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Elder Family Learning Initiative

This initiative covers various aspects of elder care, including health care issues, activities of daily living (ADLs), health changes, tying levels of care to service options, level of care changes, and planning. It provides valuable information for families navigating the elder care journey.

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Elder Family Learning Initiative

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  1. Elder Family Learning Initiative Part One: General Family Education

  2. Understanding Elder Care Options Lesson One

  3. A) Health Care Issues Maintenance and Preventative Care • Physical examination • Alternative medical care • Assistance with care management • Transportation, prescriptions reminders, substance abuse and treatment • Mental health issues • Depression, dementia

  4. B) Activities of Daily Living (ADLs) • Dressing • Grooming • Eating • Toileting • Bathing • Bed mobility • Ambulating • Transfers ADLs more dependent on cognitive and social functioning than physical ability

  5. Instrumental Activities of Daily Living • Telephone • Obtaining and preparing food • Paying bills • Keeping house • Doing laundry • Taking medication

  6. C) Health Changes that Lead to Higher Levels of Care Common Changes: • Advancement of specific diseases or medical conditions • 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 • Anxiety, dementia

  7. 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?

  8. Positive Intervention • Planning • Right match of care/caregiver for older person • Implementation that is respectful and empowering

  9. 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

  10. Service Options • Retirement living • Assisted living • Residential care facility • Above may be in context of continuing care retirement communities with life care options

  11. Service Options (Continued) • Skilled nursing facility/intermediate nursing facility • Adult foster care • Home health care • Home care • Hospice care

  12. E) Level of Care Changes How are level of care changes determined? • Care needs of resident • Caregiving capability of facility • Appeals process

  13. Questions to Ask to Avoid Changing Levels of Care • 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? • 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?

  14. 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

  15. Planning Lesson Two

  16. Resources and Interventions Necessary to Make Good Decisions

  17. A) Advanced Directives • Living will • POLST (Physician’s Order for Life Sustaining Treatment) • Code status • Life support • Palliative care

  18. A) Power of Attorney • Durable Power of Attorney (for financial issues) • Medical or Health Care Power of Attorney

  19. 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

  20. Informal Approach • Joint bank account • Names of adult children are put on bank account and safe deposit box • Physician and other care providers defer to long-term informal decision-makers

  21. 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

  22. E) Family Dynamics of PlanningVariables 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

  23. Resources to Assist Family to Plan During an Emergency • Medical providers • Aging services professionals • Second degree relatives, friends, and acquaintances

  24. Elder Family Learning Initiative Part Two: Advanced Family Education Lessons Three and Four

  25. Family Interaction and Involvement Lesson Three

  26. 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

  27. The Decision Making ProcessWho 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 thefamily. • Role of Medical Providers • Medical professions will offer information about possible treatments and give recommendations butcannot make decisions for the person or family

  28. 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.

  29. 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)

  30. 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 • Social workers • support groups • individual therapists

  31. 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

  32. 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

  33. 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

  34. Communication Between Resident, Family and Staff • Consensus building a balancing act • Getting outside help to facilitate consensus building and deal with facility/family conflicts • Ombudsman • Aging service staff • Family counselors / therapists • Support groups

  35. Planning and Care across Different Settings Lesson Four

  36. A) Care Conference 101 • A Care Conference will address • 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

  37. A Care Conference May Include • The resident • Family members • Staff Participants: • Rehabilitation Therapy • Nursing • Social Services • Dietary • Activities

  38. Developing a Service Plan • The Service Plan is a document that addresses: • Care • Treatment • Medications

  39. 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

  40. B) Who Are the Providers and What Do They Do? • Administration • Reception • Housekeeping and maintenance • Medical • Nursing staff • LPNs, CNAs, CMAs • Aides • Activities or recreation staff • Dietary staff • Social service staff

  41. C) Relating to Other Residents and Families • Establishing community • Helping resident to adapt • Changing rooms • Transfers and discharges

  42. D) End of Life • The culture of death in Long-Term Care facilities • Care at the end of life • Logistics for families • Death certificates and funerals • Care of families during and after death

  43. E) Grief Issues • Anticipatory grief • Spiritual needs • Rituals • Counseling / bereavement groups • Additional grief issues for residents • Loss of independence, space, privacy, choice, friends, associations, pets, driving, physical function, communication, intimacy, family deaths

  44. Elder Family Learning Initiative The End

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