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Chapter 19: Global Models of Health Care

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Chapter 19: Global Models of Health Care Introduction Meeting the needs of a rapidly growing older adult population is challenging worldwide Will compare models of ... – PowerPoint PPT presentation

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Title: Chapter 19: Global Models of Health Care


1
Chapter 19 Global Models of Health Care
2
Introduction
  • Meeting the needs of a rapidly growing older
    adult population is challenging worldwide
  • Will compare models of healthcare to provide
    insights into how to meet these challenges

3
Background
  • Japan
  • By 2020, the 65 and older population will
    comprise 27 of the total population
  • USA
  • The elderly are expected to make up 16.6 of the
    total population in the United States
  • Italy
  • Just over 24 of the population will be 65 or
    older

4
Japan
  • Currently, the elderly in Japan enjoy the highest
    life expectancy in the world.
  • 1970s free elder care, but was terminated in 1982
  • Gold Plan (1989)
  • Home help
  • Short-stay institutions
  • Day services
  • Education regarding normal aging
  • Long-Term Care Insurance program (2000)
  • 65 or older pay 10 of nursing costs monthly
    premium
  • Can choose among agencies providing services
  • Emphasis on caring for elders at home due to
    overuse of hospitals elder abuse addressed as a
    potential problem

5
Germany
  • 1st country to establish a national health care
    program
  • Solidarity Principle members of society are
    responsible for providing adequately for
    anothers well-being through collective action.
  • PCP is gatekeepers to hospital access
  • In 1995, those age 60 and older comprised 21 of
    the German population
  • By 2030, 36 of the population will be 60 years
    of age and older
  • LTC coverage in Social Security System coverage
    is mandatory created to relieve financial
    burden of long-term disability and illnesses
  • Most German elders still cared for at home by
    relatives

6
England
  • National Health Service (NHS)
  • Universal system of health care based on clinical
    need
  • Care is free at point of care
  • PCPs are independent contractors
  • 75 of the funding for the health care comes from
    taxes
  • Nearly 100 have access but long waits
  • Secondary care referral to specialists or
    hospitals for care

7
Canada
  • Health care system known as medicare
  • Universal coverage at no cost at the point of
    access
  • Each of the 10 provinces responsible for
    provision of health care services
  • Services based on need
  • Funded primarily through taxes
  • MD in private practice
  • Hospitals primarily not-for-profit
  • Long wait times
  • Vision, dental and meds covered for seniors

8
U.S. Health Care System and Policies
  • Effects of an Aging Society
  • By the year 2050, 30 of the population will be
    over the age of 65 years
  • The population over the age of 85 is expected to
    double

9
Effects of Morbidity and Mortality
  • Life expectancy is 77.1 in the U.S.
  • This is behind many other countries including
    Japan, Singapore (highest at 80 years), Canada,
    Australia, Italy and others
  • Number of chronic illnesses increases with aging
    population requiring interdisciplinary team with
    expertise in geriatrics to meet the physical and
    psychosocial consequences

10
Social Security
  • Federal old-age pension program
  • Mandatory participation through payroll
    contributions
  • Fewer benefits than many other industrialized
    nations
  • Delayed retirement credit (DRC)
  • 75 of poor elderly are women who depend on
    social security as main source of income
  • Women are 60 of recipients at age 65

11
Medicare
  • Through Social Security Act to provide some kind
    of universal health care insurance for elderly
    and those with ESRD
  • Part A Hospital insurance
  • Inpatient care
  • Skilled nursing facility
  • Hospice care
  • Home health
  • Part B Supplemental medical insurance
  • Lab
  • Home health
  • Doctor visits
  • Some outpatient therapies
  • Mental health services
  • Outpatient hospital services

12
Medicare (contd)
  • Part C
  • HMO
  • PPO
  • Part D
  • Prescription drug plan
  • Does now cover some screenings

13
Medicaid
  • Financed by state and federal government
  • Administered by state Coverage and eligibility
    differ from state to state
  • Three types of protection
  • Health insurance for low-income families and
    people with disabilities
  • LTC for older Americans and persons with
    disabilities
  • Supplemental coverage for low-income Medicare
    beneficiaries for services not covered by
    Medicare
  • LTC insurance available but very expensive

14
Settings for Care in the U.S.
  • Acute Care
  • Long-Term Care
  • Home Care
  • Assisted Living

15
Chapter 20 The Interdisciplinary Team
  • Bonnie M. Wivell, MS, RN, CNS

16
Introduction
  • Elderly deal with
  • Normal age changes
  • Impact of chronic illness
  • Realities of real or potential changes in
    function and/or cognition
  • Interdisciplinary Team
  • Diverse skills and expertise
  • More effective, better coordinated, and better
    quality services

