Gerontology: Chapter 8

The Continuum of Care

Independent Living:

Older people may feel that by giving up their home, they are giving up their freedom & independence.

They may feel emotionally attached to a home that holds years of cherished memories.

They may like the neighborhood & not want to leave friends.

They may want to maintain a large house for when family & friends visit.

Many people, of all ages, either do not like or are even fearful of change.

As health care professionals:

We must respect competent older peoples’ wish to remain in their own homes, even if we do not believe that this is the best possible plan for them.

Garrett describes Violet. He concludes that while safety is crucial, the home environment should be of the person’s choosing if at all possible. Home improvements to in-crease safety may be a preferred alternative.

Lack of adequate income:

American Housing Survey reported (95): a third of the nations’ elderly reported not having enough money left over after housing expense for essentials like food, clothing and health care.

Reverse Mortgage Program:

Borrowers use their home as collateral, & the bank sets up either and annuity or a line of credit to be used as needed until the home is sold. This allows those with inadequate monthly income, but substantial home equity, to continue to reside in their own homes. When the older person decides to or needs to sell or he or she dies, the bank then recovers the investment.

A Home!

Apart from the spouse or life partner, a home may be the single most important factor in the life of an elderly person.

It is crucial that the home environment foster a sense of security & comfort. This is especially important for the remaining spouse after the death of a long-time partner. This is exactly when it may be difficult for the one left (usually a widow).

Elder decides to move with family:

Nearly 1 in 5 elderly who are not living in a group home reside in multigenerational households. This arrangement may have a cultural bias; studies have found that older people of southern, central & eastern Europe descent are more likely to reside with family.

In the US, research shows that most elderly people prefer not to live with their children.

Single Room Occupancy (SRO)

Usually widowed or unmarried. They are inexpensive & may be located in familiar neighborhoods. Rarely have a private bathroom or kitchen. Considered by some to be substandard housing.

Continuing Care Retirement Communities: (CCRCs) The person pays an entrance fee and a monthly

fee, and in return gets a home, & certain services. Homes are arranged in a small community--may be free-standing houses, condominiums, or apartments & can include residential treatment facilities to provide ongoing long-term care. Services may range from none to comprehensive health care services as needed.

Continuing Care Retirement Communities: (CCRCs) Type A: Extensive Type B: Modified

contract Type C: Fee-for-

service

Disadvantages of CCRC’s

Cost is still out of reach for many elderly Financial risk – like an insurance policy Lack of uniform standards on regulations Do not accept all applicants

– 60% (incontinent)

– 90% (unable to perform one or more daily living tasks)

May be tight-knit, made up of senior citizens

Congregate Housing:

Includes independent living units, adult congregate living facilities, rental retirement housing, & senior retirement centers.

Sometimes subsidized by state & federal government programs.Generally do not offer personal assistance or health services, although resident may be eligible for home care services through an outside agency. Often offer group dining & socializing centers.

Assisted Living Centers: Residential care: Bridging the gap between independent living

and 24-hour-a-day nursing care. Defined: a special combination of housing &

personalized health care (services) designed to respond to the individual needs of those who need help with activities of daily living (ADLs). Care is provided in such a way that promotes maximum independence & dignity for each resident.

Board and Care Facilities:

Tend to be located in older, larger, single family homes.

Provide meals, transportation, other services, and “protective oversight” as needed.

Problems with assisted living centers:

Lack of adequate licensing, inspection,& enforcement of these facilities may put residents in danger of abuse or neglect. Governmental agencies blame this deficiency on limited financial resources.

Lack of public funding, again causing this vital resource to be financially out of reach for many elderly people who need exactly this type of arrangement.

More problems…..

There is no training or education required for residential care operators. Therefore some caregivers may be ill equipped to care for older people who have physical problems, mental illness or dementia.

The cost per month can vary from $20 to more than $200 per day, with an average cost of $72 per day(1995)--also charge an initial deposit.

Home Health Care:

Fastest growing industry in the U.S.

Expansion due to the rise of managed care, which focuses on moving people out of the more costly health care settings, such as hospitals, as quickly as possible.

Home Health Care Agencies: >9000 that are Medicare certified Offer therapies (occupational, physical) respiratory, speech, home health care aides,

social work intervention, psychological & nutritional counseling & nursing care.

Rehabilitation health care service providers arrange for an acute level of rehabilitation in the person’s home.

In 1995, 10 million required home care services. Impact of managed care.

Rehabilitation: process of restoring someone -- To their highest possible

level of functioning after an injury or illness.

A combination of rehabilitation specialists, nurses, & therapists, work with patients or clients.

Patients generally have 3+ hrs. therapy/ day x5 days/week

Long-Term Care

Because of their physical or cognitive impairments, others must assist them in completing their daily tasks.

It is a 24 hr. day job. Caregiver needs

support in order to get rest and relief.

Adult Day Care Programs

Provides a break for caregivers during the day by offering health & social services & supervision for the elderly person who is not safe when left alone.

Nursing Homes:

Provide round-the-clock care through the use of paid caregivers, nurses & CNAs.

1.6 million in U.S. reside in nursing homes. 1 out of 3 people will become nursing home resident sometime in their life.

1987:Omnibus Budget Reconciliation Act (OBRA) All nursing homes must have quality assurance

programs. Facilities must provide enough staff for residents to

attain (& maintain) the highest functional level possible.

Registered nurses must be available 8 hrs a day 7 days a week.

Aides must be certified. All new residents must have a clear & individualized

plan of care. Assessment forms must be filled out within 4 days.

OBRA

Restraints are to be used minimally & only under doctors’ orders.

There is a residents’ bill of rights, which includes their right to refuse any medication or treatment.

If not followed, they can lose their Medicare/Medicaid certification.

Housing & Health Connection:

Independence Empowerment Social & emotional

support Purposeful activity Accessibility

Independence:

Some view as living comfortably without needing regular assistance from anyone else, others viewed it as living in one’s own apartment or home, & the ability to make one’s own decisions.

Empowerment:

Closely related to independence. It relates not only to older people’s ability but also to the privilege of making choices that affect their own lives.

Older person wanted to make choices about, their own lives-- The type of environment in which they live

(housing in general). Where they would go if they needed

additional care (continuity of care). Control over their day-to-day lives

(reflecting their personal view of independence).

Social Support Theory:

Theory that those who are lacking adequate social support systems are more susceptible to disease because of a decrease in functioning of the body’s immune system. During tense times, the love & support of other people can decrease stress & may also help to increase a person’s sense of control.

Reminiscence Sessions:

Can give the person the opportunity to speak about their personal history & experiences. Elderly people often enjoy talking about their past & processing their feelings through this sort of life review.

Intergenerational, social interaction programs also valuable, especially if grandparents live away from grandchildren.

Purposeful Activity:

Lack of participation leads not only to physical but also cognitive & emotional decline. It can lead to premature physical death and premature death of the spirit.

Accessibility:

A supportive environment fosters comfort, safety & ease of movement.

Environmental design falls into 2 categories:

Building new, accommodating structures

Adapting existing structures

Adaptation & Compensation: Raised toilet seats & grab bars tacking down or eliminating

scatter rugs better lighting shower seats no excess furniture smoke alarms resetting water heater to 120F removing door thresholds move items within reach

Physical Therapy:

Transfer into & out of the tub or shower safely Use a walker or cane to accommodate for decreased

balance Use safer techniques when using kitchen appliances Use new, more effective techniques for completing daily

activities Use joint protection & energy conservation techniques Compensate for the physical changes of aging (eyesight,

memory, hearing)