Exam 3: Lecture 9 Flashcards
Expectation that older will cease full-time work and be entitled to economic assistance.
Retirement
What are the economic assistance for retirement?
social security and medicare
Historically retirement was…
A few years of rest before death
Now retirement is…
Transition to new life role
New jobs (change job roles)
Going part time (life passion job)
Traveling
Family
Some may be retired longer than worked full time (retire early)
What is the Great Recession of 2009+?
Stock market suffered
Many laid off
Hiring freezes
Retirement plans suffered
What are current economic trends and retirement?
New career paths later in life (found something they like to do better)
Many families currently unable to plan for retirement
Majority of Baby Boomers plan to work past 65 or never retire (didn’t have people to talk to them and educate them)
What is involved in retirement planning?
research tells us retirement = happy and healthier older people
1/3 of adults in the 50s have no retirement plans
young adults are advised to begin retirement planning and middle adults must do retirement planning.
Retirement prep largely aimed at those with…
High education
High occupational status
Gov’t employees
Employed in companies with pensions
Retirement prep often lower priority for those who…
Poor health
Minorities
Women (in many cultures, the men don’t let the wives work)
Lower socioeconomic status
Lower education
Retirement men vs. women?
Men retire as planned
Women retire earlier due to family needs
Women have more variability in work due to interrupted careers, sporadic work history
Gender bias
what are the nursing responsibilities for retirement?
Discuss retirement with clients (esp in primary care)
Discuss transition to retired status
Health issues affecting retirement
Resources for planning and support
Social Security
Established in 1935 – during the Great Depression
Set up as an “age-entitlement” program under President Franklin D Roosevelt (FDR)
–> Monetary support available at a certain age regardless of personal resources
Funded by payroll taxes – employees & employers both
Amount of benefit calculation
–> Average salary during 35 of his/her working years
2019- average benefit $1461/month (+$39 𝚫 2018)
Max benefit at full retirement age $2861/mo (+$73 𝚫 2018)
Current full benefit age is 65-67 y.o.
–> May start at 62 y.o. at reduced benefit amount
May earn up to $17,640/yr. via employment if under full retirement age (+$600 𝚫 2018).
–> Unlimited if over full retirement age.
What consist under supplemental security income?
Provides for minimum level of economic support to persons 65+, blind or disabled regardless of earning power in early life or when capable of working
Either provides total support or supplements low Social Security benefit
What is regarded under financing health care?
In the United States health care has always been a purchased service, not a right
Federal government provides majority of care via its insurance plans…
Medicare: 65+ or older and living in US
Railroad Medicare
Medicaid: people with disabilities, or in poverty/low income households
TRICARE
Veterans Administration
What is the medicare history?
In 1934 FDR appointed Committee on Economic Security (CES) to write Social Security bill
Original report included health insurance plan, but because of much opposition to it, Roosevelt deferred health insurance part of bill to avoid losing Social Security
medicare is…
An insurance plan for persons who are age 65, blind or totally disabled, including persons with ESRD (part of body isn’t functioning)
Includes A, B, C, & D
Supplemental/Medi-gap Insurance Policies?
People often purchase supplemental insurance plans
–> Help with high Medicare co-payments
Cover only deductibles and part of coinsurance amounts based on Medicare
–> Approved amounts contracted with providers
Describe medicaid.
Health insurance program jointly funded by federal and state governments using tax dollars
Provides health services for low-income children, pregnant women, those who are permanently disabled, and persons age 65 and older who are eligible
Eligibility – determined by the state
What is considered as LTC insurance?
Designed to cover expenses of LTC not covered by health insurance or Medicare
purchased before retirement typically
wide range of benefits/care
wide range of $$ coverage
some have ,ax time of coverage – i.e. for 5 years
often through a job
Cost of LTC?
LTC is expensive and becoming more expensive
LTC in the US
–> overly reliant on institutional care
–> primarily financed by individuals or Medicaid
Most don’t plan for their LTC needs and not knowledgeable about existing resources
Majority of LTC services are provided by unpaid caregivers (relatives at home)
Who are the payers of LTC?
Medicaid: primary payer and there are large differences across states.
Medicare: wound not cover unless some skilled needed
Private LTC insurance: relatively few people have purchased this insurance
Out-of-pocket spending: accounts for about 22% of national spending for LTC
Residential care options in later life?
Most prefer to stay at home and “age in place”
Depends on appropriate support for changing needs
Possible isolation/loneliness
Residence Options: Dependent upon financial resources
Shared housing with family members or others
What is consisted in community care?