17
Teams
  • Multidisciplinary
  • Team members with expertise in certain areas
  • Individual goals
  • Interdisciplinary
  • Different disciplines with common goals
  • Complex problem solving/more effective treatment
  • Interdependent in their work
  • Share accountability for outcomes
  • Coordination and integration of care assessment
    and planning
  • Patient seen as a whole
  • See pages 655-658 for various members

18
Why Teams Are Needed
  • IOM Crossing the Quality Chasm report from 2001
  • Effective teams have a culture that fosters
    openness, collaboration, teamwork, and learning
    from mistakes.
  • Mandated interdisciplinary education in its
    publications
  • For patient safety and quality of care
  • Assessment, Consultation, Management

19
Types of Teams
  • GITT Geriatric Interdisciplinary Team Training
  • Established in 1994 by John A. Hartford
    Foundation
  • An organized training program for professionals
    of various disciplines focused on learning about
    working in teams, use of teams in gerontology
  • Development of a core curriculum in
    interdisciplinary training

20
Types of Teams
  • GAIT Geriatric Assessment Interdisciplinary Team
  • An interdisciplinary training model developed in
    Maryland as elective for student education from
    various healthcare disciplines
  • GAT Geriatric Assessment Team
  • Consultation team that evaluates functional,
    social, fall risk, nutrition, medication,
    depression, cognition, and incontinence problems
  • Inpatient or Outpatient
  • Underutilized

21
Types of Patient Care Units
  • GEM Geriatric Evaluation and Management
  • ACE Acute Care for Elders
  • Designated inpatient units wherein the elderly
    are assessed and treated
  • Staffed with geriatric team members
  • Units show better outcomes
  • Patients more likely to be discharged home

22
Palliative Care Hospice
  • Active across care settings where geriatric teams
    are also found
  • Goal of Palliation to prevent and relieve
    suffering and to provide the best possible QOL
    for patients and their families regardless of the
    stage of disease or need for other therapies
  • Address EOL physical, psychosocial, and spiritual
    issues
  • Ease transition from purely curative care to
    supportive care
  • Care goals determined by patient and family

23
Challenges
  • Socialization to team approach
  • Identified roles
  • Trust and respect
  • Inconsistent team members
  • Accreditation issues
  • Reimbursement
  • Shared power
  • Turf issues

24
Benefits
  • More comprehensive approach to care
  • Increased patient and team member satisfaction
  • Increased quality of care
  • More cost effective
  • Avoid redundancy of services
  • Education of other team members
  • New skills
  • Increased productivity
  • Potential for time saving

25
Chapter 23 The Gerontological Nurse as Manager
and Leader
  • Bonnie M. Wivell, MS, RN, CNS

26
The Nurse Manager
  • All geriatric nurses need to develop management
    skills
  • A unique position to improve quality, positive
    outcomes, and cost-effectiveness of patient care
    in a variety of settings
  • Multitude of tasks
  • Ensuring quality nursing care
  • Patient and family satisfaction
  • Staff retention
  • Commitment
  • Contentment

27
Characteristics of an Effective Nurse Manager
  • Organized
  • Consistent
  • Fair
  • Optimistic
  • Goal-oriented
  • Flexible
  • Creative
  • Resourceful
  • Professional
  • Standard-setter
  • Trustworthy
  • Honest

28
Delegation
  • Managerial and legal act
  • Skill that must be learned and practice
  • Licensed nurse are still accountable for the
    well-being and safety of the patients entrusted
    to them
  • Inappropriate use of unlicensed assistive
    personnel (UAP) in performing functions outside
    their scope of practice is a violation of the
    state nursing practice act and is a threat to pt.
    safety. The RN has an increased scope of
    liability when tasks are delegated to a UAP.

29
The Delegation Process
  • Right Task
  • Right Circumstances
  • Right Person
  • Right Direction/Communication
  • Right Supervision

30
Skills of Nurse Managers
  • Team building
  • Goal setting
  • Facilitating change
  • Stress management
  • Decision-making
  • Conflict resolution
  • Expertise
  • Communication
  • Listening
  • Inspiring trust

31
The Nurse Leader
  • Effective leaders are often good managers
  • However, a good manager is not always a good
    leader
  • Leaders tend to be visionaries who focus on the
    larger picture
  • Managers focus on day-to-day operations
  • Leaders can be mentored to be more effective
    managers

32
Leadership Strategies
  • Transactional leading by an inconsistent system
    of rewards and consequences
  • Transformational leading by example,
    encouragement, and empowerment of the staff
  • Strategies
  • See past the present
  • Using good communications techniques
  • Trust through positioning
  • Development of self

33
Charismatic Leader
  • Characterized by their determination to change
    the current state of affairs accompanied by an
    awareness of forces in the environment and their
    followers needs
  • 3 stages
  • Determine the conditions that cause change and
    recognize followers
  • Encourages followers to partake in the vision
  • Ability and desire to go above and beyond

