Day One (Chapter 1 & 2)

What are the Healthcare Settings?

1) Long Term Care (LTC)

2) Home Health

3) Outpatient

4) Acute Care

5) Subacute Care

6) Assisted Living

7) Rehabilitation

8) Hospice

9) Adult Day Services

10) Clinics (PCP office or Reproductive clinics)

Home Health

People Receiving Services: Clients

→ Aging in place

Household tasks- Laundry, Groceries, Dishes, etc.

*Aides work more independently

Outpatient

Services provided for less than 24-hrs

→ No overnight stay required

After surgeries / procedures

Acute Care

People Receiving Care: Patients

Hospital setting

Emergent illnesses / Traumas

*Immediate Care!

Subacute Care

• Less Care (attention) than ACUTE

• More Care (attention) than LTC

Assisted Living

Alternate Title: Personal Care Facility

People Requiring Care: Resident

Requires 24-hr care

→ Not necessarily skilled care around the clock.

*Independent Living + / Skilled Nursing -

Provides: Medication management, Housekeeping, Meals

*Could have facility requirements that need to be met to stay here

Rehabilitation

People Requiring Care: Clients

OT / PT / SLP

Compensate for an injury/ change in personal abilities.

Located in: Skilled facilities or private rehab centers

Hospice

End of life care: About six months or less

LTC Hospice workers supplement what the facility offers

Adult Day Services

People Requiring Care: Clients

Supervision for adults; Provide a break for Family Members / Care Takers

Long- Term Care

People Receiving Treatment: Residents

Designed for: Chronic illness / Developmental disabilities

→ Developmental Disabilities: Makes up Longest Average Stay

Requires 24-hr skilled nursing care

*This is their home- WE are here for them!

Who is a part of the healthcare team?

• Dr

• RN

• LPN

• NA

• PT

• OT

• SLP

• Med. Tech

• Social Worker

• Dietitian

• Housekeeping

• PA

• Activities

• Medical Record

• MDS Coordinator

• Chaplin

• Family

• RESIDENT

→ THE MOST IMPORTANT

NA Roles

• Collect Specimen

• Vitals

• Transport Residents

• Ensure Clean & Proper Storage of Environment and Equipment

• Answer Call Bells

• Make & Report Observations

• Measure & Report Intake of Food & Residents Output

• Assist w/ Admissions, Transfers, & Discharges

NA’s Can’t…

• Give Medications

• Put Tube in Body Opening/ Remove them

• Sterile procedures

• Diagnose & Prescribe

• Take Telephone Orders

• Anything w/o Proper Training

• Anything beyond scope

Maslow’s Hierarchy of Needs

(FIRST PRIORITY) Physiology

|

Safety

|

Belonging / Social Connection

|

Esteem

|

(LAST PRIORITY) Self- Actualization

*If one or more of these levels are unmet, it leads to feelings of inadequacy and depreciated self-worth.

What are each need?

Physiological- Toileting, Sleeping, Breathing, Eating, & Drinking

Security & Safety- Shelter, Financial Security, Clothing, & Safety

Belonging- Time w/ family, friends, & staff

Esteem- Feeling useful

Self-Actualization

Behaviors that manifest when belonging is missing…

• Crying / Tearfulness

• Depressive symptoms

• Inappropriate comments

• Inappropriate gestures

Factors that affect resident’s access to belonging…

1) Spousal Loss

2) Spousal Separation

3) No family / No visitors

4) Cognitive decline / Disease progression

Belonging / Lonliness Statistic

-Prolonged isolation is as damaging to health as smoking 15 cigarettes a day

-Loneliness increases premature death by 26%

-Lonely individuals have 50% higher chance of developing dementia

What is Elderspeak?

Communication which features characterists including…

• slower rate

• elevated pitch

• elevated volume

• greater repetition

• exaggerated intonation

• inappropriate terms of endearment

  • Honey, Sweetie, Sugar, Dear, & Cuties

• Simpler vocab / grammar

Treat Residents with…

• Compassion

• Tactfulness

• Sympathy

• Empathy

• Explain why you are doing

• Don’t promise a precise return

• Don’t rush

• Take responsibility for mistakes

Passive Physical Restraints

Objects utilized to prevent an individual from moving

→ Side Rails

*Used for convenience of the staff

Chemical Restraints

Alters Mental Functioning of the resident

*Used for convenience of the staff

Active Physical Restraint

Restraint is placed on the physical body

Requires:

• Doctor’s Order

• Family Consent

• 15-min checks

• Restraints are in good working order

• NA knows how to do it

• Release restraints every 2-hrs

Residents Rights

1. Free choices

2. Freedom from abuse and restraints

3. Privacy

4. Confidentiality of personal and clinical records

5. Accommodation of needs

6. Voice grievances

7. Organize and participate in family / resident groups

8. Participate in social, religious, and community activities (Voting!)

9. Examine survey results & correction plans

10. Manage personal funds

11. Information about medicare & medicaid

12. File complaints about abuse, neglect, or misappropriation of property

13. Information about advocacy groups

14. Immediate and unlimited access to family or relatives

15. Sharea. room w/ a spouse if they are both residents in the ame facility

16. Perform or not perform work for the facility if it is medically appropriate

17. Remain in the facility except in certain circumstances

18. Use personal possessions

19. Notification of change in condition

Physical Abuse

Infliction of injury, unreasonable confinement, or punishment w/ resulting physical harm.

• slapping

• too hot or cold bath water

• rough handling

• biting

Psychological Abuse

The threat of injury, unreasonable confinement and punishment, or verbal intimidations and humiliation which may result in mental anguish such as anxiety or depression.

• Ignoring

• Name calling

• Screaming

• Demeaning language

Sexual Abuse

Sexual contact that results from threats, force, or the inability of the person to give consent

• Rape

• Fondling

• Inappropriate touching

• Exposing the individual

Financial Exploitation

An improper course of conduct with or without informed consent of the older adult that results in monetary, personal or other benefit, gain or profit for the perpetrator or onetary or personal loss for the older adult.

• Stealing

• “Borrowing”

• Ignoring reports of loss or theft

Active neglect

The willful deprivation of goods or services which are necessary to maintain physical or mental health.

• Withholding food items

• Ignoring call lights

• Making the individual wait

• Not feeding a client whom you know needs help

Passive Neglect

The deprivation of goods or services which are necessary to maintain physical or mental health, without a conscious attempt to inflict physical or emotional distress

• Leaving older person on toilet

• Telling a client you will return in 5 minutes and do not

HIPPA

H- Health

I- Insurance

P- Portability

A- Accountability

A- Act

*Protect confidential information

**Direct medical question about resident to the unit manager

AWIPES

A- assemble equipment

W- wash hands

I- identify

E- explain process

S- safety

Nursing Process: ADPIE

A- Assess

D- Diagnosis

P- Plan

I- Implement

E- Evaluate

*Care plans are individualized to each resident

HMO / PPO

Health Maintenance Organizations

Preferred Provider Organizations