Transcript NUR 430 Gero Group Project

Living At Home
Safely
Home Sweet Home
Case Study
 Mr. Harms is a 84 year old man that still lives in his own
home. He has children and grandchildren that visit him
regularly. His adult son calls him on a daily basis to
check in. Mr. Harms takes medications to regulate his
blood pressure. His medications consist of a betablocker, a daily aspirin, an occasional Aleve, a daily
multivitamin, vitamin E and Vitamin C. Mr. Harms is
independent with ambulation but on occasion has had
some minor falls with only bumps and bruises. His falls
have been related to tripping over his rug in the hallway
and trying to get down the front stairs to go get the
mail. He enjoys working in his flower garden and
meeting the guys for coffee at the local café. Mr. Harms
also attends church regularly when he is able to get a
ride. He doesn’t drive anymore due to his macular
degeneration.
Patient
and
Family
Teaching
 In relation to the above described case study, the
following slides will discuss the possibilities of keeping
Mr. Harms in his own home, the availability of alternative
housing, and the teaching information for the patient
and family.
 In addition, a home environment assessment should be
done to include stairs, bathing and toileting,
medications, predetermined wishes, nutrition and
cooking, falls, smoke detectors, emergency numbers,
temperature of home and water, neighborhood safety,
and finances. (Tabloski, p.65).
Additional Patient and Family
Teaching
 Teach bleeding risks of combined medications
 Encourage patient to get all medications at the same
pharmacy, preferably from one provider, and keep a list
of medications in wallet at all times
 Teach blood pressure monitoring, recording, and
symptom reporting as necessary
 Encourage patient to change positions slowly to avoid
falls
 Provide chair or bench to do outdoor activities with
flower garden
 Put flowers in reachable areas
 Arrange for transportation to church and other enjoyed
activities outside of the home
Causes of safety
decline at home
1.
Decline in overall health
status
2.
Polypharmacy
3.
Lack of family or social
support: Self isolation
4.
Refusal to see primary care
physician routinely
5.
Low fixed incomes
6.
Depression/Anxiety or other
psychological disorder
7.
Significant loss of spouse or
loved one
8.
Lack of resources or
equipment needed to
minimize safety risks
9.
Fears of losing independence
or moving to a facility
10. Impaired memory or
judgment
Considerations for living at home
safely
 Legal aspects
 Finances
 Power of Attorney
 Advance Directives
 Ethical
 Cultural
 Respect cultural beliefs and customs of patient and family
 Professional
 Be respectful of patient and family at all times
 Spiritual
 Transportation to church or arrange visits from church officials
 Available television stations or radio stations to listen to
services
Lifeline
 Medical alert system that provides access to help
24/7/365
 Necklace or bracelet worn with button to push for access
to help
 Standard or advanced fall system that if unable to push
button after a fall the system will be automatically
alerted
 Cost is about $1/day and most companies have no
equipment fee, no contracts, and no set up fee
 Volunteers age 55 and over who make a difference by
providing assistance and friendships.
 They assist with grocery shopping, bill paying, and
transportation to medical appointments, and they alert
doctors and family members to potential problems.
 Senior Companions also provide short periods of relief to
primary caregivers.
Senior Companions
 Any housing arrangement designed exclusively for seniors,
generally those aged 55 and over.
 Housing varies widely, from apartment-style living to
freestanding homes.
 Housing is friendlier to older adults, often being more
compact, with easier navigation and assistance in yard
maintenance (if there is a yard).
 Also called retirement communities, retirement homes, senior
housing, and senior apartments.
 Socialization with other elders.
 Transportation services to ease commutes for shopping, etc.
Independent Living
Types of
Independent Living

Subsidized senior housing. In the U.S., there are senior housing complexes,
subsidized by the U.S. Department of Housing and Urban Development (HUD), for
low-income seniors. Keep in mind that depending on the area, waiting lists can take
years, so it’s a good idea to plan well in advance for this option.

Senior apartments. Senior apartments are apartment complexes restricted by age,
usually 55 and older. Rent may include community services such as recreational
programs, transportation services, and meals served in a communal dining room.

Retirement communities. Retirement communities are groups of housing units for
those aged 55 and older. These housing units can be single-family homes, duplexes,
mobile homes, townhouses, or condominiums. If you decide to buy a unit, additional
monthly fees may cover services such as outside maintenance, recreation centers, or
clubhouses.

