INTEGRATED CARE > Care home medicine, carers > Flashcards

Care home medicine, carers Flashcards

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1
Q

What is a residental home?

A

Residental home:
* provide accommodation and personal care e.g. washing, dressing, taking meds, toileting.
* Some offer activities within and outside of the care home.

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2
Q

What is a nursing home?

A

Nursing home:
* provide accommodation + personal care
* AND always has 1 or more qualified nurse on duty to provide nursing care.
* e.g for people with severe learning disabilities
* or complex condition that needs qualified nursing support such as a NG tube
* or demential patients
* or mental health Dx

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3
Q

Main difference between residental home and nursing home?

A

Residental is just care for personal care.
Nursing must have at least 1 qualified nurse present

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4
Q

How is care home funded?

A
  • Self funded
  • Financial help from the local authority via Adult Social Care
  • Financial help from family
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5
Q

Describe admissions process for care home

A
  • Referral by pt, a local authority or family member
  • Visits to the homes you are interested in
  • Pre-admission assessment by suitably qualified staff from the home
  • The home confirms that they are able to meet the individuals needs
  • Funding agreement
  • Admission
  • Six week review

https://www.ventry-care.com/advice-centre/the-admission-process/

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6
Q

What is referral process/criteria for care home?

A
  • Referrals from people following local authority/health services assessments
  • Referrals made independently of the local authority

With all applications, it is important that the home is fully aware of the person’s needs and has the resources to meet them. The home will decide about admitting the person in principle based on this assessment and terms and conditions and/or a contract can then be agreed

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7
Q

When shoud a care home be considered?

A
  • When an older person is struggling to live alone, even with the help of carers, friends or family.
  • If they have recently suffered a significant deterioration in their health or mobility, caused by an illness or a fall.
  • If they need extensive support and supervision to live safely and comfortably, and this can no longer be provided at home by family and/or carers.
  • When someone’s home is no longer a suitable environment in which to have their care needs met.
  • When a social care needs assessment indicates that a care home is the best place for you to live, following a fall or a stay in hospital, for example
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8
Q

What are signs that a pt may need to be referred for care home?

A

Daily living:
* Person is truggling with personal care or ADLs
* e.g. washing, going to the toilet, getting out of bed, cooking or eating meals, or keeping the home clean and comfortable

Safety:
* can no longer live safely at home - e.g. at risk due to falls, high fraility, risk of malnourishment

Memory problems:
* confusion or disorientation
* affecting living - e.g. leaves cooker on

Health needs:
* needs help with medication or mobility

QofL:
* lonely or isolated

Care support:
* carer feels overwhelmed or can no longer support person

Needs assessment:
* care needs assessment suggests needs moving in care home.

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9
Q

What is the purpose of a care needs assessment?

A

Finds out what type and level of support is needed
May be the start of the referral process into a care home

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10
Q

What is involved in care needs assessment?

A
  • The assessment will identify your care needs - what kind of care you require and how much support you need.
  • A social worker, occupational therapist, nurse or someone else working on the local authority’s behalf will carry out the assessment.
  • Discuss with you how you live and any personal care preferences and what you find difficult on a daily basis.
  • Ask how you wish to live your life and whether there are certain aims you would like to achieve but are unable to do so because of your care needs.
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11
Q

What common conditions are seen in a care home?

A
  • Dementia
  • Parkinson’s
  • Stroke Care - after community rehab
  • Frailty, Osteoporosis
  • PEG feeding
  • Heart Failure
  • COPD/Respiratory conditions
  • Cancer and palliative care
  • OA and chronic pain
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12
Q

What are the main funding streams to support care?

A

NHS continuing healthcare
NHS funded nursing care
Social services

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13
Q

Describe NHS continuing healthcare

A
  • Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare.
  • Must be assessed by a team of healthcare professionals (a multidisciplinary team). The team will look at all your care needs and relate them to:
  • what help you need
  • how complex your needs are
  • how intense your needs can be
  • how unpredictable they are, including any risks to your health if the right care is not provided at the right time
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14
Q

What is threshold in £ for self funding?

A

If you have over Over £23,250 = self funding

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15
Q

What may be the circumstances for moving into a care home?

