HCM 421 Midterm Review

Aging in Place

A term used to describe a person living in the residence of their choice, for as long as they are able, as they age. This includes being able to have any services (or other support) they might need over time as their needs change.

Labeling Theory

A theoretical perspective derived from symbolic interactionism, premised on the belief that people derive their self-concepts from interacting with others in their social milieu; in how others define us and react to us If person believes in labels given by others, may impact their well-being & self-esteem.

What is certification?

A voluntary process by which a nongovernmental agency grants a time-limited recognition to an individual after verifying that he or she has met predetermined and standardized criteria.

What is Accreditation?

A voluntary process of review that allows healthcare organizations to demonstrate their ability to meet regulatory requirements and standards established by a recognized accreditation organization such as ACHC.

Instrumental Activities of Daily Living (IADL's)

Activities considered necessary for independent living. IADLs include doing housework, cooking, doing laundry, grocery shopping, taking medication, using the telephone, managing money, and moving around outside the home

3 Main Theories of Aging

Activity, Continuity, & Labeling.

Where are services for acute conditions normally delivered?

Acute care may require a stay in a hospital emergency department, ambulatory surgery center, urgent care center, or other short-term stay facilities.

Senescence

Age-related loss of function. To clarify, mutation happens overtime during reproduction while senescence is in the here and now. Examples include worsening eyesight & hearing, joint pain, digestive issues

What are the basic differences between Medicare and Medicaid?

Medicare: finances health services for elderly, certain disabled, and late stage renal failure; run by federal gov. paid for by taxes; hospitals & insurance Medicaid: finances health services for the poor; state program with federal money; requirements for those are made by the states

Cohort

A generational group.

What are the main factors that impact aging?

- Disease can increase the speed and degree of changes - Lifestyle - Nutrition - Economic Status - Social Environment

What is the aging tsunami?

A term coined by Ken Dychtwald in "The Age Wave', refers to the rise in median age of the US workforce. This is due to baby boomers coming of age.

What is the greatest payer of LTC services?

Medicaid

What is the Disengagement Theory?

People naturally disengage as they age. This theory claims that it is natural and acceptable for older adults to withdraw from society.

NOT Examples of Normal Aging

- Can't think the same - Can't do like before - Can't get started - Can't seem to move on - Doesn't think it out at all - Can't place the person - Words won't come, not even later - Confused about past versus now

What are the universal physiological changes that all persons will experience with aging?

- Decreased night vision - Decreased muscle mass - Loss of hair pigment - Decreased lung vital capacity - Decreased height - Decreased gait speed

What are the visible signs of aging in the integumentary system?

- Hair loses color; hair loss occurs - Skin becomes dry and less elastic - Dark yellow or brown colors spots appear (senile lentigines aka liver spots) - Increased sensitivity to temp - Lines and wrinkles appear - Fatty tissue layer of skin diminishes - Nails become thick, tough, and brittle Lastly, because of the need of oxygen and nutrients, the elderly may experience: Weakness, dizziness, numbness in hands & feet, and rapid heart beat.

What triggers confusion in the elderly.

- Increased sensory impairment or loss e.g. sights and/or hearing - Anxiety and/or depression - Unfamiliar surroundings - Grief or loss (of significant person, role, ability, or social function) - Infection e.g. urinary tract infection - A full bladder, constipation, incontinence - Acute confusion - delirium

What are social problems with aging?

- Loss of income - Loss of close family - Loss of community - Social Isolation

What is Gerotranscendence?

A term coined by Tornstam in 1994. The concept describes the elderly selectively investing in some relationships while discarding others. They may disengage, but this is by choice and at will.

Who are the clients in long-term care? (5 groups)

1. Older Adults: Only 4.5% of those over 65 will be an LTC facility resident; health disparities among races & cultures 2. Children: birth defects, brain damage, mental issues; 18-64 major injury, illness, surgery complications 3. Young adults: disabled by neurological malfunctions, degenerative conditions, traumatic injury 4. Ppl w/ HIV/AIDS: once terminal, chronic condition, leaves person w/ debilitating illness 5. Ppl requiring sub-acute or high tech care: post-acute discharges from hospital or those on ventilators, comas, advanced Alzheimer's patients

Examples of Normal Aging

-Slower to think -Slower to do -Hesitates more -More likely to 'look before you leap' -Know the person but not the name -Pause to find words -Reminded of the past

Quality of Care

Achievement of desirable clinical and satisfaction related outcomes

What are the main areas of emphasis in OBRA-87? (Be somewhat familiar with this.)

