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Geriatrics 2 > Social Work > Flashcards

Social Work Flashcards

1
Q

What do medical social workers do?

A
  • D/C plans
  • Case mgmt
  • Legal issues
  • Pt’s rights/concerns
  • Crisis intervention
  • Disease education
  • Support groups/therapy
  • Outpt. settings (e.g. dialysis, free clinics, PCP settings)
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2
Q

Most seniors enroll in this insurance program at age 65

A

Medicare

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3
Q

Seniors often select what in addition to Medicare to cover costs (co-pays, deductibles)

A

Medicare supplement

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4
Q

Medicare Part A

A

Hospital insurance

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5
Q

Medicare Part B

A

Outpt services

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6
Q

Medicare Part C

A

Medicare HMO/replacement plans

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7
Q

Medicare Part D

A

Prescription coverage

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8
Q

What does medicare not cover?

A

Long-term NH care

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9
Q

What is the future of medicare?

A

More restrictions & changes keep happening

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10
Q

Medicaid is insurance for what populations?

A
  • People >65
  • Blind or disabled
  • Under 19 + pregnant
  • Relative or caregiver of a child
  • Categories for families/disabled/NH/illegal aliens/dialysis pt.
  • Asset and income
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11
Q

What does medicaid cover that medicare does not?

A

Long-term NH placement

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12
Q

Family care in MKE county

A
  • Case mgmt
  • Home services: shopping, cooking, cleaning, personal care worker
  • Paid caregiver
  • Contracts w/ NH, transport, home care agencies
  • Income limits (T-19)
  • Contracted agents provide case management
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13
Q

In MKE county who CANNOT get paid to be a caregiver

A

A spouse; a friend/relative CAN

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14
Q

Community care

A
  • Case mgmt/social work
  • Own MDs/RNs
  • Transportation
  • Day care
  • In-home services
  • Income requirements (T-19)
  • Aim to keep client’s in the community
  • Program expanded to include patients with disabilities
  • Family care contract
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15
Q

Utilizing healthcare resources

A
  • Shorter length of stays
  • Medicare DRG system/building
  • Uninsured & underinsured population
  • Aging population
  • Push to reduce costs & be efficient
  • Repeat admission may not be covered
  • Hospital does not get payment for “never” events (e.g. HAP, pressure ulcers)
  • Difficult for seniors to move at quick pace of healthcare
  • Tighter inpt criteria (i.e. hip replacement can be outpt in a bed status)
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16
Q

Observation status

A
  • Medicare has strict guidelines on what meets inpt. hospital criteria
  • Admission for weakness/placement alone is not acute care criteria
  • Contact case mgmt/utilization with questions
  • Need >2 days to be inpt. status
  • SNF rehab is not covered
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17
Q

Social work triggers

A
  • AODA/mental health problems
  • Advanced age/alone/no support system
  • Non-compliance
  • Cognitive problems
  • Economic & social problems
  • Multiple medical problems
  • Multiple hospital admissions/ER visits/911 calls
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18
Q

Long-term acute care is indicated for….

A

Pt. that require on-going complex medical tx

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19
Q

What are examples of complex medical tx that might require the pt. to be in long-term acute care?

A
  • VAC/wound care/HBO
  • IV ABX
  • Tracheostomy care/vent
  • Multi-system problems
  • Needs are too complex to be managed at a lower level of care
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20
Q

It has become more difficult to get insurance to approve what kind of care?

A

Long-term acute care

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21
Q

What is inpt rehab?

A
  • Pt. remain in the hospital and undergo rehabilitation
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22
Q

Inpt. rehab requires participation in at least __ hours of therapy

A

3

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23
Q

Inpt. rehab requires pt. to undergo at least __ types of therapies

A

2 (e.g. PT, OT, ST)

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24
Q

What is the goal of inpt. rehab?

A

D/C home

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25
Q

What is subacute rehab?

A

Short term rehab stay

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26
Q

What type of institution offers subacute rehab?

A

NH facilities

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27
Q

Subacute rehab consists of __ hours of therapy per day

A

2

28
Q

What is an advantage of subacute rehab?

A

Medical tx are available (e.g. O2, labs, IVs, wound care)

29
Q

Medicare coverage of subacute rehab

A

Days 1-20 @ 100%

Days 21-100 @ 80%

30
Q

What are two examples of outpt therapy?

