ch 5 old people living arrangments

How can environment hamper or encourage successful aging?

The environment and social environment is important for both healthy and disabled people

What are some examples of built environments?

• Cities

• Homes

What are some examples of social environments?

• Family interactions

• Staff in facilities

Why do needs vary for old people most times?

• Different disability status

• Cognitive impairment

• Gender

• Race

Women have a greater degree of disability than men.

True

How can social change alter where people live and who they live with?

• Affordability

• Housing

• Designs of houses

• Availability

What is person-environment fit?

Created by Lawton and Nahemow

• Establishes points of balance between competence and environmental press, called adaptation levels

• Helps decide whether the old perople is a good match for their environment

What is proactivity?

• Choosing new behaviors to exert control over the changes

• Often results when people are high in competence

What is docility?

• Allowing the situation to dictate one’s options when the changes occur

• Results in low competence

What is competency in the person-environment fit model?

Upper limit of how much someone can function

What is environmental press in the person-environment fit model?

• Physical (stairs)

• Interpersonal (adjusting behavior patterns)

• Social demand (deal with laws/customs)

• They are stimulating factors

What is the relationship between high competence and environmental press in the person-environment fit model?

The higher the competence, the more complex environment preferred

How can we use the person-environment fit model to plan for the aging society?

We can plan for the older society or they may have taken individual steps for their own environments

What is aging in place?

The tendency of old people to age in the same place over time, despite changes to their abilities and needs

Older Floridians contribute more to state and local taxes than they take in services

True

Rural areas contain more old people

True

Are old men or old women more liekly to live with children?

Old men

What is the Preventative and Corrective Proactivity Model?

Kahana & Kahana model

• Explains how life stressors and lack of good congruence in person-environment interactions, especially when the person has nothing to help buffer or protect against these things, result in poor life outcomes

What are the 3 helpful buffers within the preventative and corrective proactivity model?

• External resources (friends, home modifications, etc)

• Internal resources (positive outlook on life)

• Specific proactive behaviors (physical exercise, etc)

What are 2 proactive adaptations?

• Corrective: actions taken into response to stressors

• Preventative: actions that avoid stressors

Do old people tend to engage in more corrective or preventative adaptations?

Corrective

What was Schooler’s experiment on the 4000 old people living in long term care facilities (LTCF)?

He examines the impact of stressors:

• Environment change

• Resident mobility

• Major life events

What were the findings of Schooler’s experiment on the 4000 old people living in the LTCF?

• Old people adaptation depends on their perception of environmental stress and their attempts to cope

• Social systems and institutions may buffer the effects of stress

What is everyday competence?

A person’s potential ability to perform a wide range of activities considered essential for independent living

What is Willis’ model of everyday competence?

• Distinguishes antecedents, components, mechanisms, and outcomes of everyday competence

• Helps see if old people are comeptent for decisions

What is the congruence model?

Kahana (1982) found that people with needs search for the environments that meet them best

_% of 65+ live in the community not institutions

95%

What are some ways old people seek out new housing options?

• Rehabilitation (common)

• Modifying the environment

• Moving to a setting

What are some options for coping with impairment?

1. Staying at home with increased services, whether from family or formal care

• Advantage: familiar setting

2. Move to a setting with greater environmental support

• Advantage: higher medical care

What problem may arise for old people who are aging in place?

• Houses are typically built with younger, able people in mind

• This creates an unfit and challenging environment

What is home modification?

Improvement or repair to the environment in order to more easily perform tasks, reduce accidents, increase independence

What is an auxiliary dwelling unit and how may this be useful?

• A separate living space attached to the main home (to family) such as a room above the garage

• Maintains independence, comfort, and safety via proximity

What are some key community resources to keeping old people living at home?

• Family caregivers

• Adult day care/services

• Meals on wheels

• Visiting nurses

• Transportation services

How helpful are family caregivers to society?

