Community-Aging Adult, Home Health, Hospice, SBIRT

What are some common misconceptions about older adults?

• Inability to live independently​

• Most with diminished intellectual capacity or senility​

• Homogeneity: all alike, with no individual differences​

• Inability to learn new things​

• Withdrawn, inactive, nonproductive​

• Liability: expensive, draining on economy​

What Primary health prevention factors are needed for a healthy older adult?

• Health education; follow-through of sound personal health practices; recommended immunizations ​

• Nutrition, oral health, exercise, safety needs, sleep​

• Economic security needs​

What does Secondary Prevention do for the health needs of older adults?

• Focus on early detection of disease and prompt intervention​

• Routine screening for hypertension, diabetes, cancer

What does Tertiary Prevention do for the health needs of older adults?

• Follow-up and rehabilitation​

• Health issues: Alzheimer’s disease, arthritis, cancer, depression, diabetes, cardiovascular disease, osteoporosis

What is Elder Abuse?

• “Intentional or neglectful acts by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult” ​

  • Physical abuse​

  • Neglect​

  • Emotional or psychological abuse​

  • Verbal abuse and threats​

  • Financial abuse and exploitation​

  • Sexual abuse​

  • Abandonment

Which would be most accurate when describing the changes​ occurring in the older adult population globally?

• A. Males have a longer projected life expectancy than females.​

• B. Most countries have adequate social programs for older adults.​

• C. Adults over age 65 are expected to account for about 25% of the population by 2050.​

• D. The over-80-year age group is the fastest-growing segment of the group.

D. The over-80-year age group is the fastest-growing segment of the group

Who are the home health clients?

• Clients include individual, family, significant others​

• Individuals are predominantly:​

• Older than 65 years, but not exclusively​

• Individuals tend to:​

  • Have chronic health needs (e.g.,​ diabetes, COPD, CHF)​

• Rely on care from family members (who may exhibit signs of compassion fatigue)

• FOCUS: empowerment for highest possible levels of function and health

Who provides reimbursement for home health care?

• Corporate​

  • Insurance companies, HMOs, PPOs, and case management programs​

• Governmental third-party payers​

  • Medicare, Medicaid, military health system, and Veterans’ administration​

• Individual clients and families​

What is the Medicare Home health criteria and reimbursement?

• The patient must:​

  • Be confined to home or homebound​

  • Need skilled services (from a nurse or therapist)​

  • Be under care of a physician​

  • Receive services under a home health plan of care established and periodically reviewed by a physician​

  • Have had a face-to-face encounter related to home health condition with a physician or NP

• Episode of care: 60 days​

• Admission: assessment using Outcome and Assessment Information Set (OASIS)​

• Medicare documentation: OASIS, Medicare plan of care

What is the OASIS document and what does it do?

• The Home Health Outcome and Assessment Information Set contains data items developed to measure patient outcomes and for improve home health care.​

• The OASIS assessments are required of all home health agencies certified to accept Medicare and Medicaid payments.

What is standard nurse practice during a home visit?

• Contacting patient and/or family to schedule visit​

• Locating the home​

• Assessment begins at the curb​

• Promoting self-management​

• Collaborating, mobilizing, strengthening, teaching, and solving problems​

• Focus is on the three levels of prevention

What are some challenges when a nurse visits a home?

• Infection control​

  • Clients​

  • Home health care team​

• Medication safety​

• Risk for falls (do home safety check)​

• Technology at home​

• Nurse safety

What is the role of the home health nurse?

• Nurse as a case manager for each client​

• Coordinating other professionals and paraprofessionals involved in the client’s care​

• Serving as primary contact with client’s healthcare provider​

• Case conferencing with team members (Medicare mandate—every 60 days)​

• Supervising paraprofessionals

What are the goals of hospice care?

• Provide​

  • Provide comfort and relief of physical, emotional, social and spiritual suffering​

• Promote​

  • Promote dignity ​

• Prepare​

  • Prepare patient/family for death​

    • Provide a peaceful “good” death as defined by the patient and family​

    • Empower patient/family to make decisions relating to life closure​

What is Palliative Care?

• Consists of comfort and symptom management ​

• Does not provide a cure​

• As any care, primarily intended to relieve the burden of physical and emotional suffering that often accompanies the illnesses associated with aging

What are the 4 types of hospice & palliative care?

• Routine home care with intermittent visits​

• Continuous home care when condition is acute and death is near​

• General inpatient/hospital care for symptom relief​

• Respite care in nursing home of no more than 5 days at a time to relieve family members

What are the 4 categories of hospice providers?

• Home health agencies​

• Hospital-based facilities​

• Skilled nursing facilities​

• Freestanding facilities

What are the Medicare Hospice Benefit Requirements?

• Client must:​

  • Have a prognosis of 6 months or less to live​

  • Acknowledge a terminal prognosis​

  • Choose comfort care instead of life-extending care​

  • Sign up for comfort-focused hospice benefit​

  • Waive regular Medicare health services

What is the role of the practicing hospice nurse?