A
  1. PT/OT

2. Cardiac rehab

31
Q

What type of insurance covers outpt. therapy?

A

Medicare + secondary insurance

*only certain diagnoses are covered, long-term care is not

32
Q

Pt. must be doing what in both subacute & outpt. rehab?

A

Reaching goals

33
Q

How do people pay for NH care?

A

Private pay

34
Q

What are some advantages to nursing home care?

A
  • 24 hrs nursing services
  • Custodial care
  • Specialized units for Alzheimer’s dementia
35
Q

Services that assisted living/group homes usually offer

A
  • Medication assistance

- Bathing/dressing/cleaning/transport

36
Q

How do people pay for assisted living/group home care?

A

Private pay

37
Q

Pts qualify for homecare if…..

A

They are homebound

38
Q

Homecare services include:

A
  • RN visit (medications/lab draws/BP/dressing changes)
  • Aid visit (baths)
  • PT/OT
  • Social work
39
Q

How do people pay for homecare?

A

Medicare covers it 100%

- Requires MD order

40
Q

Who qualifies for hospice care?

A

Pt. with a life expectancy of less than 6 months

41
Q

Hospice is changing from an active tx plan to

A

Comfort measures

42
Q

What is the focus of hospice care?

A

QOL

43
Q

What is palliative care?

A

The step in between treatment and comfort measures

44
Q

Is palliative care more or less restrictive than hospice care?

A

Less (e.g dialysis is continued, not all meds are stopped)

45
Q

Palliative care teams help pts…

A
  • Discuss long-term plans

- Review overall medical condition and goals

46
Q

Two types of hospice care

A

Home hospice & residential hospice

47
Q

What does medicare cover in regards to home hospice care?

A

100% coverage

48
Q

Home hospice….

A
  • Does not provide 24 hrs
  • Family/caregiver to be primary support
  • Focus comfort
49
Q

What is residential hospice care?

A

Small facilities that specialize in end of life care

50
Q

What does medicare cover in regards to residential hospice care?

A

It covers treatment/medication costs only, private pay is required for room & board

51
Q

What is the most restrictive type of care?

A

NH care

52
Q

What hospital D/C care is NOT common?

A

Assisted living/group home

53
Q

Why is D/C from hospital to assisted living/group home not common?

A

Pts are not independent enough to go directly into this type of care

54
Q

What can we do to help pt. cope with their diagnosis?

A

Connect pt. with community agencies

55
Q

Examples of community resources

A
  • Support groups
  • Education
  • Case mgmt
  • Assistance w/ federal applications (e.g. insurance, food stamps, home help)
  • Population health
56
Q

Barriers to compliance:

A
  • Transportation
  • Insurance costs
  • Lack of family support
  • AODA/mental health
  • Case mgmt
  • Lack of medical knowledge
  • Language/cultural barriers
  • Bad decisions/noncompliance
57
Q

Psych meds in dementia pts….

A
  • Take up to a month to work

- Often need multiple adjustments

58
Q

What is the best management for behaviors?

A

Prevention!

59
Q

Strategies to combat confusion?

A
  • Keep pt up for all meals
  • Keep shades open
  • Stay awake during daytime hours
  • Follow a routine
  • Stay out of bed as much as possible
  • Have family visit & support staff
  • Consider activity boards/sitting in the hall
  • Avoid middle of the night labs/tests
  • Work w/ pt. (don’t force tx)
60
Q

Goals of HCP as an advocate for elderly pt.

A
  • Return pt. to prior functioning
  • Preserve dignity
  • Include them in decision making
  • Take a holistic approach
61
Q

It is important for an elderly pt. to do what before something serious happens

A
  • Establish a POA

- Create their own advanced directive

62
Q

Social work is often a member of the hospital _______ team

A

Bioethics

63
Q

The bioethics team must consider

A
  • POA issues
  • Guardianship
  • Available options & funding
  • Quantity vs quality of life
  • Should seniors be forced to follow medical rules vs. enjoying life?
64
Q

Where do we report abuse/neglect?

A

Department of aging

65
Q

Referrals to social work can help…

A
  • Maintain better long term outcomes for pts.
  • Increase compliance
  • Make our job easier
  • Let patients know you care

Geriatrics 2 (4 decks)

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