DHC - CH 4
What is the size of the older population expected to grow by?
By almost 50% from 2016 to 2030.
What will the population growth of the older population likely change demands for?
Health care, social services, and caregiving in the US
As the older segment of the population increases what services will be required?
More services will be required for the treatment and management of chronic and acute health conditions and disabilities. Case management is necessary to coordinate the care of older adults with multiple health problems.
Why is there an overall aging of the population?
The increasing life expectancy and decreasing fertility; this trend follows that of other developed countries.
Define chronic diseases.
Conditions that last 1 year or more and require ongoing medical attention, limit activities of daily living, or both. Chronic diseases are the most important of future disabilities.
Why do Americans continue to live longer?
Because of more effective diagnosis and treatment for heart disease and cancer, the two leading causes of death in those 65 years of age and older
What are some common chronic diseases in older adults?
Arthritis, stroke, diabetes, chronic lower respiratory diseases, and dementia, including Alzheimer’s disease.
With aging there is a loss of functional ability including limitations in what?
Vision, hearing, mobility, communication, cognition, and self-care.
What are some examples of Instrumental Activities of Daily Living (IADLs)?
Managing money, shopping, preparing meals, and taking prescribed medications.
Define Activities of Daily Living (ADLs).
Basic skills required to independently care for oneself, such as eating, bathing, dressing, maintaining personal hygiene, and mobility
What is the most common disability in people ages 65-74?
Mobility impairment
What is the second most common disability in people 65-74?
Difficulty hearing
What are the most debilitating conditions accompanied by functional impairments among older adults?
Stroke and dementia
What is the most common cause of dementia?
Alzheimer’s disease
In what population is stroke more common?
Women, Asian and Pacific islanders, African Americans, and Hispanics and in those over 85 years of age.
Why is a stroke a leading cause of long-term disability?
Since a stroke can cause either left or right sided paralysis that impairs mobility and the ability to swallow and speak
Define dementia?
A decline in cognitive function that affects memory, language, and problem-solving skills.
What are the early symptoms of Alzheimer’s disease?
Difficulty remembering names and events.
What are the later symptoms of Alzheimer’s disease?
Disorientation and confusion as well as personality and behavior changes (suspicion and agitation).
What are the later stages of Alzheimer’s disease?
Inability to complete ADLs and eventually difficulty in speaking, swallowing, and mobility, requiring total bed care for 24 hours a day.
According to the Alzheimer’s Association, how many people have Alzheimer’s disease?
1 in 10 people age 65 and older and 1 in 3 people age 85 and older
Define caregiving.
Attending another person’s health needs and well-being and often includes assistance with one or more ADLs such as bathing and dressing as well as multiple IADLs such as paying bills, shopping, and providing transportation.
What do the Medicare-covered benefits apply to?
To the treatment of patients with acute illnesses who require hospitalization, short-term skilled nursing care in rehabilitation centers or nursing homes, or home health care.
What are the four parts of Medicare?
Part A, Part B, Part C, and Part D
Describe Medicare Part A.
Hospital insurance, and all elderly beneficiaries are automatically enrolled.
Describe Medicare Part B.
Supplemental medical insurance and is voluntary, although over 90% of older adults purchase Part B.
What is Medicare Supplemental Health Insurance?
Often called Medigap insurance, it's
from a private company to cover deductibles and copayments for Parts A and B.
Describe Medicare Part C.
Supplemental Hospital and Medical insurance (optional)
Describe Medicare Part D.
Medication Insurance for Prescriptions (optional)
What does Medicare Part A pay for?
Hospital expenses minus a deductible for the first 60 days of each benefit period. Medicare A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.
What does Medicare Part B pay for?
80% of the cost of the outpatient services for doctors, physical, occupational and speech therapy, diagnostic and laboratory tests, and durable medical equipment such as wheelchairs or oxygen tanks as well as preventive screenings for diabetes, cardiovascular disease, and cancer.
What is Medicare Part C also called?
Medicare Advantage
What does Medicare Advantage provide?
All of Part A and Part B. Most also include Part D.
What does the structure of Medicare Advantage Plans follow?
That of a managed care organization (MCO)
If an older person has Medicare and Medicaid, what does Medicaid cover?
A broad range of services not covered by Medicare, acting as a supplemental insurance for older adults and the disabled.
What is protected under the Medicaid Spousal Impoverishment provisions? And what does this ensure?
That a certain amount of a couple’s combined resources is protected for the spouse living in the community since long-term care can rapidly deplete the lifetime savings of elderly couples.
Define long-term health care.
