Transcript Cedar-Sinai-EFLI

Elder Family Learning
Initiative
Part One:
General Family Education
Understanding Elder
Care Options
Lesson One
A) Health Care Issues
Maintenance and Preventative Care
 Physical examination
 Alternative medical care
 Assistance with care management
 Transportation, prescriptions
reminders, substance abuse
and treatment
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Mental health issues
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Depression, dementia
B) Activities of Daily Living (ADLs)
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Dressing
Grooming
Eating
Toileting
Bathing
Bed mobility
Ambulating
Transfers
ADLs more dependent on cognitive and
social functioning than physical ability
Instrumental Activities of Daily
Living
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Telephone
Obtaining and preparing food
Paying bills
Keeping house
Doing laundry
Taking medication
C) Health Changes that Lead to
Higher Levels of Care
Common Changes:
 Advancement of specific diseases or medical
conditions
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Diabetic care, incontinence
 Increase in amount of time needed to assist
person with everyday tasks
 Decline of cognitive functioning that lead to
changes in behavior
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Anxiety, dementia
Questions to Ask When Determining
Level of Care
 How are levels of care changes
determined?
 What are questions to ask when
choosing an option for care?
 What are the costs involved in
these levels of care?
Positive Intervention
 Planning
 Right match of care/caregiver for
older person
 Implementation that is respectful
and empowering
D) Tying Levels of Care to Service
Options
Why are there so many options?
 Continuum of care
 Lowest level of care
 Service at each level
 Limitations on care
 Asset issues
Service Options
 Retirement living
 Assisted living
 Residential care facility
 Above may be in context of
continuing care retirement
communities with life care options
Service Options (Continued)
 Skilled nursing facility/intermediate
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nursing facility
Adult foster care
Home health care
Home care
Hospice care
E) Level of Care Changes
How are level of care changes
determined?
 Care needs of resident
 Caregiving capability of facility
 Appeals process
Questions to Ask to Avoid Changing
Levels of Care
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What are the most critical care needs that
need to be met and what environment will
meet those needs?
 What are the costs involved in the care
options being considered?
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Insurance, private funds, Medicaid
 What amenities are offered by the facility
that my loved one would benefit from?
 Should we consult financial planners and
elder care attorneys to assist with our
decision?
Inconsistencies Which May Lead to
Inappropriate Placement
 Decision made during a time critical or
urgent situation
 Care needs of individual do not meet
the caregiving abilities of the
facility/caregiver
 Placement denied due to another
resident allowed to stay longer than
appropriate
 Disagreement in level of care change
may lead to appeal
Planning
Lesson Two
Resources and Interventions
Necessary to Make Good Decisions
A) Advanced Directives
 Living will
 POLST (Physician’s Order for Life
Sustaining Treatment)
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Code status
Life support
Palliative care
A) Power of Attorney
 Durable Power of Attorney (for
financial issues)
 Medical or Health Care Power of
Attorney
C) Guardian/Conservatorship
 Conservatorship
 Least intrusive. Conservator takes over
management of individual’s finances
 Guardianship
 Guardian takes over all decisions for the
person: medical, social, recreational
 Difficult and expensive to obtain, usually a
last resort
 Family may appoint non-family member as
guardian/conservator
Informal Approach
 Joint bank account
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Names of adult children are put on bank
account and safe deposit box
 Physician and other care providers
defer to long-term informal decisionmakers
D) Competency and Elders Rights
 Autonomy – acting on one’s own without
control from others
 Competency – ability to make choices
 Possesses and retains values
 Can communicate and understand
information
 Can reason and deliberate about choices
 Elder’s Rights – freedom over safety
E) Family Dynamics of Planning
Variables That Predict Issues
 Internal factors that influence a family’s ability to
plan:
 Communication style
 Family resources available (financial, time and
energy)
 Family history of conflict/troubled relationships
 Family experience with change over time
 Shared family values and absence thereof
Resources to Assist Family to Plan
During an Emergency
 Medical providers
 Aging services professionals
 Second degree relatives, friends,
and acquaintances
Elder Family Learning
Initiative
Part Two:
Advanced Family Education
Lessons Three and Four
Family Interaction
and Involvement
Lesson Three
A) The Decision Making Process:
Who Is In Charge?