1. Emphasis on both quality of life and quality of care 2. Expectations to improve ADL function 3. Care plans to be driven by comprehensive assessment 4. Training and testing of nursing assistants for certification 5. Right to remain in the nursing home barring unusual circumstances 6. Address the needs of residents with MR (ID) and mental illness 7. Right to have personal funds managed 8. Right to return to the nursing home after brief absence 9. Right to choose one's physician and access one's medical records 10. Right to organize resident and family councils 11. Access to an ombudsman 12. Right to be free of unnecessary physical or chemical restraints 13. Remedies against nursing homes that fail to meet federal standards 14. Change in inspection procedures to include interviews with residents and family, and observation of dining and med pass

What is PPS?

A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).

What is the "Money Follows the Person Program"?

5 year demonstration project that provided grants to states to strengthen their Medicaid programs to move ppl out of nursing homes and into community care facilities. Funding would move from nursing home to community facilities with patients.

Geriatrician

A physician specialized in aging and caring for the elderly

What is "symbiosis" and how does it apply to aging?

A state of living together in a mutually beneficial relationship. It provides a sense of being useful, competent, and needed.

Which provides for short-term rehabilitation or skilled nursing care? A.) Medicare B.) Medicaid

A.) Medicare

Which is a federal program? A.) Medicare B.) Medicaid

A.) Medicare Medicare is 100% federally managed.

Chronic Care Conditions

Medical conditions that persists over time, is generally irreversible, and can result in complications if left untreated. Examples: Atherosclerosis, Diabetes, Cancer, COPD, HIV/AIDS, Arthritis

Which one has income and resource limits? A.) Medicare B.) Medicaid

B.) Medicaid

Which provides for chronic care? A.) Medicare B.) Medicaid

B.) Medicaid

Which is a federal/state program? A.) Medicare B.) Medicaid

B.) Medicaid Medicaid is a federal program administered by the state.

What are the common negative perceptions of aging?

Becoming old means becoming ill and disabled, the elderly lead boring and useless lives, the elderly don't care about looks, the elderly don't care about sex, the elderly are slow & cant learn new things

4 Types of Aging

Biological: changes in the efficiency of organs of the body; central life span predictors Chronological: years since birth Social: changes in social roles, relationships, and social context as we age Psychological: changes that occur in memory, learning, adaptivity, personality, motivation

What is the general progression of aging?

Body deteriorates & memory faces challenges; chronic conditions & comorbidity --> functional impairment (disability) --> ADL limitations (dependency) --> Need for LTC

Briefly elaborate on the differences between certification, licensing, and accreditation.

Certification differs from licensing in that it is nearly always offered by a private, non-governmental agency. Under licensing law, practitioners of the licensed occupation must have a license in order to practice. It is involuntary. On the other hand, certification is voluntary. One does not have to be certified in order to practice. Accreditation is a non-governmental, voluntary process that evaluates institutions, agencies, and educational programs, (i.e., institutions that grant certificates or diplomas) while certification and licensing involves individual practitioners.

Where are services for chronic conditions delivered?

Chronic conditions normally require long term care. LTC can take the form of rehab centers, home-health care, hospice, and nursing homes.

Evidence Based Practices

Delivery of services using best practices that have been established through clinical research

What are the difference between the 3-D's?

Dementia - Is a condition that affects the brain and causes a progressive decline in a person's functioning over time. It is an umbrella term for a larger group of illnesses and can be caused by one or more illnesses. Cannot be cured. Depression - Intense or prolonged feeling of unhappiness. Can be mistaken for physical illness. Treatable. Delirium - A sudden state of severe confusion, often with hallucinations and physical agitation. Treatable.

