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3403: FINAL EXAM NEW CONTENT Exam Q&As Caregiving - Correct Answers ✅-Families and other unpaid caregivers provide the majority of care for older adults in the United States -Informal care provided by caregivers is the foundation of the long-term care system -Caregiving is considered a major public health issue -Increased attention is being given to the physical and mental health of caregivers -34.2 million Americans have provided unpaid care to an adult over 50 in the last year Caregivers - Correct Answers ✅-75% are female -average duration of the role is 4 years -70% of working caregivers have work related difficulties because of their caregiver role -40-70% of caregivers have clinically significant symptoms of depression -children (~40%), spouses (~38%) and other family or friends (~20%)
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Impact of Caregiving - Correct Answers ✅Caregivers are considered to be "hidden patients" -there can be negative psychological, economic, and physical effects of caring for a person who is impaired -Increased levels of depression and anxiety -Poorer self-reported physical health -Compromised immune function -Increased mortality rates -Higher rates of insomnia -Increased alcohol use several circumstances are associated with caregiving issues: - Correct Answers ✅-competing role responsibilities (job, children) -insufficient resources -living in the same house as person they're caring for -financial burdens
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-What are some things you think spousal caregivers might be prone to? Loneliness, depression, increased risk of dying -role changes that might have to occur Spousal Caregiving: Spouse might need to learn to - Correct Answers ✅WIFE: -Drive -Manage money -Make decisions by themselves HUSBAND: -Cook -Shop -Do laundry -Provide personal care to their wives Care for Those With Dementia - Correct Answers ✅-Caregivers of those with dementia provide more hours of help, for a longer time, than caregivers of other older people
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-Twice as many indicate substantial negative aspects of caregiving, including financial, emotional, and physical difficulties -Demands of caregiving are intensified if there are behavioral disturbances and impairments in activities of daily living Caring for Disabled Adult Children - Correct Answers ✅-An increasing number of disabled children are surviving into adulthood and outliving their parents -Often, the parent has been a caregiver the person's entire adult life, ending only with the death of the parent or the adult child -Challenges include -Financial resources -Health of caregiver -How child will be cared for after aging parent's death Long-Distance Caregiving - Correct Answers ✅-Because of the increasing mobility of today's global society, more children are providing help "long distance"
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-Linkages to ongoing support and resources -Counseling -Relief and respite from daily care demands -Stress management Reducing Caregiver Stress - Correct Answers ✅ Grandparents Raising Grandchildren - Correct Answers ✅-An increasing number of grandparents are raising grandchildren -Reasons grandparents are raising grandchildren vary among countries, groups, and individuals -There are both blessings and burdens, and each caregiver's experiences are unique -Nurses need to screen grandparents for distress and offer support, advice, and referral to reduce stressors Interventions with Grandparent Caregivers - Correct Answers ✅
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Discharge Planning - Correct Answers ✅Discharge planning begins with the initiation of care and includes the family. You are responsible for an accurate assessment of who will provide caregiving and what will be needed for care in the home at the time of discharge. Consider how the patient's physical and/or cognitive limitations will affect daily living activities and the impact this will have on the family. For example, if a patient who is an older adult is discharged to home after surgery and the patient's spouse cannot perform required dressing changes, you need to find out if anyone else in the family or neighborhood is willing and able to do this. If not, you will need to arrange for a home care referral. If the patient also needs exercise and strength training, you consult with the primary health care provider to recommend referral for physical therapy. Elder mistreatment - Correct Answers ✅maltreatment of older adults, including physical, sexual, and psychological abuse, and financial exploitation and neglect More Likely to Abuse or Neglect - Correct Answers ✅• Family member
- One with emotional or mental illnesses
- One who is abusing alcohol or other substances
- History of family violence
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Gerontological Nursing Roles: Generalists - Correct Answers ✅Work in hospitals, homes, or subacute and long-term facilities or in the community providing care to individuals and their families Acute Care Nurses - Correct Answers ✅-Most nurses working in acute care are caring for older patients, although many have not had gerontological nursing content -Function in the direct care provider role; as care managers, discharge planners, care coordinators, or transitional care nurses; or in leadership and management positions Community and Home-Based Care Nurses - Correct Answers ✅-Perform comprehensive assessments, including physical, functional, psychosocial, family, home, environmental, and community -Provide and supervise care for those with a variety of care needs and for those receiving rehabilitation, palliative, and hospice services -Advances in technology affecting how older adults age in place; remote monitoring of health and safety