Continuing Care Retirement Communities (CCRCs). CCRCs offer service and
housing packages that allow access to independent living, assisted living, and skilled
nursing facilities in one community. If residents begin to need help with activities of
daily living, for example, they can transfer to an assisted living or skilled nursing
facility on the same site.

Sited from http://www.helpguide.org/elder/independent_living_seniors_retirement.htm
What is Assisted Living?
Assisted Living
Communities
provide:
1. Comfortable
apartments with
home like amenities
such as personal
bathrooms, kitchens,
and dining areas
2. Access to meals and
medications, group
activities, and social
events
3. Professional
assistance if needed
and for emergencies
4. Are not federally
regulated but do have
their own individual
services and
regulations
Benefits to
Assisted Living
Facilities:
1. Increased
independence
and freedom to
continue life as
desired with
minimal
assistance and
supervision.
2. Peer and
professional
support
3.
Decreased
stress on family
members
4. Care that fits
you!
Assisted Living Resources:
 Eldercare.gov
 Assisted Living
Federation of America:
alfa.org
 AARP.org
 Assisted Living
Nebraska:
www.assistedlivingnebra
ska.com
Home
Health
Care

Historically home health care primarily consisted of private duty nurses or family members. Over the
last 20 years the complexity and scope of home health care has grown relating to the rising cost of
health care, the aging population, growing emphasis on managing chronic illness and stress,
preventing illness and enhancing quality of life.

For a time Home Health Care was viewed as end of life care. People were discharged from an acute
care facility and sent home to die. Now people are able to stay home and avoid being admitted to
acute care.

A Home Health Nurse must be able to work independently, provide direct care, manage the care
(including therapies and other members of the interdisciplinary team). They must be able to educate
their patient and be willing to research and consult to provide the best care possible. The relationships
between the nurse and client is generally more intimate and the nurse needs to be aware of
inadequate care or limited support. The nurse is more likely to pick up on abuse or caregiver burn out
of family members. Having a family member that lives at home can cause more stress on family
members because of the increased and complex duties they may be expected to perform. The nurse
needs to advocate for both the client and the family.

Families tend to question care more often when it is in their loved ones home. They ignore advice
more frequently and may do things their own way and set their own priorities and schedules. The
nurse should attempt to have a close relationship with the family of their client.

Medicare costs for home health increase 10 % each year. 3rd party payees favor home health
because it’s more cost effective than acute care.

There is increasing ability to provide high technological services in the home.

Consumers want to stay home instead of going into an institution.
Paying For
Home Health Care
 Private Pay
 3rd party reimbursement
 Combination of sources
 There must be a physicians order and physician approved
plan before Medicare or Medicaid will cover any part of care.
The nurse should ensure they also have a DME (durable
medical equipment) benefit with their insurance or that
they’re able to pay privately.
 Oasis (the Outcome and Assessment Information Set) is
required as part of the Medicare condition of participations
(http://www.cms.hhs.gov/oasis/)
 In Nebraska an agency must be licensed and certified.
Certification is necessary in order to receive and pay from
Medicare.
Non-Medical Private Pay Homecare
 Non-Medical Private Pay Homecare agencies provide
caregivers to assist the older adult in their own home from
3 hours a day to 24 hours a day.
 Services are out of pocket and not covered by Medicaid,
Medicare or insurance.
 Some are now starting to work towards being able to accept
respite waivers for caregiver relief, this is difficult as they
are private pay/non-medical agencies, and would have to
become Medicaid/Medicare certified to accept the waivers.
 Services provided are primarily Non-Medical. Cost of these
programs in this area is around 20 dollars an hour for a
minimum of 3 hours.
Service agencies can provide
 Laundry, Linen changes
 Meal planning, preparation, feeding assistance
 Bathing assistance, personal hygiene, incontinence cares
 Standby assistance with morning and evening routines
 Transfer assistance
 Medication reminders
 Errands
 Incidental transportation
 Light housekeeping and organization (dishes, vacuuming,
dusting)
 Clutter prevention
 Kitchen and bathroom cleaning
 Companionship
 Light exercise-walks
 Friendly and supportive conversation
 Plan and encourage social activities
Service agencies
 Remaining in the home 24 hours a day if family member is
not able, this is especially helpful in those with Alzheimer’s
or those needing 24 hour care and is not safe alone.
 Services can be used temporarily or long term; the benefits
outweigh the costs if it is affordable to the older adult.
 Beneficial to someone just out of the hospital who may
need a little extra help until regaining strength.
 These services can also provide regular respite relief to
caregivers to avoid caregiver burnout, allowing caregivers
to attend to own needs or social outings.
 Often time’s Medical home care is used in conjunction with
private pay services, and agencies will communicate on the
patients needs.
Home Adaptations

Presence of grab bars around bath tubs and toilets, along with non slip
surfaces in the shower and bath tub. A hand held shower head should
be installed if it doesn’t exist. A raised toilet seat and a shower chair if
necessary for safety. There should be some sort of safety lighting for at
night. The walk ways need to be clear from clutter and throw rugs
should be removed.