The help needed by people of any age who are unable to complete ADLs because of physical and/or mental impairment. Nursing facility services provided by Medicaid-certified nursing homes primarily provide long-term care. The National Study of Long Term Health Care Providers in 2012 showed the majority of people served by long-term care providers were served by residential care facilities and nursing homes.
What is the Preadmission Screening and Resident Review?
A federal requirement designed to ensure that individuals are not inappropriately placed in a nursing home for long-term care.
What are Intermediate Care Facilities for People with Intellectual Disability (ICF/ID)?
Available only for individuals in need of and receiving active treatment, which consists of a program of specialized and generic training, treatment, and health services.
Explain Inpatient Psychiatric Services for Individuals under Age 21.
Provides comprehensive mental health treatment for children and adolescents who, due to acute mental illness, substance abuse, or severe emotional disturbance, are in need of treatment that can most effectively be provided in a residential treatment facility.
Explain the services for individuals age 65 or older in an Institution for Mental Diseases?
The services of an institution for mental diseases (IMD) meet federal and state requirements of a hospital or nursing facility but are also considered an IMD for older adults with mental or intellectual disabilities who require ongoing long-term care.
What are the 3 types of services in nursing facilities?
Skilled nursing or medical care and related services
Rehabilitation needed due to injury, disability, or illness.
Long-term care- health related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition
Define Skilled Nursing Facility (SNF).
A nursing home that provides the level of care closest to hospital care. 24 hour nursing services, medical supervision, rehabilitation, pharmacy, and dietetic services, and physical, occupational, and recreational therapy are provided in accordance with federal guidelines.
Who is responsible for nursing home standards?
The federal government through the Center for Medicare and Medicaid Services (CMS) is responsible for nursing home standards, while individual states are responsible for monitoring facilities to ensure that standards are met.
Nursing homes were first established in the 19th century to care for the poor and provide food, shelter, and clothing.
Who are the privately funded long-term care providers that are regulated by federal and/or state governments?
Adult care facilities, residential care communities, home health agencies, and hospice.
What are residential care communities or assisted-living facilities?
Non Medical facilities that provide a room or apartment, meals, housekeeping, medication management, assistance with ADLs as needed, and recreational activities. Some also provide transportation for shopping and doctor visits.
Define continuing care community.
Allows residents to move from independent living to assisted living to a skilled nursing facility on the same campus as their needs change.
What do home health agencies do?
Provide part-time nursing and medical care in patients’ homes as well as other services such as physical, speech, and occupational therapy; social services; and sometimes medical supplies and equipment such as wheelchairs, walkers, and so forth.
Define hospice.
They are operated on the principle that the dying have special needs that hospital personnel are too busy to handle. Hospice care helps manage pain and other symptoms associated with dying when conventional treatment is no longer of value. Hospice provides emotional support, bereavement counseling, and medical supplies and equipment. The first hospices cared for the wounded, sick and dying; however, modern hospices care only for the dying.
What are adult day care services?
They are provided in a community-based group setting, usually in a freestanding facility. Some centers may be affiliated with other health facilities or organizations including hospitals, nursing homes, residential care facilities or senior centers. Adult day care is used to supplement home caer services or as a less costly alternative to a residential care facility or a nursing care facility.
Describe the Program of All-Inclusive Care for the Elderly (PACE)
It's a form of integrated care supported by CMS, one of several programs that encourage states to provide the full array of Medicaid and Medicare benefits through a single delivery system in order to provide quality care for dual-eligible enrollees, improve care coordination, and reduce administrative burdens. PACE provides comprehensive preventive, primary, acute, and long-term care services so older individuals with chronic care needs can continue living in the community.
What is the Aging Network?
A system of federal, state, and local entities committed to supporting older Americans in living independently in their homes and communities.
What does the Aging Network consist of?
The US Administration on Aging (AOA), 56 state Aging units, 622 Area Agencies on Aging (AAAs) and more than 250 TItle VI Native American aging programs.
What do Senior Centers offer?
A noon meal as well as social, wellness, educational, and recreational programs Monday through Friday.
Who does limited health literacy affect?
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions. It affects people of all ages, races, incomes, and educational levels, but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups, those with low English proficiency and older adults.
What is the impact on the individual with low literacy skills?
More frequent medical errors, illness and disability, and loss of wages.
Define geriatrician.
Primary care physicians who specialize in the care of those 65 years of age and older and focus on common health and social issues related to the aging process.
Define interprofessional education (IPE)
Where students in different programs learn the roles and functions of other health professions and work together as a team to contribute to the assessment and treatment of individual patients.
DHC - CH 4
What is the size of the older population expected to grow by?