34
Leadership styles
  • Authoritarian leader makes decisions with little
    input from staff
  • Democratic welcome the input from staff and
    believe their opinions are important
  • Laissez-faire relaxed go with the flow
  • Situational choose style based on the situation

35
Leadership in a Multigenerational Age
  • Traditional professional nurses
  • Born pre-1945
  • Seniority and loyalty are important
  • Hard work, pride in doing a good job, working
    together, financially conservative, and cautious
  • Many of these nurses were trained in
    hospital-based diploma program Baby Boomers
  • The Baby Boomers (born 19451964)
  • Represent the largest percentage of the nursing
    workforce
  • Hold many nursing leadership positions
  • They challenged and changed the values held by
    the veteran nurses
  • Sense of professionalism and view of nursing as a
    career

36
Leadership in a Multigenerational Age
  • Generation X (Born 19641980)
  • Parents worked latch key children
  • Saw their parents laid off from work after
    sacrificing their time with their children to
    advance their careers
  • Value work-life balance
  • Want career security and flexibility
  • The Millennial or Net Generation (Born 19802000)
  • Raised during a time of violence, terrorism, and
    drugs
  • Embrace multiculturalism and technology
  • Nursing is an occupation versus a profession
  • May have as many as 10 career changes (not job
    changes) in their lifetime
  • Strengths are competence in technology and
    expectations of virtual teams

37
Professional Organizations
  • Provide quality care to patients and offers the
    latest information in gerontology
  • NGNA AHCA
  • NADONA/LTC ACHC
  • AANEX AMDA
  • AALTCN NAHCA
  • AANAC AAHSA

38
Chapter 25 Trends That Impact Gerontological
Nursing
39
Educational Levels
  • LPN, ADN, BSN
  • Advanced practice
  • GCNS-BC
  • GNP
  • The ANCC changed the advanced practice
    designations to help better distinguish between
    the various specialties of APRNs
  • CNL ill-defined
  • Doctorates
  • PhD
  • DNP
  • The DNP is the proposed new entry level into
    advanced practice nursing as of 2015

40
Life Care Planning
  • A life care plan is a comprehensive document
    designed to help meet the long-term financial and
    health needs of a person who has experienced a
    catastrophic injury (Weed, 1999).
  • Assist with determination of settlements in
    litigation
  • Nurses with rehabilitation backgrounds or case
    management experience are well-suited for this
    role
  • Certifications available
  • CLCP
  • 128 CE hours
  • Sample life care plan
  • Pass an exam
  • Can be earned by nurses or any other disciplines
    as well
  • CNLCP
  • The planner is a nurse
  • Strict prerequisites
  • Large number of practice hours

41
What is Financial Gerontology?
  • Combines the knowledge and skills associated with
    financial planning and asset management with
    expertise in meeting the unique needs of older
    adults (i.e. finances, money/asset management,
    insurance needs, living arrangements)
  • An emerging field
  • Relates gerontological concepts, issues, data and
    research findings to financial services
  • Three certifications
  • Chartered Advisor for Senior Living
  • Registered Financial Gerontologist
  • Certified Senior Advisor

42
Trends in LTC
  • The broad range of medical, custodial, social,
    and other care services that assist people who
    have an impaired ability to live independently
    for an extended period
  • 183 billion spent on LTC services in 2003
  • In 2005 Medicaid spent nearly 95 billion
  • Use up savings and other financial assets before
    eligible for Medicaid

43
Long-Term Care Insurance
  • Covers care outside the hospital, including
    diagnostic testing, rehab, custodial care,
    nursing home, assisted living, hospice, home
    health, adult day care, and respite care
  • Purchase to decrease worry about being a burden,
    stay financially independent, have more choices
    for care, preserve assets and provide peace of
    mind
  • Can be purchased at any time but premiums
    increase with age

44
Emerging Models of Care
  • Continuing care retirement communities (CCRCs)
  • A community living setting or situation designed
    for older adults that offers a continuum of care
  • Green Houses
  • 10-12 residents in home setting who enjoy private
    rooms and common living space
  • Full range of care services

45
Emerging Models of Care
  • Professional Geriatric Care Manager (PCGM)
  • A professional who specializes in helping
    families care for older adults while encouraging
    independence
  • Community living designs
  • Concept that focuses on designing, building,
    engineering, and marketing to older adults,
    especially in senior living communities

46
Summary
  • The U.S. population over age 65 is projected to
    double by 2035
  • The first baby boomers are beginning to enter the
    senior market
  • The older age groups are becoming more
    heterogeneous
  • With more older adults in the population, demand
    for services is likely to increase

47
Summary
  • Financial planners are taking courses in aging to
    cater to the older client, but is this an area
    that gerontological nurses should be working in?
  • New models of care are beginning to emerge and
    there will likely be additional models to meet
    the needs of the baby boomers as they enter older
    age

48
Helpful Websites
  • www.geriatricpain.org
  • www.nursingsociety.org/gerontology
  • www.hartfordign.org
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