Levels of Care and Caregiving

How is the neurological system affected by age-related changes? What are possible complications?

Normal aging = decreased sensory info and cognitive process

Complications = increased risk of delirium, balance and fall risk, pressure injuries

How is the cardiovascular system affected by age-related changes? What are possible complications?

Normal aging = decreased ANS (SNS) response and CO (CO = cardiac output) and reserve

Complications = increased risk of not meeting metabolic demand, orthostatic hypotension, arrhythmias

How is the pulmonary system affected by age-related changes? What are possible complications?

Normal aging = decreased airway clearance, chest wall compliance, and muscle strength; increased lung compliance

Complications = increased risk of pneumonia, work of breathing/ fatigue, atelectasis, aspiration

How is the MSK system affected by age-related changes? What are possible complications?

Normal aging = sarcopenia, decreased joint ROM and flexibility and bone density

Complications = increased fatigue, risk of falls/fractures, caloric demand for a given activity

How is the integumentary system affected by age-related changes? What are possible complications?

Normal aging = decreased elasticity and vascularity

Complications = increased risk of pressure injuries and tears, decreased wound healing

How is the visceral function system affected by age-related changes? What are possible complications?

Normal aging = decreased renal filtration, liver clearance, GI mobility, sphincter control

Complications = increased risk of edema, poor drug clearance, electrolyte imbalances, decreased cognitive and motor function

Which types of conditions are older adults more susceptible to in the acute care environment?

Delirium, pneumonia, infections, dehydration, loss of control/ helplessness, pressure injuries, muscle weakness, **functional mobility declines, anxiety/ depression/ PTSD, malnutrition

What are issues w/ hospitalizations of the older adult?

Delirium, falls in hospital, medical deterioration

List iatrogenic effects (i.e., things that occur due to medical or surgical tx) associated w/ hospitalization.

Delirium, pneumonia, infections, dehydration, loss of control, helplessness, pressure injuries, muscle weakness, functional mobility declines, anxiety, depression, PTSD, malnutrition

List hospital barriers to maintaining and restoring function.

Poor pain mgmt., tethering w/ lines and tubes, hospital furniture, social and cognitive isolation, access to and use of glasses, hearing aids and dentures, sedation, unfamiliar and unfriendly environment, sleep disturbance, polypharmacy, inconsistent staff and schedules

Describe discharge planning in the acute care environment.

Starts at evaluation!! Continually assessing, avoid discharge education overload, collaborate w/ MSW and care team, individualized to patient and family/caregiver

Which institutions fall under "in-patient post-acute care management"?

IPR (IRF) (inpatient rehab or inpatient rehab facility), SNF (skilled nursing facility), LTC (long-term care), LTACH (long-term acute care hospital)

Why are patients admitted to IPR?

Intense rehab needs (at least 2 disciplines), 3 hr/day, 5 day/week

IPR facilities are required to have ______% of CMS-13 diagnoses

60%

Why are patients admitted to SNF?

Short-term SN and/or therapy services (ex: joints, heart failure, UTI, fractures, kidney infections)

Why are patients admitted to LTC?

No REGULAR skilled interventions = NOT COVERED BY MEDICARE A --> skilled services billed to Medicare B for outpatient services

Includes nursing homes, ALFs, adult day care, home care or sitter services (non-skilled), other local/ community-based services

Why are patients admitted to LTACH?

Require hospital-level care for extended period (20-30 days) (i.e., requires daily physician attention and a multidisciplinary team, meets several criteria)

What are the pros vs. cons of home health care?

Pros = natural environment, autonomy, flexibility of scheduling

Cons = unsafe environment, may struggle leaving work at work, time mgmt., flexibility, isolation from other healthcare professionals, lengthy documentation, variable circumstances

Which 2 criteria must someone meet to be considered "homebound" and have Medicare coverage?

1. Requires need of an AD, special transportation, or the assistance of another person OR medically contraindicated to leave the home

2. Leaving the home must require considerable effort to do so

What is the goal of home health care?

Reintegrate person into the community and decrease risk of hospitalizations or nursing home admission

Which institutions fall under "Assisted Living Facility (ALF)"?

RCAC (residential care apartment complex), CBRF (community based residential facility), adult family home

What is a "RCAC" (residential care apartment complex)?

Typical "ALF" -- but provides up to 28 hrs of services per week, 24 hr emergency services available; lockable entrance, kitchen, and private bathroom available

What is a "CBRF" (community based residential facility)?

Type of "ALF" that support intermediate level of nursing (up to 3 hrs per week), doesn't provide 24/7 nursing like SNF/LTC nursing homes, can provide memory care or specialize in type of resident

What is an adult family home?

Smaller facility- "group home," provide care "above the level of room and board" (up to 7 hrs of nursing care), usually specialize in particular type of patient

What is a memory care facility?

Long-term care for residents w/ Alzheimer's or other progressive-degenerative dementia. Programming to slow progression of memory loss, 24/7 security and anti-wandering systems, lower staff-resident ratio

What is an adult day care center?

Provides services for part of the day in group setting, for assist w/ ADLs, supervision, and/or protection, offers respite to family/ caregivers

What are outpatient services?

Usually performed in a clinic setting, variety of ages and diagnoses, usually higher functioning patients

What is hospice? What is required?

End of life service:

_______: patient's journey t/o the healthcare system

Continuum of care

What are the benefits of quality continuum of care?

Coordination, communication, avoids redundancy, greater satisfaction & improvement, convenience, boosts morale, avoids unnecessary imaging

Most US adults are unpaid caregivers. Most are male vs. female? Age? Relative vs. non-relatives?

Young and middle-aged female relatives

What do family caregivers do for older adults?

Household tasks, self-care, supervision, and mobility, emotional and social support, health and medical care, advocacy and care coordination, surrogacy

_______: phase of taking on various responsibilities in a particular role

Role acquisition

_______: phase where caregiving is in full effect

Role enactment

_______: phase where care recipient dies OR caregiving shifts to a new caregiver

Role disengagement

What encompasses the "stress process"?

The background and caregiving context (caregiver's demo, relationship, and nature of relationship), stressors, mediators, outcomes or manifestations of stress

Why do PTs care about the caregivers?

Injuries, mental health, social well-being, financials

Coverage: inpatient hospital

Medicare Part A

Coverage: IPR

Medicare Part A

Coverage: SNF

Medicare Part A (Requires 3-night inpatient hospital stay. Up to 100 days per benefit period.)

Coverage: long-term acute care hospital (LTACH)

Medicare Part A (medically complex patients needing >25 days hospital-level care)

Coverage: long-term care (LTC/ custodial nursing home)

NOT MEDICARE -- covered by Medicaid, private pay, or LTC insurance

Coverage: hospice

Medicare Part A

Coverage: home health care

"It depends" Medicare A vs. Medicare B

Coverage: outpatient hospital services

Medicare Part B (i.e., same-day surgery, ER, observation, imaging, labs, outpatient rehab)

Coverage: outpatient rehab

Medicare Part B

Coverage: durable medical equipment (DME)

Medicare Part B

Coverage: RCAC (residential care apartment complex)

NOT COVERED -- may be able to get coverage via Family Care (Managed Medicaid)

Coverage: CBRF (community-based residential facility)

NOT COVERED -- may be able to get coverage via Family Care (Managed Medicaid)

Coverage: adult family home

NOT COVERED -- may be able to get coverage via Family Care (Managed Medicaid)

Coverage: memory care facility

ROOM & BOARD NOT COVERED -- medicare only pays for medical services given there

Coverage: adult day care centers

NOT COVERED -- sometimes Medicaid will