HDFS CH 5

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[[

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