• RN as central to hospice interdisciplinary team​

• Case manager; frequent visits​

• Collaboration with healthcare providers​

• Rotation through 24-hour call 7 days/week to assure continuous availability by telephone and visits for emergent problems​

• Competencies similar to those of home health nurses, along with expertise in relieving physical and emotional suffering of terminally ill people and their families​

What does SBIRT stand for?

Screening ​

Brief ​

Intervention ​

Referral to ​

Treatment

What is SBIRT?

comprehensive and integrated public health approach to the delivery of early intervention and treatment services through universal screening for persons with substance use disorders (SUD) and those at risk of developing these disorders

What is the Screening Core component of SBIRT?

The use of validated procedures to quickly assess patient substance use risk and select appropriate care.

What is the brief intervention core component of SBIRT?

A 5-15 minute discussion that aims to increase patient understanding of the risks and build toward behavior change.

What is the Referral to Treatment part of SBIRT?

A linking of appropriate patients to appropriate SUD treatment ​(specialty care)

What is the aim of SBIRT?

identify patients whose substance use puts them at hazardous or harmful risk levels, even if diagnostic criteria of an SUD is not met

How many people meet the criteria for harmful or hazardous substance use?

Approx. 15-40%

What is the current approach of preventing substance use disorders?

Focuses on early intervention Identifies individuals at an early stage in substance misuse prior to the development of a SUD

What are the principles of screening for substance use disorder?

• universal, brief, and indicative of next steps

• can be used on all patients

• only takes a few minutes

• determines an appropriate intervention based on patient risk level

How many drinks is safe for Men less than 65 yrs to have per week?

Less than 14

How many drinks is safe for Men & Women older than 65 yrs to have per week?

Less than 7

How many drinks is safe for Men less than 65 yrs to have in a day?

Less than 4

How many drinks is safe for Men & Women older than 65 yrs to have per day?

Less than 3

How much alcohol is in a “standard drink”?

• 12 oz beer (5% alc/vol)

• 8-9 oz malt liquor (7% alc/vol)

• 5 oz wine (12% alc/vol)

• 1.5 oz liquor (40% alc/vol)

What does the The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Single Question Screen?

Alcohol

What does the National Institute on Drug Abuse (NIDA) ​Single Question screen?

Drugs

What type of question does the National Institute on Alcohol Abuse and Alcoholism (NIAAA) ask?

How many times in the past year have you had more than ​(4 for men, 3 for women) ​ drinks in a day?

A response of 1 or greater is considered a positive​ screen that indicates further screening is needed.

What type of question does the National Institute on Drug Abuse​ (NIDA) ask?

How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?

A response of 1 or greater is considered a positive​ screen that indicates further screening is needed.

What is the ASSIST screen tool and what does it do?

Alcohol, Smoking, and Substance Involvement Screening Test

• developed by the World Health Organization (WHO) for use in primary care settings to detect and manage hazardous substance use.​

• It uses the same questions to assess alcohol, tobacco, and other drug use.​

What is needed when the client’s ASSIST scores are b/w 0-10 for alcohol and 0-3 for drugs?

Positive Reinforcement

What is needed when the client’s ASSIST scores are b/w 11-26 for alcohol and 4-26 for drugs?

Brief Intervention

What is needed when the client’s ASSIST scores are 27+ for alcohol and drugs?

Intensive Treatment

What is the AUDIT screening tool and what does it do?

The Alcohol Use Disorders Identification Test​

• a 10-item screening tool also developed by the WHO

• only screens for alcohol use. It assesses alcohol consumption,​ drinking behaviors, and problems related to alcohol use

What is needed when a client’s AUDIT scores are b/w 0-6 (Zone I) for Men & Women greater than 65?

Feedback

What is needed when a client’s AUDIT scores are b/w 0-7 (Zone I) for Men less than 65?

Feedback

What is needed when a client’s AUDIT scores are b/w 7-15 (Zone II) for Men/Women over 65?

Feedback/Brief Intervention

What is needed when a client’s AUDIT scores are b/w 8-15 (Zone II) for Men less than 65?

Feedback/Brief Intervention

What is needed when a client’s AUDIT scores are b/w 16-19 (Zone III)?

Feedback/Brief Outpatient Treatment

What is needed when a client’s AUDIT scores are 20+ (Zone IV)?

Brief Intervention/Medical Intervention and Referral to Treatment

What is AUDIT-C and what does it test for?

The Alcohol Use Disorders Identification Test - Consumption​

Can be used as an initial screen to determine if the full test is needed

What is the CRAFFT test and what does it test for?

Car, Relax, Alone, Forget, Family/Friends, Trouble​

a two-part tool that screens for alcohol and other drug use in adolescents (< 21 years old)

What is a brief intervention (BI)?

A brief dialogue with a patient to explore the consequences of substance use with the intent to strengthen the patient’s own motivation and commitment to positive behavior change

What are the components of Brief Interventions (BIs)?

• Feedback on the risks assoc. w/ substance use (disclosing results)

• Exploration of behaviors related to substance use (Pros vs cons)

• Strategy with set goals and specific action steps (0-10 how ready for change)

What is the F-L-O Process?

• Feedback

• Listening

• Options

What is OARS (as part of the Listening process)?

• Open-ended questions

• Affirmative statements

• Reflective statements

• Summarizations