Nursing Week

1. Foundations of Gerontological &
Community Based Nursing
Week I
Fiona Chatfield, RN, MSN, MBA, CCRN
Adrianne Maltese, R.N., MN, GCNS-BC
Los Angeles Valley College
E-mail: maltesam@lavc.edu

2. What is “Old”?
 Young Old: 65-74 years old
 Middle Old: 75-84 years old
 Old Old: those over 85 years of age
 Centenarians: >40,000 persons in US
over the age of 100. Projected that by
the year 2020, there will be > 3 million.

3. Factors influencing aging
 Health (cognitive & functional capacity)
 History (historic events/cohort group)
 Gender (affects various aspects of aging)
 Goals—to function at the highest level
one is capable of.

4. U.S. National Health Goals
’79, ’90, 2000
Healthy People 2010 objectives
 Increase quality & years of life for Americans
 Eliminate/reduce health disparities
 Increase # health professionals of racial/ethnic
minorities
 Increase awareness & achieve access to
preventative services for all
 Improved surveillance and data systems in health
care

5. Community Based Nursing
 Care for individuals, families, and groups
where they work, or go to school or as
they move through the health care system
 Movement out of traditional, structured
acute-care roles for nursing
 ↑ opportunities for nurses
 Employment opportunities and trends

6. Your Personal Experiences
 Parents & Grandparents
 Extended Family Members
 Neighbors
 Community/Church/Religious Groups
 Friends
 Fellow Employees
 Caregiver

7. Scope of Practice
 National Gerontological Nursing Associations
(NGNA) scope & standards of care:
 Emphasizes the need for competent care of older
adults so that professional nurses (RN’s) will be
prepared to “meet the special needs of the increasing
numbers of older adults, particularly those over 85
years of age, minorities, and those with decreased
financial and social resources” (ANA, 2001, p. 7)
 Recognizes that the professional nurse may be ADN,
BSN, MSN/MN, or Ph D. prepared.

8. Roles of the Gerontological Nurse
 Generalist or Specialist
 Generalist
 Various settings: home, hospital, nursing homes
 Performs: planning, delivery, evaluation of care
 Specialist
 Advanced preparation (MN or MSN)
 Gerontological nurse practitioner (GNP)
 Gerontological nursing clinical nurse
specialists

9. Food for thought…….
 What are your thoughts about
gerontological nursing? Feelings?
Impressions?
 What do you think would increase
interest in gerontological nursing?
 How does Geriatric nursing differ from
Gerontological nursing?

10. Financing Health Care & Medicare
Soc. Security Act-1965
Part A→ (free to all who are
eligible)
Part B→ optional (eligible
must
pay a premium)
Part C →(Medicare Advantage
Plan)’may include PPO’s &
MCP’ s [HMO]
Part D→ Optional-eligible
pay premium (added in
2006 to offset cost of Rx
drugs)
Long Term Care Insurance
 Hospital, SNF’s,
Home Health, Hospice &
blood transfusions
 MD visits, med equip.
OP services, home health
& med supplies
 Capitation imposed on
MCP’s
has led to abuse/denial of
care,
↓cost to elder; PPO – copays
 Monthly premium &
decuctible~$250.00/yr.
max up to $2250/yr.
 Optional (costly
premiums)

11. What is Medi-gap insurance?
 Purchased to offset Rx drug costs between
$2250.00/yr. and $5100/yr.(coverage
gap or donut hole)
 Medicare pays 95% of cost after out of
pocket reaches $3850.00/yr.

12. Medicaid –Social Security Act-1965
 Provides financial assistance –pays for
health care for poor, blind, disabled, &
families with dependent children
 Eligibility, service coverage varies from
state to state.
 States are required to cover hospital care
(inpt/outpt), SNF, home health, family
planning, MD visits, periodic screenings,
tx. for eligible children.

13. Community Health approach
 Primary Health Care
 Secondary Health Care
 Tertiary Health Care

14. Examples of Wellness Diagnoses
 Ability to perform ADL’s
 Seeks out services when appropriate
 Manages stress effectively
 Maintains healthy lifestyle
 Plans and follows a healthful regimen
 Has a effective support network
 Able to cope appropriately
 Seeks health information
 Practices health maintenance

15. Legal Issues in Elder Care
 Competence and Capacity
ability to make decisions regarding
 Finances
 medical/health decisions
 Understands consequences of
actions/choices
 Informed consent

16. Power of Attorney
 Two types:
 General POA
 Durable POA
 Appointee- known as
the Attorney-in-fact
 Power to make
financial decisions&
pay bills (no health
care decisions)
 Can make financial &
health care decisions
(must be willing to
uphold wishes on
incapacitated
person)