In some situations a hospital bed may be warranted. Lifts are available
depending on therapy evaluations and recommendations.

The ease of access to shelves should be assessed and modifications
made if necessary.

Water temps should be set below 120 at least.

Accessibility to light switches should be assessed. As well as accessibility
to toileting- including bed pans or urinals.

The availability and access of help should be assessed.

Medications should be monitored and a system should be implemented
that works best for the client.

Ensure that needles are being disposed of properly.
Medication
Management

The ability for an older person to manage medications can difficult especially when multiple
medications are involved. This poses a safety risk and can increase the number of
hospitalizations. There are many steps we can take to help.

Non-adherence-medication non-adherence happens for many reasons; the older adult is not
able to afford the medication, poor teaching on purpose of medication. Many People tend to
stop taking a medication when they feel better, not attributing to the fact that the
medication is the reason they feel better. The older adult may simply forget frequently to
take them.

Cost-We all know that medication costs can be outrageous, especially when a generic is not
available or the older person does not have access to supplemental RX insurance. Some of
the medications are not covered by insurance. Some older persons have to choose between
eating a good meal and buying medication. Contacting the manufacture of the medication
often results in discounts. Some physicians office’s will offer samples

Old prescriptions- clean out that medicine cabinet! Expired prescription and over the counter
medications can be one of 2 things, Non effective or TOXIC! Throw away all medications past
the expiration date, or discontinued medications. A person is less likely to become confused
with fewer medication bottles lying around; also this can help to reduce accidently taking the
wrong medications. Check local pharmacy for disposal instructions of certain medications,
such as narcotics and antibiotics.

Medications should be reduced to only those necessary any ineffective meds or duplicate
meds should be discontinued

Herbal supplements should be evaluated these can interact with other medications and effect
lab results such as PT INR
Medication
Consistency

All of the older person’s physicians and pharmacist need to be on the
same page with the patients currently prescribed meds and over the
counter meds they are taking.

Medication teaching should be done with the patient and
family/caregivers on all medications, side effects, purpose, dose and
frequency. This teaching can be given by the physician’s office,
pharmacist, or homecare nurse.

Using a weekly med sorter for multiple medications can decrease
confusion, avoid overdosing or missing a medication, the patient or a
family member can generally be taught how to set this up.

The Patient should have a medication list they can follow to assist with
set up, on this list should be the medication name (generic and brand),
purpose, dose, frequency and time medication is taken. Pay close
attention to a pill needing broke in half to make the correct dose. It may
be helpful to actually tape the pill or a picture of it to the list. There are
websites available to help with this.

Update any changes immediately.

A med minder or med machine dispenser can be helpful, an alarm and
verbal instruction to take medications can be set to the individual
patient. The machine only dispenses the meds due at that time.
Machines can be purchased privately or rented through programs such as
Philips the same organization that provides life line. In some cases the
machines are covered under Medicaid or Medicare.
Caregiver Burnout
 Caregiver burnout is a state of physical, emotional, and
mental exhaustion that may be accompanied by a change in
attitude -- from positive and caring to negative and
unconcerned.
 Burnout can occur when caregivers don't get the help they
need, or if they try to do more than they are able -- either
physically or financially.
 Caregivers who are "burned out" may experience fatigue,
stress, anxiety, and depression.
 Many caregivers also feel guilty if they spend time on
themselves rather than on their ill or elderly loved ones.
This puts care givers at an increased risk for Depression,
dependent adult abuse or neglect.
Signs and Symptoms
to watch for
 Withdrawal from friends, family, and other loved ones
 Loss of interest in activities previously enjoyed
 Feeling blue, irritable, hopeless, and helpless
 Changes in appetite, weight, or both
 Changes in sleep patterns
 Getting sick more often
 Feelings of wanting to hurt yourself or the person for
whom you are caring for
 Emotional and physical exhaustion
 Irritability
Prevention

Find someone you trust -- such as a friend, co-worker, or neighbor -- to
talk to about your feelings and frustrations.