Acute Care Conditions

Episodic conditions that require short-term but intensive medical interventions. Examples: Heart Attack, Stroke, Broken Bone, Asthma Attack, Flu, Burn

What are examples of cultural accommodations necessary in LTC facilities?

Facilities should make accommodations to allow the expression of culture and religion: Religious - observation of variety of religious services, dress Dietary differences - 7th Day Adventist, Muslims Health care preferences - non-traditional health treatments / alternative medical treatment

How can delirium be treated?

First line treatment for delirium is to treat underlying cause. Often will need many labs- Complete Metabolic Panel, Complete Blood Count, TFT, EEG if indicated, CT/MRI of head, sometimes LP, etc. A psychiatric or psychological consult might be needed for agitation. Medications to address short-term issues Address underlying medical issue

Demographic Imperative

Future growth of one population group at the expense of another group. E.g., growth of the elderly population while at the same time a contraction of the working population

What are the income and resource limits for Medicaid in Alabama?

Income Limit: $2,199/month Resource Limit: $2,000/month

What are the 3 major components of the LTC delivery system?

Informal system: LTC services provided by family, friends, and surrogates such as neighbors and members from church or other community organizations. Community-based system: formal services provided by various health care agencies. Intramural or extramural Institutional system: Patients whose needs cannot be adequately met in a community-based setting. i.e., retirement living, assisted living, skilled nursing, subacute care or specialized care.

What are the objectives of the community based system?

It has a 4-fold objective: 1.) Most economic and least restrictive setting 2) Supplement informal system of care giving, as needed 3.) Temporary respite 4.) To delay or prevent institutionalization

What is licensure?

It is a state function that is governed by state police powers. Usually requires testing and graduating from an accredited school or program. Continuing education to stay current. Licensure is required by the law. It brings privileges and responsibilities. Must abide by the law and your board's regulations. Duty to perform within the scop of practice.

Who is eligible for medicaid?

It primarily covers low-income people who do not have the financial means to afford healthcare. The categorically needy is defined by the state and can vary from state to state. Users must meet certain minimum requirements but states may set additional requirements as well. It is a means tested program in which states establish and administer their own Medicaid programs, and determine the type, amount, duration, and scope of services within broad federal guidelines.

What is the PPS program called in LTC?

LTCH Long Term Care Hospital Prospective Payment System

Life Expectancy Vs. Lifespan

Life expectancy: average # of years of life left from a specific point in time Life span: maximum possible length of life (human: 125 years)

What are the aging cohorts?

Lost Generation: 1830 - 1900; Fought in WWI; coined by Gertrude Stein Greatest Generation: 1901 - 1924; came of age in Great Depression; Fought in WW2 Silent Generation: 1925 - 1942; Babies of Great Depression, Too young to fight in WW2; Fought in Korean War Baby Boomers: 1942 - 1962; Spike in births after WW2; rejected traditional values; sexual revolution, drugs, Vietnam war, protests; in retrospect not as rebellious as seemed Generation X: 1962-1980; new lost generation & first latchkey generation; rise in divorce & blended families; very skeptical & well educated Generation Y/Millennial: 1977-1995; Tech savvy; diverse; flexible; 2 income families and single parent homes Generation Z: 1995-Current; Unknown

Who creates health policy? How is it created?

Most health policy that affects how health care professionals care for their patients are made by the federal government or state and local governments. Policies may be created by: - Legislative bodies (most common). - Administrative agencies that interpret legislation and craft rules and regulations to implement the law - Court Decisions - Presidential Executive Orders

Where is most long term care provided?

Most long term care is provided by the informal system.

Is confusion due to dementia or major cognitive impairment apart of normal healthy aging?

No, it is not. It disrupts lifestyles.

What is typical for normal aging?

Our brain ages as we age. Our memory may not be as good and we may not remember things as quickly or accurately. We still manage to our lifestyle and have the ability to to think up strategies e.g. lists, reminders, etc.

What are the 4 parts of Medicare?

Part A: Hospital Insurance Part B: Supplemental Medical Insurance Benefits Part C: Medicare HMOs Part D: Voluntary Drug Program

What does the term "categorically needy" mean?