17. Guardians and Conservators
Guardianships & Conservatorships –
Elder is declared “incompetent” or to “lack
capacity” (eg. Chronic mental illness,
dementia, brain trauma)
 Individuals or agencies
 Must be appointed by court/hearing
 Renewed yearly
 Powers decided by court- based on extent
of capacity of the elder

18. Elder Abuse /Neglect
Types of Abuse:
 Physical
 Psychological/emotional
 Sexual
 Financial/material
 Medical (unwanted tx/procedures or
withholding of tx)
 Neglect[withholds food,clothes,shelter,care etc.]
 Abandonment by primary caregiver

19. Abuse & Neglect of elders
 Most abuse occurs in the home of elder
 Most abusers caregivers: spouses (58%)or
adult children(23-30%)(Murray,2005)
 84% white elders
 Incidences expected to increase
 Abuse is episodic & recurrent
 Multiple risk factors

20. Risk factors /characteristics of Elder
Abuse victims
 Frail elder -dependent on caregiver
 Female > 80 + years of age
 Lives alone or with abuser
 Confusion/cognitive impairment
 Incontinent episodes
 Chronic Illness
 Mental disabilities

21. Characteristics of Abuser
 Middle aged male or adult child
 Caregiving spouse w/ history of previous
abuse/alcohol abuse
 Previous history of violence/substance
abuse/mental health problems
 Financially dependent on abused
 Feels overwhelmed by burden of care
 Feels frustrated and resentful
 History of abuse and being abused
 Refuses to allow visitor to see elder alone

22. When elder abuse is suspected
Nursing Interventions:
 Conduct assessment of elder
 Check for bruises (varying stages), wounds,
fractures, signs of punishment/restraints
 Check labs
 Malnutrition/dehydration
 Sudden behavioral changes in elder
 File mandatory report to “Adult Protective
Services” (within required timeframe)

23. Characteristics:
Ageism & Elderspeak
 Beliefs/myths/
stereotypes of elders
 Prejudice through
attitudes & behaviors
 Any discrimination
 A form of ageism
 Singsong voice
 Speaks in childlike
fashion
 Use of “pet names”
eg. “honey” “dear”
“momma” “grandma”
Using “we” in
questions/statements
when “you” is meant

24. Communicating with Elders
 Communication is especially important to
gerontological nurses
 Gerontological nurses need to communicate
effectively with older pts with a variety of
physical and cognitive impairments
 Communication is dynamic process including
verbal and non-verbal signals.
 Nonverbal communication is thought to make
up ~80% of communication.

25. Communicating with Elders
 Guide to Communication
 Ask how the patient would like to be addressed
 Do not yell or speak too loudly
 Try to be at eye level with the patient
 Try to minimize background noise as it can make it
difficult for the pt to hear
 Monitor the patient’s reaction
 Touch the patient if appropriate and acceptable
 Provide written instructions (use large
print/contrast paper)
 Keep it simple when interacting with cognitively
impaired, anxious or client in pain or pain

26. Communicating with Elders
 Active listening
 Use open-ended statement to encourage
the patient to talk
 Avoid misunderstandings
 Do not be afraid to acknowledge your
own feelings
 Encourage reminiscing & life review
 What if a patient starts to cry?

27. Communication Barriers
 Fear of one’s own aging
 Fear of showing emotion
 Feeling the need to write down every detail
 Lack of knowledge of the patient’s culture,
goals and values
 Unresolved issues with aging relatives
 “professional distance”
 Being overworked, overscheduled, or lacking
proper time to communicate with older
patients

28. Lewis Study Guide Case Study Question:
Chapter 5 #21 (pg 26)
 An 82 year old patient with multiple health
problems is hospitalized with a hip fracture.
 What Medicare coverage will apply to treatment
of the fractured hip?
 What criteria must be met for the patient to
receive Medicare benefits for hospitalization?
 The patient is transferred to a skilled nursing
facility for rehabilitation. Will Medicare continue
to cover the expense of the skilled facility?

29. Case Study cont’d
 The patient is too frail to complete
rehabilitation and it is D/C’d. Custodial care is
indicated. If the patient is placed in a nursing
home or taken home to be cared for, what
Medicare coverage is available for expenses?
 The patient is taken to a daughter’s home for
custodial care. The daughter and son-in-law
are both employed. What community-based
service might be appropriate to allow the
family members to continue employment?

30. Discount! Discount! Discount!
 We are happy to announce our services at
discounted rate to during this nursing
week.
 The offer valid till 21st may 2014.

31. Contact us:- 011-25464531, 9818569476
E-mail:- nursingnursing@yahoo.in