Chapter 12 & 13: Long-term care & Death and dying Flashcards
institutional facility
group residential setting that provides individuals with medical or psychological care; short-term (e.g. hospitals) or long-term
aging in place
with appropriate principles, older adults can remain in their own homes or communities
alternate level of care (ALC) patients
reside in hospitals but no longer need high level of care and are just waiting for a long-term care bed
home care
personal support workers providing assistance to older adults within their own private residences; heavily reliant on unpaid caregivers
adult day programs
older adults who need assistance or supervision during the day receive a range of services in a facility (e.g. nursing home) or a stand-alone agency
respite care
gives family caregivers a break while allowing older adults to receive needed support services
supportive or assisted living facility
provides supportive care services and supervision to individuals who do not require skilled nursing care; not the same as retirement homes
nursing home
type of medical institution that provides a room, meals, skilled nursing and rehabilitative care, medical services, and protective supervision
competence-press model
predicts an optimal level of adjustment that institutionalized people will experience when their competence levels match the demands of the institutional environment
green house model
an alternative to traditional nursing homes that is an individual home with a small community of 6 to 10 residents and skilled nursing staff
culture change movement
promotes person-centered care by adopting care to the needs of the individual in innovative ways
death
irreversible cessation of brain function that can be determined by prolonged absence of respiratory and cardiac functions
dying
period during which the organism loses its vitality
dying trajectory
temporal pattern of the disease process leading to a patient’s death
four types of dying trajectories
sudden death, terminal illness, progressive organ failure, frailty
sudden death trajectory
individual is at a high level of functioning until death suddenly occurs
terminal illness trajectory
people have an advance warning of a terminal illness and were functioning at a high level until the disease progressed
organ failure trajectory
death occurs over a prolonged period with dips and recoveries until the organ failure completely compromises life
frailty trajectory
immediate cause of death may be an acute illness developing against a backdrop of general loss of function; e.g. later stages of Alzheimer’s
anorexia-cachexia syndrome
individual loses their appetite (anorexia) and muscle mass (cachexia)
death ethos
a culture’s prevailing philosophy of death e.g. belief in ghosts and afterlife, treatment of those dying, funeral ritual, representation in arts
tamed death
viewing death as familiar and simple, and a transition to eternal life that tamed the unknown
invisible death
preference that the dying retreat from the family and spend their final days confined in a hospital
social death
process in which the dying become treated as non-persons by family or health care workers as they are left to spend their final months or years in the hospital or nursing home
5 stages of dying for terminally ill patients
denial, anger, bargaining, depression, acceptance; shows as a progression instead of discrete steps
death with dignity
the period of dying should not subject the individual to extreme physical dependency or loss of control of bodily functions
good death
patients have the autonomy in making decisions about the type, site, and duration of care they receive at the end of life
legitimization of biography
attempting to see what one has done as having meaning and preparing to leave a legacy
awareness of finitude
point in time when one first thinks about their own mortality and passes the age when other people close to them have died
terror management theory
when thoughts of death are activated, consciously or unconsciously, they can experience beneficial effects, particularly those who can cope with stressful situations
advance directive
document that describes one’s preferences for future care if they are unable to speak for themself
overtreatment
occurs when patients with DNRs receive active life support that includes resuscitation and do not have their DNR orders respected
2 ways of medical assistance in dying (MAiD)
Clinician-administered MAID (used to be voluntary euthanasia) and self-administered MAID (used to be assisted suicide)
hospice palliative care
provision of holistic, person-centered end of life care that begins when the patient no longer wishes to receive active treatment
bereavement
process wherein people cope with the death of another person
attachment view of bereavement
the bereaved can continue to benefit from maintaining emotional bonds to the deceased individual
dual-process model of coping with bereavement
the restoration dimension are the practical adaptations or life changes that accompany death; the loss dimension is coping with the direct emotional consequences
long-term care
entire continuum of care, from receiving in-home help with daily tasks to institutionalized care
Benefits of home care
maintained sense of identity, control, and autonomy, familiarity of surroundings and community, prevention or delay of institutionalization, cost-effective
Who most likely uses government-funded home care?
