Gerontological & Community Based Nursing

Gerontological & Community Based Nursing

Care across the continuum

Professor Adrianne Maltese

Care across the continuum

Professor Adrianne Maltese

Housing Options for Older Adults

Housing Options for Older Adults

Elder friendly Communities Shared Housing (adult & children

share) Cohabitation- Group homes(share

home W/older adult/intergenerational)

l

Elder friendly Communities Shared Housing (adult & children

share) Cohabitation- Group homes(share

home W/older adult/intergenerational)

l

Benefits- Elder friendly communities

Benefits- Elder friendly communities

Address Basic needs Optimize Physical & Mental Well being Promote Social & Civic Engagement Maximize independence for

frail/disabled

Address Basic needs Optimize Physical & Mental Well being Promote Social & Civic Engagement Maximize independence for

frail/disabled

New Models of Community Care

New Models of Community Care

PACE (All inclusive care for elders) Capitated system Cost - monthly for all inclusive care Must meet requirements for

nursing home admission Paid for by

Medicare/Medical/Medicaid

PACE (All inclusive care for elders) Capitated system Cost - monthly for all inclusive care Must meet requirements for

nursing home admission Paid for by

Medicare/Medical/Medicaid

Adult day Care ServicesAdult day Care Services

Community based programs Provides social & health services Caregiver respite Dementia care

Community based programs Provides social & health services Caregiver respite Dementia care

Senior Retirement Communities

Senior Retirement Communities

Various economic levels /cost to consumer

Need for low-income public housing complex for older adults.

Other types:Foster care, Residential Care FacilitiesAssisted living

Various economic levels /cost to consumer

Need for low-income public housing complex for older adults.

Other types:Foster care, Residential Care FacilitiesAssisted living

Other housing choices/costsOther housing choices/costs

Foster care Residential Care facilities Assisted living Continuity car Residence

Communities Population specific Communities Nursing Homes

Foster care Residential Care facilities Assisted living Continuity car Residence

Communities Population specific Communities Nursing Homes

Coalition of Nursing Home Reform

Coalition of Nursing Home Reform

Issues to be dealt with: Public - negative views Lack of support & respect Inadequate caregiver salaries Poorly staffed ->unrealistic workload Frail -very sick elders Creating home environments

Issues to be dealt with: Public - negative views Lack of support & respect Inadequate caregiver salaries Poorly staffed ->unrealistic workload Frail -very sick elders Creating home environments

Principles of Culture Change in Nursing homes

Principles of Culture Change in Nursing homes

Empower staff Involve residents in their care/decision

making Provide individualized care Built relationships Provide sense of community & belonging Engage resident in meaningful activities Create a homelike environment Respect for all staff and the value of caring

Empower staff Involve residents in their care/decision

making Provide individualized care Built relationships Provide sense of community & belonging Engage resident in meaningful activities Create a homelike environment Respect for all staff and the value of caring

Omnibus Reconciliation Act 1987 (OBRA)

Omnibus Reconciliation Act 1987 (OBRA)

OBRA - mandated MDS -Minimum Data Set Increased training requirements Elimination of use of meds/restraints Bill of Rights for Long Term Care

residents

OBRA - mandated MDS -Minimum Data Set Increased training requirements Elimination of use of meds/restraints Bill of Rights for Long Term Care

residents

Loss & GriefLoss & Grief

Loss ->grief->process of bereavement

“Grief is the individual’s response to a loss and mourning is an active and evolving process that includes those behaviors used to incorporate the loss experience into one’s life after the loss.”

Loss ->grief->process of bereavement

“Grief is the individual’s response to a loss and mourning is an active and evolving process that includes those behaviors used to incorporate the loss experience into one’s life after the loss.”