Persons whose Medicaid eligibility is based on their family, age or disability status. Persons not falling into these categories cannot qualify, no matter how low their income. The Medicaid statute defines over 50 distinct population groups as potentially eligible, including those for which coverage is mandatory in all states and those that may be covered at a state's option.

Ageism Terms

Prejudice: Any preconceived opinion or feeling not based on knowledge; theory, or reason Bias: A particular tendency or inclination towards something Ethnocentric: The belief in the inherent superiority of one's own ethnic group Stereotype: A simplified and standard conception or image invested with special meaning and held in common by members of a group

What are health disparities? What are they based on -gender, race, etc?

Preventable differences in the burden of disease, injury, violence and opportunities to achieve optimal health that are experienced by socially disadvantaged populations Health Disparities are based on gender, social and economic status, education, as well as race and ethnic backgrounds. Ex: Women live longer and are healthier than men; poor ppl are less healthy than wealthy ppl; POC are less healthy than white people.

Public Policy vs. Private Policy

Public Policy: Issues that the government thinks must be addressed Private Policy: Strategic decisions that senior managers make to better serve their markets.

Extramural Services

Services delivered outside the home. Ex: Adult day care, mental health outpatient clinics, congregate meals, and respite care

Intramural Services

Services taken to home. Ex: Meals on wheels, home health care, homemaker, chores and errands, handyman services

Long Term vs Short Term Memory

Short term: what you just did, hear, said; secondary memory; if repeated moves to long term Long term: tertiary memory also remote memory; stored experiences & learning from years ago; past life experiences

Activity Theory

States that elders seek to remain active. Satisfaction based on new experiences; being useful and doing enjoying things increases longevity.

Continuity Theory

States that older adults will usually maintain the same activities, behaviors, and relationships as they did in their earlier years of life. Life's experiences have helped them get where they are, will help see them on down the road

Legal prohibitions against age discrimination are covered under what law(s)?

The Age Discrimination in Employment Act of 1967 (ADEA)

What is OBRA-87 and the Nursing Home Reform Act of 1987?

The Nursing Home Reform Act was passed as part of OBRA-87. It is legislation heavily influenced by a study by the Institute of Medicine and addresses quality issues in nursing homes.

What is cultural competency?

The ability of an organization to deliver health care services in accordance with the cultural needs and preferences of the patients.

Activities of Daily Living (ADL's)

The most commonly used measure of disability. ADLs determine whether an individual needs assistance in performing six basic activities: eating, bathing, dressing, using the toilet, maintaining continence, and getting into or out of a bed or chair (transferring). Grooming and walking a distance of eight feet are sometimes added to evaluate self care and mobility

In discussing health care demographics, what does the term "capacity" stand for?

The number of beds which a hospital or health care facility has been designed and constructed to contain.

Sensory Memory

The shortest term element of memory; retention of impressions of sensory information after sensation ends; every memory starts with a sensory stimuli

Comorbidity

The simultaneous presence of two or more health problems.

Gerontology

The study of human aging and the changes that accompany aging and the special problems of aging

Homeostasis

The tendency of the body to seek and maintain a condition of balance or equilibrium within its internal environment, even when faced with external changes. A simple example of homeostasis is the body's ability to maintain an internal temperature around 98.6 degrees Fahrenheit, whatever the temperature outside.

What is Ageism and who coined the term?

The term was coined by Robert Butler in 1969. Ageism is the prejudicial treatment of the elderly based on stereotypes and misconceptions about the elderly.

Quality of Life

The total living experience which results in overall satisfaction with one's life. The integration of social, environmental, and personal factors—including safety, comfort, personal preferences, dignity, interpersonal relations, and pain management—into the delivery of care. These factors are considered just as important and desirable as better health.

What are the key differences between certification and accreditation?

Time Period Approval: - Accrediting is longer: 3, 5 years -Certification = 1 year Cost: -Accrediting can be very costly - Certification costs are very low Timing and Prior Notice: - Annual re-certification surveys are unannounced -Accreditation surveys are mostly announced and have a general window of arrival Fines and Penalties: -Certification can have penalties of up to $10,000 a day. -Accreditation does not have these.

What are resident or patient rights? Be specific.

