Nrs 433V Introduction To Nursing Assessment Answers

Congregate Care

Don and Mary were happily married for 50 years and had two successful children and five grandchildren. Don and Mary met while serving in the U.S. Army during the Korean Conflict. After their military service ended, they married and embarked on their careers. Don and Mary were healthcare professionals; Don was a professor at the local medical school, and Mary was a hospice nurse. Don and Mary were always active in their church and volunteere3d their time in the community. Both retired at age 65 to [pursue their dreams of international travel and spending their children’s inheritance. During the early years of their retired life, the couple continued to work part time, travel extensively, and spend time with their grandkids. Their retirement plans seemed to be going swimmingly until Don noticed that his wife was having memory problems at the age of 78. Mary always kept up on the latest topics and was always th first to complete the crossword puzzles and other logic games in the newspaper. However, Mary seemed to become increasingly forgetful; she would run errands to purchase specific items and return home empty-handed. The couple decided to seek help from a gerontologist. An extensive battery of cognitive and neuropsychological test determined that Mary’s language skills and mental abilities had markedly diminished. Mary was diagnosed with Alzheimer’s disease, an incurable terminal brain disease. After the initial shock of the diagnosis, the couple developed a plan to cope with the disease – Don was going to be Mary’s caregiver. The p progression of the disease was tough for Don and the family o watch. At first Mary became confused, then she became progressively irritable and aggressive. Five years after the diagnosis, Mary became almost totally withdrawn. Her appetite was nonexistent, and she became incontinent. Additionally, Mary suffered from “sundowners syndrome” – a phenomenon whereby the individual experiences confusion and exasperation during the late afternoon or early evening hours. Don struggled to care for her and keep an upbeat attitude; however, he too was experiencing the deterioration of aging. After years of being a competitive runner, his knees and other joints prevented him from fully assisting Mary. Don hired a home health aide to visit daily to assist Mary and also do some light household chores. As Mary’s condition grew more serious, he had to make a decision. He was no longer able to care for her, and his own ailments were starting to severely impact his ability to take care of himself. Additionally, their retirement savings had dwindled to the point that they needed financial assistance from family members to get by. The case of Mary and Don is not uncommon, as many seniors experience the inevitable choice of long-term care.

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Long-term care alternatives for Mary and Don

Almost all geriatric patients will require long-term care. Living with Alzheimer’s disease makes it even harder for one to escape long-term care. Mary and Don’s care may not be very different. Don’s efforts, as Mary’s primary caregiver, are not adequate anymore owing to his aging condition, not to forget the toll lifestyle conditions are taking on him. The hired aide apparently cannot meet the needs for both. There are various long-term care options that Mary and Don will need to consider: respite care, adult day care, nursing home care or hiring a geriatric care management services.  

During respite care, Mary and Don will be provided with companion services that are aimed at giving a peace of mind for a few hours away from their daily routine. This program is likely to benefit Mary even more because of her Alzheimer’s condition (Kirkley et al., 2011). It will offer her an impeccable prospect for socialization. She can start a meaningful relationship with other patients with dementia while spending time in respite care. During weekends or holidays, they can opt to convert their house into a respite center during which they can invite their family and friends (Maayan, Soares?Weiser & Lee, 2014). Don and Mary served in the military and as healthcare professionals; they must be having a long list of friends. Don can notify such friends and invite them over to spend some with them and reminisce about the old good times they spent together.

Another option for long term care plan available to the geriatric couple is an adult day care center. This option offers a chance for socialization, music, patient to patient support groups, and mind and body exercises in safely monitored environments and some supportive health care services though to a limited extent (Fields, Anderson & Dabelko-Schoeny, 2014). Most geriatric daycare centers provide meals and transportation services for their patients. In case they opt for an adult day care center, it will be prudent for Mary and Don to settle for one that caters to the needs of patients suffering from Alzheimer’s condition and those who do not. Putting them in separate day care centers will not be a good idea. They need to continue making new memories together until the end of times (Alliance, 2012).

