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Decision Making

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Richard Anderson

on 25 February 2013

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Transcript of Decision Making

Nursing home admission:
What Decision Making Martha, Daniel, Ruth, Romeo, Lorena, Jamie, Ederlen, Veronica Nursing home admission What factors influence the necessity of admitting an older adult to a nursing home? Physiological Factors Mental Health Functional Status Environmental Characteristics Social and Economic Status Hip fracture and stroke are high risk factors for nursing home admission (Brown & Abdelhafiz, 2011). Alterations in vision Implications include safety concerns such as risk for falls and difficulty with IADLs and impact on overall quality of life (Smith & Cotter, 2012).

Diseases that alter vision are more frequent in older adults (cataracts, macular degeneration, glaucoma, diabetic retinopathy, etc) Alterations in Hearing Implications include safety concerns such as inability to hear oncoming cars, honking horns, doorbells or telephones and impact on quality of life that leads to depression or isolation (Smith & Cotter, 2012).

Hearing changes common in older adults include conductive hearing loss, sensorineural hearing loss, tinnitis, and Meniere's Disease among others Implications include increased risk for Falls and calluses or serious foot lesions that can lead to loss of limb and immobility (Smith & Cotter, 2012).

Diseases that alter peripheral sensation more frequent in older adults include peripheral neuropathy, diabetic neuropathy, phantom limb pain, and acute sensory loss Alteration in Peripheral Sensation Additional Factors Cognitive, Behavioral, and Emotional Status History of mental health treatment was linked to greater likelihood of nursing home admission among Alzheimer’s patients (Miller, Schneider & Rosenheck, 2011). Dementia, Delirium, Parkinson’s disease and Depression 90% of all dementia patients will need to be placed in a nursing home at some point in their lives (Rose & Lopez, 2012). Physical functioning is measured by the ability to accomplish basic activities of daily living (ADLs), including bathing, dressing, toileting, transferring, continence, and feeding. IADLs that require a higher level of cognition and judgment than physical activities
Driving is reported to be the most common dilemma families face as dementia progresses (Rose & Lopez, 2012). Physical environment to determine safety, physical barriers, and layout of home as well as access to services, such as shopping, pharmacy, transportation, emergency services. Social support network includes identifying present and potential caregivers and assessing their competence, willingness to provide care, and acceptability to the older person. If support or willingness is not available, older adult will likely enter a nursing home. Increased state funding for health and community services has a direct correlation with delayed nursing home admission rates in childless senior citizens (Murumatsu, et al, 2007). Nursing Home Admission: Concerns Individual preferences of the patient must be considered along with the clinical history of the patient to facilitate transitions in levels of care. Feelings of isolation and hopelessness are common after nursing home placement and patients and caregivers require assessment and interventions to address these risks (Rose & Lopez, 2012). Interdisciplinary communication that involves the patient and family as much as possible is ideal (Gopalraj, Grooms, Setters, Kaundar & Furman, 2012). Important Questions to Address What levels of care are offered? Intermediate care offers nursing supervision and assistance with personal care. Skilled care provides skilled nursing, medical and rehabilitation services. Does the home have an Alzheimer's unit?
What are the fees and charges? Does the home take Medicare and Medicaid? Are there additional charges for special services?
Are there special services offered, such as physical therapy, occupational therapy, accommodations for special dietary needs? Does the home look and smell clean? Is the atmosphere pleasant?
Are safety measures apparent-fire doors, sprinklers, call lights, grab bars in hallways and bathrooms?
Do the residents look clean, well-groomed? Do you see positive interactions between the staff and residents?
Is the diet appealing? Is the diet appealing?
Are call lights answered promptly?
Is there a range of activities?
Any provision to match roommates for compatibility?
Are there support groups for residents and families? Decision making barriers Certain factors exist that may prevent some Older Adults in participating in the decision of whether or not they should be admitted to a nursing home. bowel incontinence: the family considers this issue an indicator that the patient cannot care for themselves and need assistance level of dependency: inability to perform activities of daily living (ADLs) marital status: according to the study, patients were less willing to leave their homes if they still had a significant other in their lives. People who live alone are more likely to be placed in a nursing home race/ethnicity: Hispanics and African Americans are less likely to be placed in a nursing home. Caucasian patients have a higher risk of being placed in a nursing home disabilities: hearing impairment, visual impairment, walking impairment dementia & depression Providing assistance The nurse and interdisciplinary team members can aid the older adult and family overcome the issues previously discussed Set up and schedule an interview or tour When it comes to level of dependency, the nurse can practice mind stimulating activities to increase their brain activity Performing functional assessments can aid the nurses to identify what areas to focus their attention Being observant and assessing the patient to make sure they are safe Providing the patient with glasses, hearing aids, walkers, and canes to aid their daily living Providing the family with brochures and information about services and fees Have the family stay involved in the care of their loved ones, visitation and volunteer activities Having a better knowledge of the fears and concerns of the family will help develop and maintain a good relationship between the family, RN and interdisciplinary team- allowing for better care of the patient Always include the patient and family in the plan of care Ask for referrals Nursing Home Criteria #9 Size of Nursing Home Facility What does the older individual prefer?