Program for All-Inclusive Care for the Elderly (PACE
Adult Day Services
Residential care facilities
Continuing care retirement communities
What is consisted in skilled nursing facilities?
2 levels:
Skilled nursing care (sub-acute)
Chronic care (long-term/custodial)
Offer 24/hour care for those needing specialized nursing care
What is the PACE program?
Program for all inclusive care for the elderly.
Community Care
Also a Care Model
Comprehensive continuum of care by interdisciplinary team
Alternative to LTC facility
Includes primary care, acute care, nursing home care & specialty care
Community care other considerations?
Adult Day Services
Residential Care/Assisted Living (RC/AL)
Continuing Care Retirement Communities
–> Independent to high-level care
What are the typical residents of LTCF?
Women > 80 yrs
Widowed
Dependent in ADLs & IADLs
However, … chances for older person to live in LTC is 4-5% — will grow over time
If 85 yo – 1 in 2 chance of spending some time in NH
23% of Americans die in NH – expected to grow to 40% by 2040
Where can you find and compare options for nursing homes?
MDS – Minimum Data Set
QAPI - Quality Assurance Performance Improvement
Nursing Home Compare – 5-Star
Advancing Excellence in America’s Nursing Homes
INTERACT - Interventions to Reduce Acute Care Transfers
What are the essential factors in choosing a LTCF?
Central Focus
Interaction
Milieu (“feel” of the environment)
Environment
Individualized Care
Staff
Safety
What are the models of care?
Different ways of focusing on improving care
PACE - Program for All Inclusive Care for the Elderly
NICHE – Nurses Improving Care for Health system Elders
ACE - Acute Care for the Elderly
Home like, directed by residents, relationships fostered
Med mgmt., discharge planning/teaching, etc. (RNs and APRNs)
How do you differentiate the Models of Care?
Population – who is it for – are there eligibility requirements
Location – where is the model used
Emphasis – what aspects are a focus of the model
What are the Legal and Economic Needs of Older Adults?
health and personal care planning
residents rights in LTC
housing issues
litigation and administrative advocacy
fiduciary representation
retirement planning
legal capacity
income, estate, gift taxes
public benefits
insurance matters
What are the family types?
Traditional couples
–> Married or partnered
Non-traditional couples
–> LGBT couples
Divorce
Older adults and adult children
Never-married older adults
Grandparents
Siblings
Fictive Kin – nonblood, who fake families
–> CNA, RN, case managers, paid caregivers
What is considered in older adults as caregivers?
Caring for those with dementia
Caring for adult children who are disabled
Grandparents raising grandchildren
What is elder abuse?
Complex phenomenon
All socioeconomic, racial, and ethnic groups
Can be intentional, accidental, episodic, or recurrent
Elder abuse is reportable by law
Most abuse…
Occurs in home
Spouses or adult children
Majority of documented cases are white elders (84%)
What are the types of abuse?
Physical
Sexual
Emotional or psychological
Medical
Financial or material – exploitation
Discrimination
Abandonment
What is considered with neglect?
neglect– self or caregiver
caregiver neglect – passive
self neglect
What is at risk for abuse?
Women
Single
Cognitive impairment/dementia
Dependent on caregiver
Incontinent
Frail or mental disability
Previous abuser of the caregiver
Institutional setting
What are the common bruising patterns of abuse? wrap around bruises
Wrap around bruises
Accidental bruises don’t form a wrapped appearance
A bruise that wraps the wrist, arms, neck, or ankle may indicate force
Look for thumb pad on one side and finger pads on the other
What are the common bruising patterns of abuse? linear bruising
Linear bruising
Accidental bruising doesn’t follow linear pattern
Striking with an object can cause linear bruising
May be seen on back, buttocks, thighs, or arms
What are the Nursing Interventions – Elder Abuse?
Prevent the abuse from continuing
Licensed nurses are considered mandatory reporters—required to report suspicions of elder abuse to Adult Protective Services
Reasonable belief that a vulnerable person has, is, or likely to be abused, neglected, or exploited
Evidence collection
Observe for obvious bruises or body marks
Observe and ask about medications
Looks for signs of restraints
Note body odor, dirty clothing or body, or other signs of neglect
Observe for pressure ulcers, dehydration, or malnutrition
Photograph injuries and general conditions (follow facility policy) ALWAYS GET PHOTOS
how do you prevent elder abuse?
educate professionals and public
support systems and groups
stress management
care resources
counseling and caregiver self care
respite care and home health
resources for meals and transportation