By almost 50% from 2016 to 2030.
What will the population growth of the older population likely change demands for?
Health care, social services, and caregiving in the US
As the older segment of the population increases what services will be required?
More services will be required for the treatment and management of chronic and acute health conditions and disabilities. Case management is necessary to coordinate the care of older adults with multiple health problems.
Why is there an overall aging of the population?
The increasing life expectancy and decreasing fertility; this trend follows that of other developed countries.
Define chronic diseases.
Conditions that last 1 year or more and require ongoing medical attention, limit activities of daily living, or both. Chronic diseases are the most important of future disabilities.
Why do Americans continue to live longer?
Because of more effective diagnosis and treatment for heart disease and cancer, the two leading causes of death in those 65 years of age and older
What are some common chronic diseases in older adults?
Arthritis, stroke, diabetes, chronic lower respiratory diseases, and dementia, including Alzheimer’s disease.
With aging there is a loss of functional ability including limitations in what?
Vision, hearing, mobility, communication, cognition, and self-care.
What are some examples of Instrumental Activities of Daily Living (IADLs)?
Managing money, shopping, preparing meals, and taking prescribed medications.
Define Activities of Daily Living (ADLs).
Basic skills required to independently care for oneself, such as eating, bathing, dressing, maintaining personal hygiene, and mobility
What is the most common disability in people ages 65-74?
Mobility impairment
What is the second most common disability in people 65-74?
Difficulty hearing
What are the most debilitating conditions accompanied by functional impairments among older adults?
Stroke and dementia
What is the most common cause of dementia?
Alzheimer’s disease
In what population is stroke more common?
Women, Asian and Pacific islanders, African Americans, and Hispanics and in those over 85 years of age.
Why is a stroke a leading cause of long-term disability?
Since a stroke can cause either left or right sided paralysis that impairs mobility and the ability to swallow and speak
Define dementia?
A decline in cognitive function that affects memory, language, and problem-solving skills.
What are the early symptoms of Alzheimer’s disease?
Difficulty remembering names and events.
What are the later symptoms of Alzheimer’s disease?
Disorientation and confusion as well as personality and behavior changes (suspicion and agitation).
What are the later stages of Alzheimer’s disease?
Inability to complete ADLs and eventually difficulty in speaking, swallowing, and mobility, requiring total bed care for 24 hours a day.
According to the Alzheimer’s Association, how many people have Alzheimer’s disease?
1 in 10 people age 65 and older and 1 in 3 people age 85 and older
Define caregiving.
Attending another person’s health needs and well-being and often includes assistance with one or more ADLs such as bathing and dressing as well as multiple IADLs such as paying bills, shopping, and providing transportation.
What do the Medicare-covered benefits apply to?
To the treatment of patients with acute illnesses who require hospitalization, short-term skilled nursing care in rehabilitation centers or nursing homes, or home health care.
What are the four parts of Medicare?
Part A, Part B, Part C, and Part D
Describe Medicare Part A.
Hospital insurance, and all elderly beneficiaries are automatically enrolled.
Describe Medicare Part B.
Supplemental medical insurance and is voluntary, although over 90% of older adults purchase Part B.
What is Medicare Supplemental Health Insurance?
Often called Medigap insurance, it's
from a private company to cover deductibles and copayments for Parts A and B.
Describe Medicare Part C.
Supplemental Hospital and Medical insurance (optional)
Describe Medicare Part D.
Medication Insurance for Prescriptions (optional)
What does Medicare Part A pay for?
Hospital expenses minus a deductible for the first 60 days of each benefit period. Medicare A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.
What does Medicare Part B pay for?
80% of the cost of the outpatient services for doctors, physical, occupational and speech therapy, diagnostic and laboratory tests, and durable medical equipment such as wheelchairs or oxygen tanks as well as preventive screenings for diabetes, cardiovascular disease, and cancer.
What is Medicare Part C also called?
Medicare Advantage
What does Medicare Advantage provide?
All of Part A and Part B. Most also include Part D.
What does the structure of Medicare Advantage Plans follow?
That of a managed care organization (MCO)
If an older person has Medicare and Medicaid, what does Medicaid cover?
A broad range of services not covered by Medicare, acting as a supplemental insurance for older adults and the disabled.
What is protected under the Medicaid Spousal Impoverishment provisions? And what does this ensure?
That a certain amount of a couple’s combined resources is protected for the spouse living in the community since long-term care can rapidly deplete the lifetime savings of elderly couples.
Define long-term health care.