There are 7 main areas pertaining to patients' rights under the Patient's Bill of Rights: 1. Information for Patients - Patients have the right to accurate and easily understood information about their health plan, health care professionals, and health care facility. If he/she speaks a different language, has a physical and mental disability, or just doesn't understand something, help should be provided so that they can make informed health care decisions. 2. Choice of Providers and Plans - Patients have the right to choose health care providers who can give high quality health care when needed. 3. Access to Emergency Services - If a patient has a severe pain, injury, or sudden illness which they believe puts their health in danger, they have the right to be screened and stabilized using emergency services. A patient is able to use these services whenever and wherever needed without needing to wait for authorization and without any financial penalty. 4. Taking Part in Treatment Decisions - A patient has the right to know their treatment options and take part in decision related to their care. Parents, guardians, family members, or others that the patient chooses can speak for the patient if they cannot make their own decisions. 5. Respect and Non-discrimination - Patients have the right to considerate, respectful care from doctors, health plan representatives, and other health care providers that will not discriminate against them. 6. Confidentiality (privacy) of Health Information - A patient has the right to talk privately with health care providers and to have their health care information protected. A patient also has the right to read and copy their own medical record. A patient has the right to ask that their doctor changes the record if it is not correct, relevant, or complete. 7. Complaints and appeals - Patients have the right to a fair, fast, and objective review of any complaint that they may have against their health plan, doctors, hospitals, or any other health care personnel.

What causes delirium?

There are many causes. Some examples include: epilepsy, CNS trauma, CNS infection, CNS neoplasm, endocrine dysfunction (pituitary, thyroid, adrenal, parathyroid, pancreas), liver failure, UTI, cardiac dysrhythmias, hypotension, vitamin deficiency, sepsis, electrolyte imbalance, iatrogenic- any medication, substance withdrawal

Who is eligible for medicare?

There is no income requirement, however you must be 65 or older, have end-stage renal disease (ESRD) at any age, or have been disabled with certain conditions for at least 24 months in order to qualify

What are geriatric syndromes?

These are multifactorial, and shared risk factors—including older age, cognitive impairment, functional impairment, and impaired mobility. Syndromes include: - Sensory Impairment - Falls - Incontinence - Dementia - Depression - Delirium - Polypharmacy - Sleep Problems - Pressure Ulcers

Why are changes to the nervous system so important as aging occurs?

This shapes the behavioral, cognitive, and personality functioning of the aging individual.

Who is the least likely to use long term care facilities by race, ethnic groups, etc. Why?

Utilization is low in Hispanics, Asians, and Native Americans; lowest is the Asians; due to the cultural views of caring for elderly

What are examples of physiological changes that might occur and are becoming more common?

While these changes are becoming more common, they are not inevitable. - Hearing loss - Macular degeneration - Hypertension - Heart disease - Cancer - Parkinson's disease - Dementia

What is the Continuum of Care? Pg. 16 Figure 1-4

o The full range of long-term care services that increase in the level of acuity and complexity from one end to the other-from informal and community based services at one end of the continuum to the institutional system at the other end.

Provide examples of diversity categories and cultural groups encountered in healthcare?

• Geography • Culture • Gender • Spirituality • Parental Status • Homeless persons • Substance users • Language • Disability • Sexual orientation • Age • Incarcerated persons • Profession (e.g., healthcare workers)

Examples of major public health policies over the last 50 years.

• Legislative policy: Prospective Payment System (PPS) was required by the Balanced Budget Act, 1997 • Regulatory policy: PPS payment methodology developed by the Health Care Financing Administration, now known as CMS (Centers for Medicare and Medicaid Services) • Judicial policy: National Federation of Independent Business v. Sibelius; the U.S. Supreme Court upheld part of the Affordable Care Act to be constitutional (2015) - Olmstead v. L. C. - protected the rights of individuals with disabilities; the Developmentally Disabled have a right to live in the community (1999) • Executive policy: Executive orders have provided incentives for the adoption of HIT (Health Information Technology) - EO # 13335 -- Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator - April 27, 2004 - George W. Bush (Bush II) •Patient Protection and Affordable Care Act