A
  • Medical issue - unpredicted (e.g. stroke) or predicted (e.g. increase in health needs)
  • Personal choice
  • Respite
  • Temporary stay for rehabilitation
  • Planned admission through GP/Social referral
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16
Q

What support may people need in care home? (i.e what do people need help with in care home)

A
  • Washing
  • Dressing
  • Medication administration
  • Pressure sore prevention
  • Mobility
  • Toileting
  • Meal preparation

(add any others you think i missed)

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17
Q

What NHS services are available in care homes/ do residents use?

A
  • GP visits - care home residents are registered with a GP practice
  • Nursing
  • Secondary care services - including Outpatients clinics.
  • OT
  • Dieticans and nutritional support
  • Physio, speech and language therapy
  • Opticians, audiology, dentists, podiatrists
  • NHS funded rehabilitation
18
Q

What are challenges in delivering care and treatment to patients in care home?

A
  • Reduced staffing
  • Complex care needs
  • Funding crisis
  • Ageing population but reduced care home spaces
19
Q

Challenges in care of patients with dementia?

A
  • Continual supervision
  • Dignified end of life
  • Supporting families as well as patient
  • Recognising and managing pain
  • Managing sleep, changes in sleep patterns and wakefulness
  • Challenging behaviours
  • Communication problems
  • Coping with secrecy, dishonesty and repetitive behaviours
20
Q

Risk factors for getting pressure ulcer in care home?

A
  • Limited mobility or being unable to change position without help.
  • A loss of feeling in part of the body.
  • Having had a pressure ulcer before, or having one now.
  • Not having eaten well for a period of time.
  • Thin, dry or weak skin.
  • A significant cognitive impairment.
21
Q

When should pressure ulcer risk assessment be done in care home?

A
  • within 6 hours for anyone who moves into a care home with nursing
  • For people living in care homes who have one or more risk factors and who have been referred to the community nurse, a pressure ulcer risk assessment should be carried out and documented on their first visit
22
Q

How often should repositioning of patient happen in care home (to prevent pressure ulcers)?

A
  • Repositioning is recommended every 6 hours for people at risk of developing pressure ulcers and every 4 hours for people at high risk.
  • How often it will happen should be agreed with the person, taking their needs and wishes into account.
23
Q

What can be used to prevent pressure ulcers/sores in care home setting?

A

high-specification foam mattress for adults

24
Q

How to manage continence issues in care home?

A
  • general advice about healthy living, in particular diet and drinking appropriate fluids
  • improving access to toilet facilities and wearing easily removable clothing
  • reviewing existing medication
  • bladder and bowel training programmes
  • pelvic floor exercises
  • provision of pads, continence aids and other supplies to help manage incontinence.
24
Q

How to manage continence issues in care home?

A
  • general advice about healthy living, in particular diet and drinking appropriate fluids
  • improving access to toilet facilities and wearing easily removable clothing
  • reviewing existing medication
  • bladder and bowel training programmes
  • pelvic floor exercises
  • provision of pads, continence aids and other supplies to help manage incontinence.
25
Q

How to manage falls in care home?

A
  • ensure safety at the scene
  • assess for and attend to obvious injury
  • ask for additional help as required
  • safely move the resident from the floor (where appropriate)
  • report and comprehensively record the fall and the consequences of the fall, including completing:
    – an accident/incident report form required by the organisation
    Managing Falls and Fractures in Care Homes for Older People – good practice resource 79
    – a post falls report
    – the falls diary/update the database

The responses made should be in keeping with an individual’s Palliative Care Summary (PCS), Anticipatory
Care Plan (ACP) including Verification of Expected Death and Do Not Attempt Cardio Pulmonary
Resuscitation (DNACPR) decision recording and guidance.

26
Q

What does ‘ceilings of care’ mean?

A

It is what the maximum therapy which is appropriate for a patient when (s)he becomes unwell
I.e whether the patient is for
1. For full escalation
2. For ward based care but for NIV/CPAP but not for CPR, intubation
3. Ward based case only - not for NIV, CPAP and not for CPR/intubation
4. Palliate if deterioates

27
Q

Who establishes the ceilings of care?

A

Based on discussions and decisions that have made. They may have a :
1. DNACPR/ RESPECT form in the community
2. An advanced directive
3. The doctor looking after the patient decides.

