HDFS CH 5
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PART 1
[[HERE’S WHAT WE KNOW UP FRONT:[[
WHY ARE PPL IN NURSING HOMES
- they can’t care for themselves
- need help eating, using the restroom, standing, walking, laying down, & performing personal hygiene routines
THE STATS:
- almost half are 85 yrs old
- 90% of mobile residents need assistance or supervision
- 80% need help with 3 or more
- 50% are incontinent
- 35% have difficulty hearing or seeing
DESCRIBING PERSON-ENVIRONMENT INTERACTIONS
- competence & environmental press
* competence is the theoretical upper limit of a person’s capacity to function
* environmental press refers to the physical inerpersonal, or social demands that environments put on people - adaptation level: where behavior & affect are normal
- zone of maximum performance potential
* a slight increase in press improves performance - zone of maximum comfort
* created by slight decrease in press - the model suggests that behavior depends on one’s competence level in an environment with a particular level of environmental press
* proactivity is choosing new behaviors to meet new desires or needs
* docility os allowing the situation to dictate the options - preventive & corrective proactivity (PCP) model
* life stressors & lack of good congruence in person-environment interactions result in poor life outcomes
* two types of proactive adaptations
* preventative adaptations: actions that avoid stressors & increase or build social resources
* corrective adaptations: actions taken in response to stressors & can be facilitated by internal & external resources - stress & coping framework
* interaction with the environment can produce stress (lazarus, 1984)
* adaptation depends on perception of environmental stress & the attempts to cope
* harmful, beneficial, or irrelevant
* if harmful, what is the coping mechanism & response? outcome positive or negative?
* [[schooler[[
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PART 2
WHERE PPL LIVE: PERSON-ENVIRONMENT INTERACTIONS
DESCRIBING PERSON-ENVIRONMENT INTERACTIONS
- everyday competence is a person’s potential ability to perform a wide range of activities considered essential for independent living
* broader than just ADL or IADL
* necessary determinate for whether an elderly person can take care of themselves
* behavior is expressed in a particular environmental context, and one needs to consider cultural and contextual differences in everyday competence
* think George vs Clara, Grace vs Emma, Fred vs Bert
THE ECOLOGY OF AGING
- aging in place
* balancing environmental press & competence through selection & compensation
* being able to maintain independence
* feeling at “home” - deciding on the best option
* does the individual have significant cognitive or physical impairment requiring intervention
* what is the severity
* the individual needs to be an integral part of the decision making
* what is the ability of family & friends to support or provide care
* get a physician’s diagnostic evaluation
* required in many states - home modification
* helping people deal with tasks of daily living by modifying the environment
* hook for car keys near the door
* handrails in the bathrooms
* door handles that are easier to grasp
* widening doorways
* lowering countertops
* wheelchair ramps - adult day care
* designed to provide support, companionship, & certain services during the day
* goal is to delay placement in more formal care setting
* three types of adult day care
* social services, meals, recreation, & minor health care
* more intensive health care, therapy, for serious medical problems
* specialize care for dementia or developmental disabilities
* profit (22%) or nonprofit (78%) - [[congregate housing[[
- assisted living
* a supportive living arrangement for people who need assistance with personal care but are not physically or mentally impaired to require 24 hr care
* essential attributes
* as much like a single-family house as possible
* emphasized personal control, choice, dignity, & autonomy
* [[should meet routine[[
* utilize checklist to ensure the selected facility meets specific requirements of the individual
* generally smaller & cost less
* lack of regulations over quality of care
* sense of well-being is higher with control over decisions & establishing stronger relationships
LIVING IN NURSING HOMES
- types of nursing homes
* there are four types of nursing homes
* intensive skilled
* skilled nursing & rehabilitation
* intermediate care
* custodial care
* the basic difference btw the types of nursing homes is the number of health care workers on staff - intensive skilled
* 24 hr care for residents needing constant monitoring or complicated medical procedures that are usually provided by registered nurses - [[skilled nursing & rehabilitation[[
* [[24 hr medical monitoring under the direct supervision of a physician[[ - who is likely to live in nursing homes
* characteristics of people most likely to be placed in a nursing home
* very old (typically over age 85)
* European American female
* financially disadvantaged
* widowed or divorced
* has lived in a nursing home for more than a year
* has no children or siblings nearby
* the number of older adults of color in nursing homes is increasing
* person-centered care planning (considered best practice today)
* based on promoting residents’ well-being through increasing their perceived level of personal control & treating them with respect
* focus on the individual
* involves a team who know & cares
* residents show an improvement in well-being & activity level, love longer, & decrease in the need for certain medications & soft restraints with this approach
* special care units
* supportive environment for people with moderate to severe dementia requires certain specialized design & intervention features
* help people function at the highest level possible
* special training in working with persons with dementia
* design elements that take functional limitations into account
* memory aids like color-coded halls
* residents wear wrist or ankle bands that trigger alrms
* selecting the right special care units that provide research-based staff training
* communication, behavior management, methods for assisting w health & hygiene, dealing w incontinence, handling sexuality, controlling wandering, supervising eating, addressing memory failure, assisting w mobility
* how not to communicate with residents
* patronizing speech
* inappropriate speech based on stereotypes of incompetence & dependence
* infantilization or elder speak
* inappropriate use of first names
* terms of endearment-”honey”, “sweetie”
* assumption of greater Impairment than may be the case
* cajoling to demand compliance
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