 Role of the Resident
 Residents in care are given every opportunity
possible to make their own decisions.
 Role of the Facility Staff
 Documents from medical facility or previous
living environment will detail person’s
capacity for decision-making
The Decision Making Process
Who Is In Charge? (continued)
 Role of Family Members
 If person unable or refuses to direct their
own care, then family member(s) will be
asked to fulfill this role. Long distance
caregivers and local caregivers have
different roles in the family.
 Role of Medical Providers
 Medical professions will offer information
about possible treatments and give
recommendations but cannot make
decisions for the person or family
B) Interactions in Long Term
Care Facilities
 Staff accept most informal
arrangements unless and until resident
is unable to direct care.
 Facilities must intervene to ensure an
acceptable standard of care, which may
conflict with family’s values.
 Advance directives can help avoid
conflict by communicating wishes of
patient.
Sources of Potential Family Conflict
 Feelings of guilt
 Family culture
 Long distance caregiving
 Family member with untreated mental illness
or substance abuse issues
 Conflict occurs between family and staff due
to values, policy and regulations (specific to
the setting)
Addressing Conflict
 If resident had a problematic relationship with
a family member, the facility is not the place
to resolve the conflict.
 Other family members should discourage
visits that cause distress
 Improve communication by seeking help
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Social workers
support groups
individual therapists
C) Positive Visits
Visits are key to the recovery and adjustment of
residents in long term care
 Facilities will try to adapt to needs of the
individuals family as much as possible
 Late night visits
 Allow family and resident to eat together
 Accommodate large family gatherings
Types of Visits
 Primary caregiver visits
 Tend to be longer, caregiver will assist with
grooming, snacks, and alert staff to needs
 Casual visitors
 Short, frequent visits are best if the resident is
weak or ill
 Keep conversation positive
 Volunteer visitors
 Can be arranged if resident has no family living
nearby who can visit
D) Culture of the Family and the
Facility
 Culture – norms of the family
 Actions, attitudes, behaviors, beliefs, family
values
 Culture changes in crisis
 Some long-term care facilities have their own
culture associated with faith based, fraternal
lodge or ethnicity
 Medical model vs. social model
Communication Between Resident,
Family and Staff
 Consensus building a balancing act
 Getting outside help to facilitate
consensus building and deal with
facility/family conflicts
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Ombudsman
Aging service staff
Family counselors / therapists
Support groups
Planning and Care
across Different
Settings
Lesson Four
A) Care Conference 101
 A Care Conference will address
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resident’s health status
care needs
discharge plan or positive adjustments to
the facility
improving quality of life and relationships
Role of resident, family, staff, external
case management staff
Time frame, frequency
A Care Conference May Include
 The resident
 Family members
 Staff Participants:
 Rehabilitation Therapy
 Nursing
 Social Services
 Dietary
 Activities
Developing a Service Plan
 The Service Plan is a document
that addresses:
 Care
 Treatment
 Medications
When Do Care Conferences Occur?
 Within 2-3 days of hopitalization
 Within a week or two of admission to a
skilled nursing facility
 Within a month of a longer term admission
 Regularly quarterly conferences are held
for long-term residents
 Families will receive formal notice up
upcoming conference
B) Who Are the Providers and
What Do They Do?
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Administration
Reception
Housekeeping and maintenance
Medical
Nursing staff
 LPNs, CNAs, CMAs
Aides
Activities or recreation staff
Dietary staff
Social service staff
C) Relating to Other Residents and
Families
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Establishing community
Helping resident to adapt
Changing rooms
Transfers and discharges
D) End of Life
 The culture of death in Long-Term Care
facilities
 Care at the end of life
 Logistics for families
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Death certificates and funerals
Care of families during and after death
E) Grief Issues
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Anticipatory grief
Spiritual needs
Rituals
Counseling / bereavement groups
Additional grief issues for residents
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Loss of independence, space, privacy,
choice, friends, associations, pets, driving,
physical function, communication, intimacy,
family deaths
Elder Family Learning
Initiative
The End