The help needed by people of any age who are unable to complete ADLs because of physical and/or mental impairment. Nursing facility services provided by Medicaid-certified nursing homes primarily provide long-term care. The National Study of Long Term Health Care Providers in 2012 showed the majority of people served by long-term care providers were served by residential care facilities and nursing homes.
What is the Preadmission Screening and Resident Review?
A federal requirement designed to ensure that individuals are not inappropriately placed in a nursing home for long-term care.
What are Intermediate Care Facilities for People with Intellectual Disability (ICF/ID)?
Available only for individuals in need of and receiving active treatment, which consists of a program of specialized and generic training, treatment, and health services.
Explain Inpatient Psychiatric Services for Individuals under Age 21.
Provides comprehensive mental health treatment for children and adolescents who, due to acute mental illness, substance abuse, or severe emotional disturbance, are in need of treatment that can most effectively be provided in a residential treatment facility.
Explain the services for individuals age 65 or older in an Institution for Mental Diseases?
The services of an institution for mental diseases (IMD) meet federal and state requirements of a hospital or nursing facility but are also considered an IMD for older adults with mental or intellectual disabilities who require ongoing long-term care.
What are the 3 types of services in nursing facilities?
Skilled nursing or medical care and related services
Rehabilitation needed due to injury, disability, or illness.
Long-term care- health related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition
Define Skilled Nursing Facility (SNF).
A nursing home that provides the level of care closest to hospital care. 24 hour nursing services, medical supervision, rehabilitation, pharmacy, and dietetic services, and physical, occupational, and recreational therapy are provided in accordance with federal guidelines.
Who is responsible for nursing home standards?
The federal government through the Center for Medicare and Medicaid Services (CMS) is responsible for nursing home standards, while individual states are responsible for monitoring facilities to ensure that standards are met.
Nursing homes were first established in the 19th century to care for the poor and provide food, shelter, and clothing.
Who are the privately funded long-term care providers that are regulated by federal and/or state governments?
Adult care facilities, residential care communities, home health agencies, and hospice.
What are residential care communities or assisted-living facilities?
Non Medical facilities that provide a room or apartment, meals, housekeeping, medication management, assistance with ADLs as needed, and recreational activities. Some also provide transportation for shopping and doctor visits.
Define continuing care community.
Allows residents to move from independent living to assisted living to a skilled nursing facility on the same campus as their needs change.
What do home health agencies do?
Provide part-time nursing and medical care in patients’ homes as well as other services such as physical, speech, and occupational therapy; social services; and sometimes medical supplies and equipment such as wheelchairs, walkers, and so forth.
Define hospice.
They are operated on the principle that the dying have special needs that hospital personnel are too busy to handle. Hospice care helps manage pain and other symptoms associated with dying when conventional treatment is no longer of value. Hospice provides emotional support, bereavement counseling, and medical supplies and equipment. The first hospices cared for the wounded, sick and dying; however, modern hospices care only for the dying.
What are adult day care services?
They are provided in a community-based group setting, usually in a freestanding facility. Some centers may be affiliated with other health facilities or organizations including hospitals, nursing homes, residential care facilities or senior centers. Adult day care is used to supplement home caer services or as a less costly alternative to a residential care facility or a nursing care facility.
Describe the Program of All-Inclusive Care for the Elderly (PACE)
It's a form of integrated care supported by CMS, one of several programs that encourage states to provide the full array of Medicaid and Medicare benefits through a single delivery system in order to provide quality care for dual-eligible enrollees, improve care coordination, and reduce administrative burdens. PACE provides comprehensive preventive, primary, acute, and long-term care services so older individuals with chronic care needs can continue living in the community.
What is the Aging Network?
A system of federal, state, and local entities committed to supporting older Americans in living independently in their homes and communities.
What does the Aging Network consist of?
The US Administration on Aging (AOA), 56 state Aging units, 622 Area Agencies on Aging (AAAs) and more than 250 TItle VI Native American aging programs.
What do Senior Centers offer?
A noon meal as well as social, wellness, educational, and recreational programs Monday through Friday.
Who does limited health literacy affect?
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions. It affects people of all ages, races, incomes, and educational levels, but the impact of limited health literacy disproportionately affects lower socioeconomic and minority groups, those with low English proficiency and older adults.
What is the impact on the individual with low literacy skills?
More frequent medical errors, illness and disability, and loss of wages.
Define geriatrician.
Primary care physicians who specialize in the care of those 65 years of age and older and focus on common health and social issues related to the aging process.
Define interprofessional education (IPE)
Where students in different programs learn the roles and functions of other health professions and work together as a team to contribute to the assessment and treatment of individual patients.