28
Q

Define a carer

A

A person of any age, adult or child, who provides unpaid support to a partner, child, relative or friend who wouldn’t manage to live independently or whose health or wellbeing would deteriorate without this help.

29
Q

What jobs do carers do?

A

Everything!

30
Q

Why may someone need a carer? (from slides)

A
  • Frail
  • disability
  • serious health condition
  • mental illness
  • substance misuse
31
Q

What are challenges faced by carers?

A

NICE:

  • Impact on physical and mental health:
    1. neglect own health
    2. more likely to report a long term condition, disability, or illness
    3. significant distress
    4. depression
    5. anxiety
  • Social effects:
    1. social isolation
    2. loneliness
  • Financial difficulties
    1. higher bills
    2. financial pressures
  • Work and employment
    1. more likely to retire early (8 years early on average!!)
    2. tiredness and stress takes over
32
Q

What are benefits of carer receiving support in general practice?

A
  • Improved support with their caring, physical health, and emotional wellbeing needs.
  • Increased confidence in their caring role and feeling that they are providing safer care.
  • Reduced anxiety, depression, and stress.
  • Maintenance of good physical health, for example through improved self-care and being offered health checks.
  • Lower risk of injury because of improved manual handling techniques.
  • Improved awareness of available support services.
  • Feeling enabled to have a life outside the caring role.
  • Reduced risk of carer/family crisis and breakdown.
33
Q

Carers who do not get support/become overwhelmed are at risk of carer stress and leads to carer burnout. What is carer burnout ?

A

a state of emotional, mental, and physical exhaustion. Both carer and the person you’re caring for suffer.

34
Q

Common S+S of caregiver stress?

A
  • Anxiety, depression, irritability.
  • Feeling tired and run down.
  • Difficulty sleeping.
  • Overreacting to minor nuisances.
  • New or worsening health problems.
  • Trouble concentrating.
  • Feeling increasingly resentful.
  • Drinking, smoking, or eating more.
  • Neglecting responsibilities.
  • Cutting back on leisure activities.
35
Q

Common S+S of caregiver burnout?

A
  • You have much less energy than you once had.
  • It seems like you catch every cold or bout of flu that’s going around.
  • You’re constantly exhausted, even after sleeping or taking a break.
  • You neglect your own needs, either because you’re too busy or you don’t care anymore.
  • Your life revolves around caregiving, but it gives you little satisfaction.
  • You have trouble relaxing, even when help is available.
  • You’re increasingly impatient and irritable with the person you’re caring for.
  • You feel helpless and hopeless.
36
Q

Prognosis following admission for care homes?

A

Average life expectancy: 24 months for residential home
12 months after nursing home
But highly variable- some die within a few months and others will live for many months
Not a great prognosis.

37
Q

How do people enter a care home?

A
  1. Following a medical crisis
    - unforeseeable - unexpected or rapidly progressive conditions
    - foreseeable- unwilling to consider early admission, waiting for social care assessment or bed to become available, family carer burnout or crisis, no opp to discuss increasing needs with HCP/social
  2. Planned admission
  3. Personal preference
  4. Respite care
  5. Short term admission for rehabilitation
38
Q

What kind of things are assessed when assessing a pt for free social care for long term complex needs under NHS continuing healthcare?

A

breathing
nutrition (food and drink)
continence
skin (including wounds and ulcers)
mobility
communication
psychological and emotional needs
cognition (understanding)
behaviour
drug therapies and medicine
altered states of consciousness
other significant care needs

-Assessment weights these as “priority”, “severe”, “high”, “moderate”, “low” or “no needs”.

E.g. 1 priority need, or 2 severe needs = usually eligible for NHS continuing healthcare.

39
Q

Give three barriers to carers accessing support
(From BB)

A
  • Lack of information
  • Reluctance to use services because of a sense of duty
  • Restrictions in service use due to cost or lack of availability
40
Q

Give 3 questions that you may use as part of a spiritual Hx
(From BB)

A
  • what support do you have?
  • do you have people you can talk to?
  • what is your greatest worry?
  • what is the most important issue in your life?
  • what would be the most helpful thing for you?
  • what do we need to know about you to give you the best care?
  • what gives your life meaning?
  • where do you get your strength from?
  • is relegion or faith important to you?

YEAR 4 OLDER PEOPLE INTEGRATED CARE (21 decks)

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