Loss, Grief & End of Life Care

Loss, Grief & End of Life Care

Worden’s Model 2003- “grieving process series of evolving tasks”

Acceptance stage -person accepts of reality of loss

Working stage - person works through physical & emotional pain

Adjustment stage - person adjusts to a change in environment

Relocation of loss - person is able to emotionally move on with life

Worden’s Model 2003- “grieving process series of evolving tasks”

Acceptance stage -person accepts of reality of loss

Working stage - person works through physical & emotional pain

Adjustment stage - person adjusts to a change in environment

Relocation of loss - person is able to emotionally move on with life

Loss , Grief & End of lifeLoss , Grief & End of life

Jett’s Loss Response Model - incorporates a systems approach

Loss-> stage of disequilibrium Search for meaning of loss Story of loss is told repeatedly(this helps in the grieving process) Adaptation & accommodation of new

roles

Jett’s Loss Response Model - incorporates a systems approach

Loss-> stage of disequilibrium Search for meaning of loss Story of loss is told repeatedly(this helps in the grieving process) Adaptation & accommodation of new

roles

Types of GriefTypes of Grief Anticipatory grief ->premature detachment =

sociological death; premature withdrawal of a person =psychological death

Acute grief - a crisis. - person feels physically sick & is emotionally distressed - preoccupied with the loss->functional disruption - intense for first 3 months

Chronic grief - may temporarily inhibit activities; intermittent pain of grief -exacerbated on anniversary dates.

Pathological chronic grief - c/b excessive & irrational anger, insomnia, major depression

Anticipatory grief ->premature detachment = sociological death; premature withdrawal of a person =psychological death

Acute grief - a crisis. - person feels physically sick & is emotionally distressed - preoccupied with the loss->functional disruption - intense for first 3 months

Chronic grief - may temporarily inhibit activities; intermittent pain of grief -exacerbated on anniversary dates.

Pathological chronic grief - c/b excessive & irrational anger, insomnia, major depression

Implications for nursing care

Implications for nursing care

Assessment “tell me about recent events in your life”Look for concurrent stressors“what spiritual beliefs do you hold in

relation to death?”

Assessment “tell me about recent events in your life”Look for concurrent stressors“what spiritual beliefs do you hold in

relation to death?”

Implications for nursing care

Implications for nursing care Goal- to attain healthy adjustment to the

loss ; to reestablish equilibrium Interventions - Gently establish rapportOffer reasonable hope /emotional supportOffer support for functional disruptionProvide information about the disease that

may help person to process the loss.Allow/encourage grievers to inform others Facilitate elder to reorganize their lifeGuide & encourage the reframing of

memories

Goal- to attain healthy adjustment to the loss ; to reestablish equilibrium

Interventions - Gently establish rapportOffer reasonable hope /emotional supportOffer support for functional disruptionProvide information about the disease that

may help person to process the loss.Allow/encourage grievers to inform others Facilitate elder to reorganize their lifeGuide & encourage the reframing of

memories

Conceptual Models -Death & Dying

Conceptual Models -Death & Dying

Living-Dying Interval - (Pattion 1977) -the time between first learning about the impending death “crisis knowledge until the time of the actual “physiological”death.

Living-Dying Interval - (Pattion 1977) -the time between first learning about the impending death “crisis knowledge until the time of the actual “physiological”death.

Needs of the Dying & their Families

Needs of the Dying & their Families

The “6 C’s Approach to caring for the dying & their families -

Care - best possible care Control - active participant in own care Composure -within the realm of one’s culture Communication- 4 types of communication

identified (Closed awareness,suspected awareness,mutual pretense;open awareness

Continuity - establish legacies Closure - corresponds with reconciliation &

transcendence

The “6 C’s Approach to caring for the dying & their families -

Care - best possible care Control - active participant in own care Composure -within the realm of one’s culture Communication- 4 types of communication

identified (Closed awareness,suspected awareness,mutual pretense;open awareness

Continuity - establish legacies Closure - corresponds with reconciliation &

transcendence

Palliative VS. Hospice Care(ANA-ELNEC)

Palliative VS. Hospice Care(ANA-ELNEC)

No hospitalization Focus on comfort

vs. cure No invasive

procedures

No hospitalization Focus on comfort

vs. cure No invasive

procedures

Hospice org’s. provide medical,nursing,nurse assistants,chaplain,

social worker24 hr support pt &

familyBereavement services

Hospice org’s. provide medical,nursing,nurse assistants,chaplain,

social worker24 hr support pt &

familyBereavement services

Nursing InterventionsNursing Interventions

Nursing InterventionsNursing Interventions

Encourage discussion of “end- of-life “

Decisions re: type of care Advance directives Euthanasia - Active vs. passive.

Encourage discussion of “end- of-life “

Decisions re: type of care Advance directives Euthanasia - Active vs. passive.