Introduction Flashcards
Aging
“old” is 65 years old- where someone qualifies for retirement benefits
-some define old based on functional abilities
biological aging
based on cellular decline
sociological aging
based on changes in roles and relationships
psychological aging
based on aging as a developmental stage people go through
application of maslow
assure that individual’s basic needs are met first before addressing higher level needs
centenarians
people who live to 100
struggles of elderly women
-twice as likely to be poor
-pay inequity, occupational differences, caregiving responsibiliites, longer life expectancy, rising health care costs, work patterns= reduced pension, benefits, and savings
Co-morbidities
when an adult has multiple chronic conditions
leading causes of death among older adults
heart disease, cancer, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes
most common health concerns for noninstitutionalized older adults
arthritis and hypertension
ageism
prejudice against older adults
Instrument activities of daily living
paying bills, laundry, grocery shopping
aging in place
stay in own environment
acute care
-hospital
-acute condition with chronic issues (comorbidities)
-high acuity levels
-focus on acute problem, lose the health promotion/ prevention aspect
dangers in acute care
drug reactions, falls, infection, overstimulation, immobility, confusion
-sepsis, nutritional status, complications from injuries
nursing care in acute care
-promotion of safety- environmental modifications
-assessment of baseline functioning
-goal: maximize independence, enhance functioning
-Teaching- realistic, at appropriate level
-involvement of family
After Acute Care
-promote continuity of care, successful transitions
-subacute care, rehab, assisted living, special care units, skilled, home care, home independent
subacute care
-patients are stable, but still acute
-dont need daily physician visits, high tech monitoring, or complex diagnostics
-services such as rehab, IV therapy, TPN, respiratory care, wound management
-different staffing level than a SNF
-step down from acute care
Rehabilitation Units
-can be located in hospital, subacute care, SNF
-goal is rehab and return to original place of residence
-therapy services
-medicare- funded facilities must have weekly meetings with the resident, family, and care team
community based residential facility
- a place where 5 or more unrelated people live together in a community setting
-services provided include room and board, supervision, support, and may include up to 3 hours of nursing care per week - home setting things are more stable
Residential Care Apartment Complexes
Independent apartment units in which the following services are provided: room and board, up to 28 hours per week of supportive care, personal care, and nursing services
Adult Family Home
place where three or four adults who are not related to the operator reside and receive care, treatment or services that are above the level of room and board and that may include up to seven hours per week of nursing care per resident
Skilled Nursing Facility
depends on individual’s physical/ cognitive needs, support system, community resources
-medical method vs. nursing model
-emphasis on quality of life and residents’ rights
Resident Assessment instrument
ongoing comprehensive assessment of resident, focusing on functional abilities - minimum data set and resident assessment protocols
RAI Completion
-specific deadlines for completion of the RAI- admission, annual, condition change, quarterly with abbreviated form
-Deadlines for RAI completion for Medicare A Patients- 5 or 14 days, 30, 60, and 90 days and with significant change
-RN and LPN can complete form, but only RN can sign
-can also have input from dietary, social work, therapists
Home Care
-can be multiple services or just a few
-number of visits covered by medicare or other private insurance plans
-criteria- must have skilled care need (unable to perform care alone, no one available to help), person must be homebound, require only intermittent care.
-must have physician’s statement supporting the need for home care
OASIS
-outcome and assessment information set
-Mandated by CMS for performance improvement in home care.
-Assessment monitoring tool for outcomes of homecare services
-results reported to regulatory agencies every 30 days
community programs and services
senior centers, adult day care centers, respite care, homemaker services, nutrition services, Parish Nurse, personal emergency response systems
Medicare
federal health insurance program
-not income
Medicare Part A
coverage for inpatient hospital care, limited SNF or home health care (no cost)
Medicare Part B
Medical insurance coverage- doctors’ appointments, diagnostics, therapies, some equipment and supplies (monthly premium)
Medicare Part C
(Medicare Advantage Plans)- gap coverage (monthly premium)
Medicare Part D
Medication Coverage (must have Part A and/ or B) (monthly premium)
Medicaid
-combination of state and federal funds to pay for SNF
-certain criteria for eligibility: Maximum $2000 in assets
Standards of Care
-guidelines for nursing practice
-come from professional organizations, state and federal laws
-accreditation through the joint commission- industry standards
-must also comply with organizational policies and procedures
common concerns- capacity to make own decisions, identify power of attorney (health or financial), conflict about care , disclosure of info, longterm care decisions, end of life decisions, fraud
federal government
-social security act
-centers for medicare and medicaid services (cms)
-omnibus budget reconciliation act (OBRA)
OBRA
-major reform of nursing facilities
-major parts- provision of services for nursing facilities, survey and certification process, enforcement of regulations
-resident empowerment
-focus on quality of life and residents’ rights
Quality of care
-SNF
-physician evaluations
-Resident Assessments (MDS, RAPs)
-staffing: LPN 24/7, RN minimum of 8 hrs/day, 7 days/ week
-CNA regulations
(reduce antipsychotics, reduce restraint, reduce use of indwelling urinary catheter)
Resident Rights
-resident bill of rights
-notification of resident rights orally and in writing
-prevention of involuntary transfer out of facility
drugs and restraints
-freedom from unnecessary drugs
-guidelines for chemical and physical restraints
-drugs should not be used for environmental control
-antipsychotic drugs for certain conditions
-physical restraints only for certain medical conditions. Must have documentation
Older Americans Act
-directs states to provide various services for older adults
-Ombudsmen - someone who is a spokesperson for residents in that facility
Health Insurance Portability and Accountability Act
HIPAA
-provisions deal with insurance coverage
-privacy regulations were included
Abuse and Protective Services
-neglect
-abuse
(domestic- individual with special relationship)
(institutional- facility caregiver)
(self-abuse)
-exploitation
-mistreatment
elder abuse
physical abuse, sexual abuse, emotional abuse, financial and material exploitation, neglect, abandonment, self-neglect
Autonomy and Self-Determination
-right to informed consent
-right to make decisions about body and healthcare
-living wills
-advanced directives
-do not resuscitate orders
