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Gerontology: Chapter 8


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. – PowerPoint PPT presentation

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Title: Gerontology: Chapter 8

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
  • 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
  • Garrett describes Violet. He concludes that while
    safety is crucial, the home environment should be
    of the persons 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

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

Continuing Care Retirement Communities (CCRCs)
  • Type A Extensive
  • Type B Modified contract
  • Type C Fee-for-service

Disadvantages of CCRCs
  • 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
  • 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

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 gt9000 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 persons 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
  • Patients generally have 3 hrs. therapy/ day x5

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

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

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.

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

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

Housing Health Connection
  • Independence
  • Empowerment
  • Social emotional support
  • Purposeful activity
  • Accessibility

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

  • Closely related to independence. It relates not
    only to older peoples ability but also to the
    privilege of making choices that affect their own

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
    bodys immune system. During tense times, the
    love support of other people can decrease
    stress may also help to increase a persons
    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.

  • 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
  • Use safer techniques when using kitchen
  • Use new, more effective techniques for completing
    daily activities
  • Use joint protection energy conservation
  • Compensate for the physical changes of aging
    (eyesight, memory, hearing)