Gerontological

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Gerontological Community Based Nursing

• Care across the continuum
• Professor Adrianne Maltese

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Housing Options for Older Adults

• Elder friendly Communities
• Shared Housing (adult children share)
• Cohabitation- Group homes(share home W/older
  adult/intergenerational)
• l

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Benefits- Elder friendly communities

• Address Basic needs
• Optimize Physical Mental Well being
• Promote Social Civic Engagement
• Maximize independence for frail/disabled

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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

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Adult day Care Services

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

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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 Facilities
• Assisted living

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Other housing choices/costs

• Foster care
• Residential Care facilities
• Assisted living
• Continuity car Residence Communities
• Population specific Communities
• Nursing Homes

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Coalition of Nursing Home Reform

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

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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

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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

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Loss Grief

• Loss -gtgrief-gtprocess of bereavement
• Grief is the individuals response to a loss and
  mourning is an active and evolving process that
  includes those behaviors used to incorporate the
  loss experience into ones life after the loss.

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Loss, Grief End of Life Care

• Wordens 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

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Loss , Grief End of life

• Jetts Loss Response Model - incorporates a
  systems approach
• Loss-gt 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

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Types of Grief

• Anticipatory grief -gtpremature 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-gtfunctional 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

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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?

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Implications for nursing care

• Goal- to attain healthy adjustment to the loss
  to reestablish equilibrium
• Interventions -
• Gently establish rapport
• Offer reasonable hope /emotional support
• Offer support for functional disruption
• Provide information about the disease that may
  help person to process the loss.
• Allow/encourage grievers to inform others
• Facilitate elder to reorganize their life
• Guide encourage the reframing of memories

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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
  physiologicaldeath.

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Needs of the Dying their Families

• The 6 Cs Approach to caring for the dying
  their families -
• Care - best possible care
• Control - active participant in own care
• Composure -within the realm of ones culture
• Communication- 4 types of communication
  identified (Closed awareness,suspected
  awareness,mutual pretenseopen awareness
• Continuity - establish legacies
• Closure - corresponds with reconciliation
  transcendence

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Palliative VS. Hospice Care(ANA-ELNEC)

• No hospitalization
• Focus on comfort vs. cure
• No invasive procedures

• Hospice orgs. provide medical,nursing,nurse
  assistants,chaplain,
• social worker
• 24 hr support pt family
• Bereavement services

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Nursing Interventions
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Nursing Interventions

• Encourage discussion of end- of-life
• Decisions re type of care
• Advance directives
• Euthanasia - Active vs. passive.