The option of nursing home services is also available to the couple. This is a suitable option considering that Mary requires skilled medical care and that Don needs medical too. The irritable and aggressive behavior shown by Mary may need specialized care. She is said to be complete withdrawn and lacking appetite not to forget the “sundowners’ syndrome.” In the nursing home, Mary can be provided with a room and boarding facilities and medical services round the clock. They need to make a careful selection to ensure that she gets into a nursing home designed for people with Alzheimer’s disease (Mace & Rabins, 2011).

Lastly, they can consider hiring geriatric care management services. Geriatric care managers are trained to evaluate the needs of the patient and plan for coordination of resources (World Health Organization, 2012). Mary and Don can settle for geriatric care management services with anticipation that they can assume nearly all aspects of care for both of them. Considering that they are financially distressed, they can opt for free geriatric consulting agencies provided by local government agencies and charities.

Requirements needed for Mary and Don to access long term healthcare

Each of the options for long-term health care plans discussed in the previous section has eligibility criteria that must be met by the person seeking the services. Thorough assessments are done before patients are admitted to each of the programs (Francesca, Ana, Jérôme & Frits, 2011). For instance, every person applying for long-term care in a nursing home must be above the age of 18 years and be insured with the Health Insurance Act; to which Mary and Don are eligible. Additionally, the applicant for nursing home services must satisfy the management that he or she needs nursing care available round the clock. Mary, unlike Don, requires nursing services 24 hours a day (Seitz, Purandare & Conn, 2010). As reported, she is becoming increasingly irritable and withdrawn with non-existent appetite. The hired aide may not meet all of their healthcare and dietary needs and perform house chores. Don, though a trained healthcare professional cannot keep up because of his age. Mary and Don are financially, emotionally and physically weak. Much of their savings were spent touring places. In addition, Mary is becoming increasing aggressive and may harm Don thereby qualifying as a suitable candidate for a nursing home (Kaye, Harrington & LaPlante, 2010).

Should the couple opt for a respite care plan, it will work when Don or the aide is traveling for short periods of time. For example, when Don requires medical checkups that may require him to take a break from taking care of his wife, he will need respite care services. The aide may be having her own engagements that she or he needs to attend. She may also be entitled to take leave once in while during which it will be difficult for Don to take care of Mary single-handedly. However, for the respite program to work, Mary and Don should not require nursing care around the clock.

For patients to qualify for geriatric management care, he or she must be diagnosed with a terminal illness. Mary, unlike Don, can qualify to be given a geriatric care manager because of her Alzheimer’s condition. More points to add to her need for geriatric care management include irritability and “sundowner’s syndrome.”  

Funding mechanisms that Don and Mary can explore and how they impact on the choice of their care options

Care and support services for patients with terminal illnesses have never been free. The local authorities may meet some cost, but the patients have to pay the remaining amount. For that reason, Mary and Don will need to visit their local authorities for assessment of their social care. This is crucial in that it will help determine the level of care they need and how much money or healthcare insurance they are entitled to.  

Soliciting for their healthcare needs through social services is one of the funding mechanisms Mary and Don can explore. Since Don’s age and lifestyle conditions no longer allow him to take care of his wife, he can ask social services to provide them with homecare assistants to help him out with chores such as laundry, cooking, cleaning utensils, house, and compound. This funding mechanism limits their option to settling for geriatric management at home (McSweney-Feld, et al., (eds.), 2012).

Mary and Don, having served in the U.S. Army during the Korean Conflict, do qualify for Veteran Benefits for older individual suffering from dementia. The US Department of Veteran Affairs (VA) offers a reasonable range of healthcare services such as in-home care, community-based services, and long-term care services. If the couple opts for home-based primary care US Department of Veteran Affairs, they can enjoy homemaker and health aide services, nursing home, respite services and adult day health care. In addition to listed benefits, both Mary and Don can benefit from the outpatient and inpatient care packages provided by the VA.