those who are single, have lower income, more physical limitations, and had a recent hospitalization
Types of long-term care
home care, assisted living, nursing home, retirement home
assisted living
provides government-regulated housing with a supportive environment e.g. hospitality and personal care services
Who likely uses assisted living?
those who have physical and functional health challenges, can live independently but not unaided, can make their own decisions
3 ideal attributes of assisted living facilities
physical space has a residential appearance and feel, promotes normal lifestyle, meets residents’ routine services and special needs
traits of those with greater well-being after transitioning to assisted living
had greater control over transition, optimized person/environment fit, live in smaller facilities, have positive co-resident relationships usually of similar levels of functioning, frequent family contact, moved from a hospital or other AL facility (not home)
nursing home
government-regulated type of medical institution that provides a room, meals, skilled nursing, and rehabilitative care, medical services, and protective supervision; usually the last resort
Who typically lives in nursing homes?
those with multiple health conditions and/or moderate/severe cognitive impairment (dementia); those recovering from major injuries, illness, or surgery (temporary residents)
elder abuse
physical, sexual, and psychological abuse; financial exploitation; neglect; and violation of rights
features of the traditional medical model
hierarchical, focused on physical needs, routines for residents and frontline workers, efficient, standardized, cost-driven, rule-compliant, residents often isolated
features of the culture change movement
voices of residents and carers respected, focused on emotional needs, enables continued growth, treats everyone as individuals, restructured staff roles and responsibility, encourages connections and contributions to family and community
eden alternative
close and continued contact with plants, animals, and children; daily life includes variety and spontaneity; maximized decision making; focused on the well-being of elders and workers
Benefits of non-profit facilities
more and better quality staffing, fewer regulatory deficiencies, patients have less pressure sores, less use of physical restraints
How do costs of nursing homes vary?
by province, type of ownership, and model of care; residents are required to pay out-of-pocket
factors that influence the experience of death
cultural factors, trajectories and nature of death, individual differences, social support, medical system
focus of palliative/hospice care
unique end-of-life goals, how symptoms, treatment, and issues are hindering goals, interventions to assist in reaching them, quality of life and closure
barriers to access palliative care
lack of patient understanding, limited resources, funding, and specialized doctors, reluctance to discuss dying
decisions to be made in advanced care planning
preference for what kind of and where care is received, personal wishes and goals, who makes decisions if the patient is unable to do so (e.g. living wills and advanced directives)
options for advanced care planning
refusal or withdrawal of treatment (e.g. DNR), palliative sedation
palliative sedation
admission of sedative medication to reduce patient’s consciousness and alleviate suffering, not to cause or hasten death; used as a last resort, MAID
barriers to ACP on the patient and family caregiver level
cultural beliefs, lack of emotional preparedness, preference to defer to doctors, cognitive impairment (+/-), diagnosis of less serious illnesses
barriers to ACP on health care provider level
prognosis uncertainty, lack of communication skills and preparedness of MD
Clinician-administered MAID
a physician or nurse practitioner directly administers a drug that intentionally causes death
Self-administered MAID
a physician or nurse practitioner prescribes a drug that the eligible person takes themselves
What is considered a “grievous and irremediable medical condition” for MAID eligibility?
serious, incurable illness or disability; advanced state of irreversible decline in capability; unbearable physical or mental suffering; reasonably foreseeable natural death and capable of providing informed consent (no longer the case)
6 themes that people tend to value at the end of life
clear decision making, pain and symptom management, affirmation of the whole person, preparation for death, contributing to others, completion
Completion at the end of life
deep importance of spirituality and meaningfulness of life (e.g. reviewing one’s life, spending time with loved ones, resolving conflicts, saying goodbye, prayer)
