Elder Family Learning Initiative

1. Elder Family Learning Initiative Part One: General Family Education

2. Understanding Elder Care Options Lesson One

3. A) Health Care Issues Maintenance and Preventative Care • Physical examination • Alternative medical care • Assistance with care management • Transportation, prescriptions reminders, substance abuse and treatment • Mental health issues • Depression, dementia

4. B) Activities of Daily Living (ADLs) • Dressing • Grooming • Eating • Toileting • Bathing • Bed mobility • Ambulating • Transfers ADLs more dependent on cognitive and social functioning than physical ability

5. Instrumental Activities of Daily Living • Telephone • Obtaining and preparing food • Paying bills • Keeping house • Doing laundry • Taking medication

6. C) Health Changes that Lead to Higher Levels of Care Common Changes: • Advancement of specific diseases or medical conditions • Diabetic care, incontinence • Increase in amount of time needed to assist person with everyday tasks • Decline of cognitive functioning that lead to changes in behavior • Anxiety, dementia

7. Questions to Ask When Determining Level of Care • How are levels of care changes determined? • What are questions to ask when choosing an option for care? • What are the costs involved in these levels of care?

8. Positive Intervention • Planning • Right match of care/caregiver for older person • Implementation that is respectful and empowering

9. D) Tying Levels of Care to Service Options Why are there so many options? • Continuum of care • Lowest level of care • Service at each level • Limitations on care • Asset issues

10. Service Options • Retirement living • Assisted living • Residential care facility • Above may be in context of continuing care retirement communities with life care options

11. Service Options (Continued) • Skilled nursing facility/intermediate nursing facility • Adult foster care • Home health care • Home care • Hospice care

12. E) Level of Care Changes How are level of care changes determined? • Care needs of resident • Caregiving capability of facility • Appeals process

13. Questions to Ask to Avoid Changing Levels of Care • What are the most critical care needs that need to be met and what environment will meet those needs? • What are the costs involved in the care options being considered? • Insurance, private funds, Medicaid • What amenities are offered by the facility that my loved one would benefit from? • Should we consult financial planners and elder care attorneys to assist with our decision?

14. Inconsistencies Which May Lead to Inappropriate Placement • Decision made during a time critical or urgent situation • Care needs of individual do not meet the caregiving abilities of the facility/caregiver • Placement denied due to another resident allowed to stay longer than appropriate • Disagreement in level of care change may lead to appeal

15. Planning Lesson Two

16. Resources and Interventions Necessary to Make Good Decisions

17. A) Advanced Directives • Living will • POLST (Physician’s Order for Life Sustaining Treatment) • Code status • Life support • Palliative care

18. A) Power of Attorney • Durable Power of Attorney (for financial issues) • Medical or Health Care Power of Attorney

19. C) Guardian/Conservatorship • Conservatorship • Least intrusive. Conservator takes over management of individual’s finances • Guardianship • Guardian takes over all decisions for the person: medical, social, recreational • Difficult and expensive to obtain, usually a last resort • Family may appoint non-family member as guardian/conservator

20. Informal Approach • Joint bank account • Names of adult children are put on bank account and safe deposit box • Physician and other care providers defer to long-term informal decision-makers

21. D) Competency and Elders Rights • Autonomy – acting on one’s own without control from others • Competency – ability to make choices • Possesses and retains values • Can communicate and understand information • Can reason and deliberate about choices • Elder’s Rights – freedom over safety

22. E) Family Dynamics of PlanningVariables That Predict Issues • Internal factors that influence a family’s ability to plan: • Communication style • Family resources available (financial, time and energy) • Family history of conflict/troubled relationships • Family experience with change over time • Shared family values and absence thereof

23. Resources to Assist Family to Plan During an Emergency • Medical providers • Aging services professionals • Second degree relatives, friends, and acquaintances