Having been government employees, Mary and Don qualify for Medicaid and Medicare. However, Medicare cannot cover long-term health care like Medicaid can. Mary and Don do not have a lot of income (Hurd et al., 2013). Much of their life’s savings have been spent traveling and touring the world after retirement. Medicaid focuses keeping seniors and person with disabilities in their communities rather than in nursing homes. Since the couple is over 65 years of age, they qualify for Medicaid. In addition, Mary and Don meet the criteria for Supplemental Security Income (SSI) and as such spontaneously eligible for Medicaid (Alzheimer's Association, 2013). The option of Medicaid, however, limits their choice to geriatric day care and respite centers since the program emphasizes on keeping the seniors in their communities rather than nursing homes.

What Don and Mary could have done differently

Aging can be slowed down but cannot be avoided. Eventually, it catches with everyone, and it comes with a myriad of lifestyle conditions that requiring long-term health care plan. Planning long-term medical needs one to prepare early enough (Alzheimer's Association, 2014). There are various health insurance schemes in the US that Don and Mary could have entered long before retirement. Some of the health insurance schemes are AARP, Genworth and Blue Cross. The couple should have opted for one of the insurance schemes before retirement and remit monthly premiums. Before retirement, they could have accumulated enough premiums for their long-term health care plans. In addition, Mary and Don were not any wise when spending their retirement benefits. Much of the resources were spent in their extensive travels and enjoyment with their five grandchildren. They could have cut the cost of travels in anticipation lifestyle conditions that require long-term health care plans and huge sums of money.  

I do not wish to make the same mistakes as Don and Mary. I will start making payment to AARP or Blue Cross just like my parents started about a decade ago. This will come handy when I am past the age of 65 years and requiring long term heath care services. 

References

Kaye, H. S., Harrington, C., & LaPlante, M. P. (2010). Long-term care: Who gets it, who provides it, who pays, and how much?. Health Affairs, 29(1), 11-21.

Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22(07), 1025-1039.

Francesca, C., Ana, L. N., Jérôme, M., & Frits, T. (2011). OECD health policy studies help wanted? Providing and paying for long-term care: providing and paying for long-term care (Vol. 2011). OECD Publishing.

World Health Organization. (2012). Dementia: a public health priority. World Health Organization.

Mace, N. L., & Rabins, P. V. (2011). The 36-hour day: A family guide to caring for people who have Alzheimer disease, related dementias, and memory loss. JHU Press.

Kirkley, C., Bamford, C., Poole, M., Arksey, H., Hughes, J., & Bond, J. (2011). The impact of organisational culture on the delivery of person?centred care in services providing respite care and short breaks for people with dementia. Health & social care in the community, 19(4), 438-448.

Maayan, N., Soares?Weiser, K., & Lee, H. (2014). Respite care for people with dementia and their carers. The Cochrane Library.

Fields, N. L., Anderson, K. A., & Dabelko-Schoeny, H. (2014). The Effectiveness of Adult Day Services for Older Adults A Review of the Literature From 2000 to 2011. Journal of Applied Gerontology, 33(2), 130-163.

Alliance, F. C. (2012). Fact sheet: Selected caregiver statistics. San Francisco, CA.

McSweney-Feld, M.H., Oetien, R., & Warthen, L.D. in McSweney-Feld, M.H., & Oetien, R. (eds.) (2012). Dimensions of Long-Term Care Management – An Introduction. Chicago: Health Administration Press. pp. 36-37

Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J., & Langa, K. M. (2013). Monetary costs of dementia in the United States. N Engl J Med, 2013(368), 1326-1334.

Alzheimer's Association. (2013). 2013 Alzheimer's disease facts and figures. Alzheimer's & dementia, 9(2), 208-245.

Alzheimer's Association. (2014). 2014 Alzheimer's disease facts and figures. Alzheimer's & Dementia, 10(2), e47-e92.