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Case Management - Correct Answers ✅-Care that is well managed is a solution to both increasing costs and fragmentation of care -Definition: "a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost- effective outcomes." -Example: case manager coordinates patient's acute care in hospital, follows up after discharge to home, rehab, LTC. Does not provide direct care. May oversee a caseload of patients with complex nursing and medical problems; may be APN Role of nurse in case management - Correct Answers ✅-Advocate, broker, leader, manager, counselor, negotiator, administrator, and communicator -Ideally follows the person through the entire continuum of care -Needs to know community resources, make appropriate referrals, and monitor quality of arranged services -Serve as resource person for advice, counsel, and arranging services -May help reduce 30-day readmissions, thus saving $$
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Residential care and assisted living - Correct Answers ✅-For those who cannot live independently but do not need skilled nursing care and monitoring -Choice of services (depending on needs) -Fastest growing housing option for older adults Profile of the typical resident living in Assisted Living - Correct Answers ✅- years old -Female (74%) -Requires assistance with 2-3 ADLS -Needs help with meal preparation (87%) -Needs help with medication management (81%) -45-67% have Alzheimer's disease or other form of dementia -Average length of stay= 22 months -59% move to a nursing home -33% die while a resident of Assisted Living facility Advantages of Community care services - Correct Answers ✅-Home is least restrictive
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-PACE allows people to live at home -Adult daycare provides respite for family members if person lives with them -Continuing care communities allow transitioning between levels of care without disrupting moves -Assisted living is more cost-effective than nursing home; more privacy and homelike environment; non-medical nature keeps costs lower Disadvantages of Community care services - Correct Answers ✅-Private pay for continuing care communities; can be expensive -Medicare does not pay for adult day care and assisted living -Some adult day care is private pay, some Medicaid and waiver programs -Assisted living (AL) may be covered by Medicaid and state waiver programs for low income people (See Table 6.1 on p. 67 for costs) -Services can be brought into AL, but does this substitute for 24-hour supervision by RNs? Not all states require an RN in an AL facility. Is quality care given? Skilled Nursing Facilities - Correct Answers ✅-Complex health care setting that are a mix of hospital, rehabilitation facility, hospice, and dementia- specific units
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-Residents of long-term facilities are predominantly women, 80 years or older, widowed, and dependent in activities of daily living and instrumental activities of daily living -Usually paid through Medicaid, LTC insurance or personal savings Long-Term Care - Correct Answers ✅-Describes a variety of services, including medical and nonmedical care, provided on an ongoing basis to people of all ages who have a chronic illness or physical, cognitive, or developmental disabilities -Long-term and post-acute care services are provided informally or formally in a wide range of environments Goals of Long-term care - Correct Answers ✅-Provide a safe and supportive environment -Restore and maintain highest practicable level of functional independence -Preserve individual autonomy -Maximize QOL, well-being, and satisfaction with care -Provide comfort & dignity at end of life -Provide coordinated interdisciplinary care to sub-acutely ill residents (planning to go home or to less restrictive environment
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-Stabilize and delay progression of chronic medical problems -Prevent acute medical and iatrogenic illnesses -Identify and treat acute problems and iatrogenic illnesses rapidly -Create a homelike environment -Respect the dignity of each resident see T &J, box 6.5, p 71 Cost of Long-Term Care - Correct Answers ✅-The average cost of a nursing home is $225 per day for semiprivate room, or $82,125 annually (Table 6.1) -Care is paid through -Medicaid (57%) -Medicare (14%) -Out of pocket, private insurance, other sources (29%) Quality of Care in Facilities - Correct Answers ✅-Long-term care facilities are highly regulated by state and federal laws -Omnibus Reconciliation Act (OBRA) of 1987
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usually no more than 1 to 3 months. Rehabilitation services are an essential component of post-acute units. Culture Change of Nursing Home Care - Correct Answers ✅-Nursing home care has changed from a medical model to a "home model" of nurturing, support, and empowerment of formal caregivers -Homelike setting does not look and function like a hospital -Allows person to make more decisions they are used to making for themselves -Shows greater respect for individuality and preferences Institution-Centered Culture - Correct Answers ✅-Staff & residents comply with schedules & routines designed by institution -Focus is on tasks needed to be done -Rotation of staff among units occur -Centralized decision-making with little involvement of staff & residents -Hospital-like environment -Structured activities provided to all residents
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(See Box 6.8, p 74, T &J, for additional factors) Person-Centered Culture - Correct Answers ✅-Emphasis on relationship between staff & residents -Individualized plans of care based on resident need, usual patterns & desires -Staff know residents & have consistent assignments -Decision-making as close to resident as possible -Homelike environment -Sense of community & belonging (See Box 6.8, p 74, T &J, for additional factors) Transitional Care - Correct Answers ✅-Moving the patient from one health care practitioner or setting to another as his or her needs or condition changes -Occurs for a variety of reasons -Re-hospitalizations -Infections