Set realistic goals, accept that you may need help with caregiving, and
turn to others for help with some tasks.

Be realistic about your loved one's disease, especially if it is a
progressive disease such as Parkinson's or Alzheimer's.

Don't forget about yourself because you're too busy caring for someone
else. Set aside time for yourself, even if it's just an hour or two.
Remember, taking care of yourself is not a luxury. It is an absolute
necessity for caregivers.

Talk to a professional. Most therapists, social workers, and clergy
members are trained to counsel individuals dealing with a wide range of
physical and emotional issues.

Take advantage of respite care services. Respite care provides a
temporary break for caregivers. This can range from a few hours of inhome care to a short stay in a nursing home or assisted living facility.
Prevention
 Know your limits and stay within them
 Educate yourself. The more you know about the illness, the
more effective you will be in caring for the person with the
illness.
 Develop new tools for coping..
 Stay healthy by eating right and getting plenty of exercise
and sleep.
 Accept your feelings. Having negative feelings -- such as
frustration or anger -- about your responsibilities or the
person for whom you are caring is normal. It does not mean
you are a bad person or a bad caregiver.
 Join a caregiver support group. Sharing your feelings and
experiences with others in the same situation can help you
manage stress, locate helpful resources, and reduce feelings
of frustration and isolation.
Who
can help?
 Home health services -- These agencies provide home health aids
and nurses for short-term care, if your loved one is acutely ill. Some
agencies provide short-term respite care.
 Adult day care -- These programs offer a place for seniors to
socialize, engage in a variety of activities, and receive needed
medical care and other services.
 Nursing homes or assisted living facilities -- These institutions
sometimes offer short-term respite stays to provide caregivers a
break from their caregiving responsibilities.
 Private care aides -- These are professionals who specialize in
assessing current needs and coordinating care and services.
 Caregiver support services -- These include support groups and
other programs that can help caregivers recharge their batteries,
meet others coping with similar issues, find more information, and
locate additional resources.
Community Resources
 Nebraska Department of Health and Human Services; dhhs.ne.gov
 EASTERN NE OFFICE ON AGING, Dennis Loose, Director, 4223
Center Street Omaha, NE 68105 402-444-6444 Fax: 402-444-6503
Out of State Toll Free: 888-554-2711 www.enoa.org
 AGING PARTNERS, June Pederson, Director,1005 O Street Lincoln,
NE 68508-3628 , 402-441-7070 Fax: 402-441-7160 Toll Free within
NE: 800-247-0938 aging.lincoln.ne.gov
 NORTHEAST NE AREA AGENCY ON AGING, Connie Cooper,
Director,119 W Norfolk Ave, Norfolk, NE 68701, 402-370-3454 Fax:
402-370-3279 Toll Free: 800-672-8368 www.nenaaa.com
Community Resources
 SOUTH CENTRAL NE AREA AGENCY ON AGING Rod
Horsley, Director,Suttle Plaza, 4623 2nd Ave, Suite 4,
Kearney, NE 68848-3009, 308-234-1851 Fax: 308-2341853 Toll Free: 800-658-4320, www.agingkearney.org
 MIDLAND AREA AGENCY ON AGING, Jerrell Gerdes,
Director, 2727 W. 2nd Street, Suite 440 Hastings, NE
68901, 402-463-4565 Ext. 310 Fax: 402-463-1069, Toll
Free: 800-955-9714
www.midlandareaagencyonaging.org
 BLUE RIVERS AREA AGENCY ON AGING, Larry Ossowski,
Director 1901 Court Street, Beatrice, NE 68310, 402223-1376 Fax: 402-223-2143 Toll Free: 888-317-9417
www.braaa.org
Community Resources
 WEST CENTRAL NE AREA AGENCY ON AGING,
Linda Foreman, Director, 115 North Vine,
North Platte, NE 69101, 308-535-8195
Administrative Fax: 308-535-8197 CHOICES
Program Fax: 308-535-8190 Toll Free: 800662-2961, www.wcnaaa.org
 AGING OFFICE OF WESTERN NEBRASKA,
Victor Walker, Director Bluffs Business Center,
1517 Broadway, Suite 122, Scottsbluff, NE
69361, 308-635-0851 Fax: 308-635-2321 Toll
Free: 800-682-5140, www.aown.org
Iowa Community Resources

Many patients and families are not aware of state and local community resources. Generally
some are listed in the phone book, or the patient can call the local hospital or their
physician’s office also.