24. Elder Family Learning Initiative Part Two: Advanced Family Education Lessons Three and Four

25. Family Interaction and Involvement Lesson Three

26. The Decision Making Process:Who Is In Charge? • Role of the Resident • Residents in care are given every opportunity possible to make their own decisions. • Role of the Facility Staff • Documents from medical facility or previous living environment will detail person’s capacity for decision-making

27. The Decision Making ProcessWho Is In Charge? (continued) • Role of Family Members • If person unable or refuses to direct their own care, then family member(s) will be asked to fulfill this role. Long distance caregivers and local caregivers have different roles in thefamily. • Role of Medical Providers • Medical professions will offer information about possible treatments and give recommendations butcannot make decisions for the person or family

28. B) Interactions in Long Term Care Facilities • Staff accept most informal arrangements unless and until resident is unable to direct care. • Facilities must intervene to ensure an acceptable standard of care, which may conflict with family’s values. • Advance directives can help avoid conflict by communicating wishes of patient.

29. Sources of Potential Family Conflict • Feelings of guilt • Family culture • Long distance caregiving • Family member with untreated mental illness or substance abuse issues • Conflict occurs between family and staff due to values, policy and regulations (specific to the setting)

30. Addressing Conflict • If resident had a problematic relationship with a family member, the facility is not the place to resolve the conflict. • Other family members should discourage visits that cause distress • Improve communication by seeking help • Social workers • support groups • individual therapists

31. C) Positive Visits Visits are key to the recovery and adjustment of residents in long term care • Facilities will try to adapt to needs of the individuals family as much as possible • Late night visits • Allow family and resident to eat together • Accommodate large family gatherings

32. Types of Visits • Primary caregiver visits • Tend to be longer, caregiver will assist with grooming, snacks, and alert staff to needs • Casual visitors • Short, frequent visits are best if the resident is weak or ill • Keep conversation positive • Volunteer visitors • Can be arranged if resident has no family living nearby who can visit

33. D) Culture of the Family and the Facility • Culture – norms of the family • Actions, attitudes, behaviors, beliefs, family values • Culture changes in crisis • Some long-term care facilities have their own culture associated with faith based, fraternal lodge or ethnicity • Medical model vs. social model

34. Communication Between Resident, Family and Staff • Consensus building a balancing act • Getting outside help to facilitate consensus building and deal with facility/family conflicts • Ombudsman • Aging service staff • Family counselors / therapists • Support groups

35. Planning and Care across Different Settings Lesson Four

36. A) Care Conference 101 • A Care Conference will address • resident’s health status • care needs • discharge plan or positive adjustments to the facility • improving quality of life and relationships • Role of resident, family, staff, external case management staff • Time frame, frequency

37. A Care Conference May Include • The resident • Family members • Staff Participants: • Rehabilitation Therapy • Nursing • Social Services • Dietary • Activities

38. Developing a Service Plan • The Service Plan is a document that addresses: • Care • Treatment • Medications

39. When Do Care Conferences Occur? • Within 2-3 days of hopitalization • Within a week or two of admission to a skilled nursing facility • Within a month of a longer term admission • Regularly quarterly conferences are held for long-term residents • Families will receive formal notice up upcoming conference

40. B) Who Are the Providers and What Do They Do? • Administration • Reception • Housekeeping and maintenance • Medical • Nursing staff • LPNs, CNAs, CMAs • Aides • Activities or recreation staff • Dietary staff • Social service staff

41. C) Relating to Other Residents and Families • Establishing community • Helping resident to adapt • Changing rooms • Transfers and discharges

42. D) End of Life • The culture of death in Long-Term Care facilities • Care at the end of life • Logistics for families • Death certificates and funerals • Care of families during and after death

43. E) Grief Issues • Anticipatory grief • Spiritual needs • Rituals • Counseling / bereavement groups • Additional grief issues for residents • Loss of independence, space, privacy, choice, friends, associations, pets, driving, physical function, communication, intimacy, family deaths

44. Elder Family Learning Initiative The End