Extremely, they prevent overwhelming costs for society

What is adult daycare?

• Designed to provide support, companionship, and certain services during the day

• Helps reduce problematic behaviors

What is the average demographic for adult daycare attendees?

• 70+

• 2/3 are women

What is Medicare? Who pays for it?

Federal programs that pays for covered health services for 65+ and most permanently disabled individuals under the age of 65

Where does the federal government get the money to pay for Medicare?

Money gets taken from paychecks automatically towards it

What is Medicare home health care?

• Pays/provides for part-time, skilled nursing, and therapy services for eligible beneficiaries with illnesses or injuries who are “homebound”

• Plan of care required by MD to prove if the care if beneficial, if not, it is removed

What is Medicaid? How is it paid for?

• Provides free or low-cost health coverage to millions of low-income individuals, families, children, pregnant women, and people with disabilities

• Paid 60% by federal government and 40% dependent on state

What is the eligibility for Medicaid?

Low income, limited assets

Medicaid helps children under 18

True

What are assisted living facilities (ALFs)?

Place to provide supportive living arrangements for people who need assistance with personal care (bathing, meds), but are not physically or mentally impaired to require 24 hour care

What are 3 attributes of assistance living facilities?

1. Keep it as much like a single family house as possible (private)

2. Emphasize control, choice autonomy

3. Should meet routine services and needs

Where does funding come from for assistance living facilities?

75% paid by family out of pocket, cheaper of the options

What are nursing homes (NH)?

Homes meant for those with health issues and functional impairments

What are the most common demographics for nursing home residents?

• 85+

• Women

• White

• Lives in retirement rather than home owner

• Some cognitive impairment + one issue with an ADL

What can be done to make a nursing home a home?

• Include old people in decision/selection in NH

• Establish continuity between home and NH

Where does funding come from for nursing homes?

Medicaid

Less than 5% of old people live in nursing homes

True

What is congregate housing?

Includes a range of living options such as apartment style

Where does majority of funding come from for congregate housing?

Subsidized by government agencies or nonprofit organizations

What are the requirements for living in congregate housing?

• Old person doesn’t require continual care

• Old person is oriented and know where they are

• Old person can make decisions

• Old person can follow specific service plans

What are continuing retirement communities (CCRCs)?

A single location offering from independent living to assisted living and skilled nursing depending on what is needed

Where does funding come from for CCRCs?

All privately paid and mainly for the rich

What is Kendal?

A CCRC sponsored by the Quakers

What are benefits for residents of Kendal?

Old people can choose their own recreation, do repairs and gardening, community service, etc

What are Alzheimer’s special care units?

May be in assisted living or nursing home where it is required for staff to have special training in order to advertise caring for those with Alzheimer’s disease

What is the typical design for an Alzheimer’s special care unit?

• A racetrack to wander safely

• Security

• Homelike

• Appropriate sensory stimulation

In Alzheimer’s care units, residents are less likely to have falls

False

What are special care units?

Created to provide a supportive environment for people with moderate to severe dementia

Residents of special care units tend to be younger and more impaired than the rest of the nursing home residents

True

What are dementia villages?

Basically taking the mixture of a nursing home and assisted living facilitiy and put up walls all around it

What are some bonuses of dementia villages?

Allow old people to wander wherever in gardens, nature, stores without prices to “buy” things, etc

What is the Eden Alternative?

Dr Bill and Jude Thomas created a place that is more alternatized with pets, plants, etc

How should one talk to a resident?

• No patronizing speech

• No baby talk

• Don’t use first names unless asked to

• Support conversation and keep it simple

What are some policy issues with old people?

The US has a very individualistic society causing gaps in care

How is decision-making capacity assessed for old people?

The Patient Self-Determination Act (PSDA) requires people to complete advance directives when admitted to a healthcare facility

A major ethical issue with the patient self determination act is

How to communicate this information to people with cognitive impairment in nursing homes