American Association of Retired Persons (AARP) 888-687-2277

Offer not only discounts on auto and some health insurance plans, provides access to
Advocacy in both Washington and individual states; on Medicare, Social security and
consumer safety. They can offer some community resource info on local chapters and have a
nationwide volunteer network.

American Lung Association 800-568-487

American Cancer Society (Iowa) 712-233-1188

American Diabetes Association 800-342-2383

American Heart Association Iowa affiliate 712-255-4798

American Red Cross 712-2524081

Dependent Adult Abuse Iowa 712-255-2699

Iowa Department for the Blind 800-362-2587

Books, cassette tapes and records mailed to the home free of charge to legally blind, visually
impaired, or physically disabled persons.
Local resources for
Siouxland Area

Siouxland Aging-works with Adults 60 and over to assist with needs, to help
seniors remain independent at home. This agency sets up meal programs such
as MOM’s(premade frozen meals that can be reheated at home) Meals on
wheels(sliding scale based on income), works with Medicaid waiver programs
and provides agencies, to assist with chore services, and bathing services,
transportation on transit system and wheelchair bus, and assistance with
housing issues. Also provides respite services to caregivers. A social worker is
assigned to the older adult and will become an advocate. Phone 712-2796900- www.siouxlandaging.org

The Center-works with low income seniors can provide some financial
assistance for basic utility bills, food and home repairs. Phone712-252-1861

Iowa Department of Human services- works with low income and disabled
adults- waivers, Medicaid, food stamps. Phone 712-255-0833

Non-Medical Private Pay homecare programs-Synergy and Homeinstead.
Synergy- www.synergyhomecare.com 712-605-242-6056 and Homeinsteadwww.homeinstead.com/381.Phone 712-258-4267.

Lutheran Social Services- Local transportation to physician appointments,
groceries. Phone 712-276-1075
References

AARP. Retrieved from http://assets.aarp.org/www.aarp.org_/promotions/sem/m
ember01.html?keycode=U6TPM1&packageid=&componenti
d=&whocalled=promo_enroll&cmp=IVS-KNC-ACQ-PMD-ACQJOIN

Aging Partners-City of Lincoln and Lancaster County. (2005-2009). Retrieved from
http://lincoln.ne.gov/city/mayor/aging/info.htm#naaa

CDC. Medication Safety Program. (2012). Retrieved from
http://www.cdc.gov/medicationsafety/

Centers for Medicare and Medicaid Services. Outcome and Assessment Information
Set. Retrieved from http://www.cms.hhs.gov/oasis/

Ellenbecker, C., Samia,L., Cushman, M., and Alster, K. (2008). Patient Safety and
Quality in Home Health Care. Retrieved from
http://www.ncbi.nlm.nih.gov/books/NBK2631/

Kozier, B. and Erb, G. (2008). Fundamentals of Nursing. Upper Saddle River, New
Jersey: Pearson.

Lifeline Medical Alert Service. (2013). Retrieved from
http://www.lifelinesys.com/content/home

Medical Guardian: Medical Alert Systems. (2013). Retrieved from
http://www.medicalguardian.com/ppc-Nebraska-medical-alertsystem.html?gclid=CLOHs4C957gCFSho7Aod8kgA2A
References
 Meiner,S. and Lueckenotte, A. (2006). Gerontologic Nursing 3rd
edition. St. Louis, MO: Mosby Inc.
 NonMedical HomeCare. (2013). Retrieved from
http://www.synergyhomecare.com/respite-for-family-caregivers/
 Senior Corps.
http://www.serve.nebraska.gov/pdf/americorps/nebraskasenior-corps-senior-companions.pdf
 Siouxland Aging Services. (2009). Retrieved from
www.siouxlandaging.org
 Tabloski, Patricia. (2010). Gerontological Nursing. Upper
Saddle River, New Jersey: Pearson.
 University of Rochester University. Medication Management
(2013). Retrieved from
http://www.urmc.rochester.edu/encyclopedia/content.aspx
?Conten tTypeID=56&ContentID=DM250
 WebMD. Caregiver Burnout.(2005-2013). Retrieved from
http://www.webmd.com/healthy-aging/caregiver-burnout
Tips.