A small close knit community may be just the ticket for one resident and wrong choice for another.
Keep in mind the personality of the individual.
Does the facility have grounds for walking and getting outside?
Can residents get away from the everyday activity and still be safe, if that is what they desire? #8 Residents’ Degree of Freedom It is important that nursing homes have a variety of activities for all residents particularly those who can’t leave their bedrooms.
Residents should have a say in deciding on the types of activities available to them as providing them with options demonstrates that their wishes are valued. #7 Quality of food Residents may not always eat the food that is served by the facility.
When this happens, sometimes the family members become the regular mealtime caregivers and this creates a large burden. #6 Has the nursing home corrected all deficiencies noted on state inspection reports? It is important the nursing home correct all deficiencies as this demonstrates compliance with state and federal requirements which are meant to ensure nursing homes provide residents with quality care and services. #5 Does the nursing home perform background checks to make sure they don’t hire staff with a criminal record with convictions of abuse, neglect, or mistreatment of another individual? It is important that nursing homes should ensure that they do not employ staff with a criminal record, particularly a history of abuse, neglect, or maltreatment of any kind.
A history of committing abuse against another is a good predictor of future behavior. Hiring staff with a criminal record places a very vulnerable population at risk of maltreatment. #4 Types of services offered It is important to consider the needs of the older individual for whom you are finding a nursing home for.
If they have special care needs such as dementia care, palliative care, therapy (physical, occupational, speech, etc.), dialysis, etc… these services need to be researched thoroughly before making a placement decision. #3 Resident Hygiene Finding residents that are clean, well groomed, and appropriately dressed is an indication that the staff is taking the time to ensure the residents personal hygiene needs are met.
This is particularly important for dependent adults who rely on others to meet these needs.
Finding residents who are appropriately dressed for the season and time of day is an indication that the staff is taking the time to pay attention to the residents comfort level.
Failure to observe these basic findings is a red flag for issues of general neglect #2 Does the facility accept Medical or Medicare? If you want Medicare or Medi–Cal to help pay for the nursing home care, you must select a facility that is certified by these programs.
Due to the extremely high cost of nursing home care – which averages above $200 per day or $6,000 per month – few people can afford to pay privately for very long. #1 Location Newly admitted residents will adjust more easily to their new environment when family and friends are frequent visitors.
When family and friends are close enough to visit frequently they can monitor the resident’s condition, participate in care planning and respond to emergencies quickly. Questions? Thank you! References:
Brochure/ElderAbuse. Retrieved February 11, 2013, from http: //aging.lacity.org/pdf/brochures/ElderabuseEnglish.pdf California Code-Chapter 11: Elder abuse and Dependent Adult Civil Protection Act [15600-15675.]. Retrieved February 17, 2013, from http://codes.lp.findlaw.com/cacode
Brown, S. H. M., & Abdelhafiz, A. H. (2011). Institutionalization of older people: Prediction and prevention. Aging Health, 7(2), 187-203. doi: http://dx.doi.org/10.2217/ahe.10.88
California Code-Chapter 11: Elder abuse and Dependent Adult Civil Protection Act [15600-15675.]. Retrieved February 17, 2013, from http://codes.lp.findlaw.com/cacode
Fraher, Anne, Coffey, Alice (2011). Older people’s experiences of relocation to long-term care. Nursing Older People, Vol. 23, Issue 10. p23–27.
Gaugler, J.E., Duval, S., Anderson, K.A., & Kane, R.L. (2007). Predicting nursing home admission in the U.S.: a meta-analysis. BMC Geriatric, 7-13.
Gopalraj, R. K., Grooms, L. J., Setters, B. K., Kaundar, A., & Furman, C. D. (2012). Decision-making in older adults with serious illness: Barriers to the goals of care discussion. Aging Health, 8(4), 367-376. doi: http://dx.doi.org/10.2217/ahe.12.41
Holland, C., Myint, P., & Bowker, L. (2010). Clinical practice and perceived barriers with regards to patient involvement in resuscitation decision making in the elderly semi-qualitative study. Age and Ageing, 39 Retrieved from http://search.proquest.com/docview/214131274?accountid=12597
Miller, E. A., Schneider, L. S., & Rosenheck, R. A. (2011). Predictors of nursing home admission among alzheimer's disease patients with psychosis and/or agitation. International Psychogeriatrics, 23(1), 44-53. doi: http://dx.doi.org/10.1017/S1041610210000244
Muramatsu, N., et al. (2007). Risk of nursing home admission among older americans: Does states' spending on home- and community-based services matter? The Journals of Gerontology, 62B(3), S169-78. Retrieved from http://search.proquest.com/docview/210158076?accountid=12597
Nebraska Department of Health and Human Services. (2011). When you are faced with the nursing home decision. Retrieved from http://www.answers4families.org/family/eldercare/housing/when-you-are-faced-nursing-home-decision
Nursing Home Overview. Retrieved February 11, 2013, from http://www.Medicare.gov/Nursing/Overview.asp
Rangaraj, K. G., Laura, J. G., Belinda, K. S., Kaundar, A., & Christian, D. F. (2012). Decision-making in older adults with serious illness: Barriers to the goals of care discussion. Aging Health, 8(4), 367-376. doi: http://dx.doi.org/10.2217/ahe.12.41
Rose, K., & Lopez, R. (2012). Transitions in dementia care: theoretical support for nursing roles. Online Journal of Issues in Nursing, 17(2), 13-4. Retrieved from http://search.proquest.com/docview/1220454007?accountid=12597
Siegrist, S. C. (2008). Feelings and concerns of primary family caregivers of dementia patients in nursing homes: A research study. Northern Kentucky University). ProQuest Dissertations and Theses, , 107- n/a. Retrieved from http://search.proquest.com/docview/205446824?accountid=12597. (205446824)
Smith, C.M, & Cotter, V.T. (2012). Nursing standard of practice protocol: Age-related changes in health. Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/normal_aging_changes/want_to_know_more.
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