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41 Cards in this Set
- Front
- Back
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GRACE model
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community model of care
covered by Medicare/caid - if dual eligible home assessment made by NP and gero SW meet as larger team off site focus on high risk problems contact varies - phone contact monthly, in person reassessment annually |
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Guided Care model
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community model of care
nurse centered model - manage 50-60 patients with 2-5 physicians these patients very complex, use lots of resources, chronically ill coaching to empower individual to better self manage |
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PACE model
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program of all inclusive care of elderly
community model of care goal is to provide seamless care need to be dual eligible for medicare/medicaid stay at home rather than going to nursing home to get services that would be provided at LTC faciility interdiisciplinary covered by medicare/medicaid if dual eligible!!!! |
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patient centered medical home model
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goal to improve quality at lower cost with better access
activate and engage patients/partner in care help ppl with long term interactions with HC system help them self manage |
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villiage model
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community model of care
member based community; non profit goal is to keep people in their homes link people with services they need in their community |
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interact II
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nursing home model
uses communication techniques (stop and watch; SBAR; checklists, communication guides) to keep bad things from happening care paths for conditions at high risk for transfer to hosptial from nursing home AD planning goal to keep residents out of hospital |
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pioneer network
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nursing home model
person-directed NH culture (as opposed to provider directed) this is on a continuum basing our care on the needs of the individuals, rather than our own views self as pt of team |
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green house
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nursing home model
alt to NH small, intentional communities 8-10 resident clusters recieve care w/o it being the primary focus feels more like a home setting RN responsible for 2-3 greenhouses |
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evercare
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nursing home model
NP, not RN model of care focuses on chronic management |
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GEM (geriatric evaluation and management units)
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hospital model
accepts patients as transfer from other units who meet certain criteria or are epxierncing geriatric syndromes like falls/delirium multipdisciplinary, geriatrician led used in VA settings |
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NICHE (nurses improving care for health system elders)
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hospital model
program to achieve systematic improvement for care of OA at the institution, dept, and unit levels nurse focused focuses on infusion of best practices for care of hospitalized OA uses GRN and ACE models promotes nurse autonomy, RN/MD relations, control of resources improves nurse satisfaction |
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GRN
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geriatric resource nurse
unit based nurse experts in gero care your go-to expert on gero nursing care |
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ACE
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acute care for elderly
unit specifically designed to care for older patients admission criteria varies fosters fxnal independence for OA focus on FUNCTION here trying to maintain prehospital fxn and prevent iatrogenic complications patient centered; nurse driven protocols delirium room in here |
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GITT (geriatric interdisciplinary team training)
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hospital model
not unit based team composition varies depending on institution training model |
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specialty care: delirium rooms
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hospital model
in ACE unit 1:2 ratio, almost like critical care; reduces days patients stay IP |
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is medicaid federally or state funded?
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both - state takes federal $$ and decides what to do with it
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medicare part A
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hospital insurance
limited LTC everyone gets this, dont have to pay for it federal in hospital care - doesn't fully cover MD and other services - NEED MEDIGAP for this reason! if dont have part B - MD charges for every time they see patient! bed charge is covered under this primary payer for short term SKILLED nursing care in home (less than 3 mo); must have come from hopsital first; 40% is paid by OA and family -- if need longer - medicaid covers!! hospice is completely covered! |
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medicare part B
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supplemental medical insurance (helps cover medically necessary services and SOME preventative services)
covers: MD/NP services, diagnostic tests, PT/OT, and home health voluntary enrollment - $ deducted from social security monthly - OPT OUT federal, but you pay in too FEE FOR SERVICE (office visits, ambulatory services, ER care, visits in home, hospital, nursing home) SOME preventative services |
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medicare part C
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medicare advantage programs - private health plans
benefits of medicare a/b +/- addn'l loooooots of choices here this is in lieu of A or B!! private paid insurance; gets some $$ from federal and from you |
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medicare part D
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OP prescription drug benefit
lots of choices here! over 30! supplements A and B often quantity limits, restrictions, etc 38% of ppl with this only have this coverage; 10% enrolled in medicare than dont have coverage at all! private paid and from you! |
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doughnut hole
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$320 deductible
then until $2930 in drug costs, enrollee pays 25%; plan pays 75% at $2930, hit doughnut hole where enrolle pays 100% until paid $4700 out of pocket (for the year!) after that, plan pays 15%, medicare pays 80%; enrollee pays 5% = catastrophic coverage when hit doughnut hole - 15% stop taking meds! plans to provide subsidy when hit this in the future |
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MediGap
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looooots of options out there
covers gap in insurance but doesn't cover everything - can be very expensive only benefit you're definitely going to get is coverage of pt A!!! |
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social services
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provided primarily by family!!!!
whatever is available in community - not guaranteed; not nec available! |
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older americans act
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basically trying to make things good for older adults
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people with most difficulties getting health care they need
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less than 65 yo
female poor poor health status races other than white/asian |
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47% of people on medicare live on less than 200% of federal poverty level!
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that's 2x poverty level! the end!
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who pays most for health care?
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older people and sicker people
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accountable care organizations
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ACOs
goal to get diff types of providers and care organizations to work together to deliver care; high quality care gets rewarded --improved care --improved health when health systems are buying up others - trying to create this |
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domotics
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study of the use of advanced technology within a home setting for the purposes of increasing safety, monitoring health, and improving lifestyle
aka - stalking old people in their homes by using cameras or giving them pet robot seals |
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copes payments
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made by state and federally funded combo of medical payments
made to family members who can't afford the medical care medicaid system will pay family for the care that they are giving while unable to work - through MEDICAID |
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elder mistreatment (EM)
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acts or failures to act result in harm or a serious threat of harm to the health or welfare of a vulnerable OA
involves caregiving dyad may be domestic or institutional **considered vulnerable in eyes of state if depend on another person to care for them (even if this person is paid) |
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scope of domestic EM
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btwn 2-10% of community dwelling OAs - best guess around 7%
for Q 1 case reported, 5.3 go unreported - iceberg theory |
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risk factors for domestic EM - VICTIM characteristics
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low social support
poor health dependence on others for care (impaired cog or physical fxn) previous traumatic event |
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risk factors for domestic EM - ABUSER characteristics
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financial or housing dependence of adult children
#1 perpetrator of abuse is adult child (50% of cases) may be disabled, poorly socially integrated, unemployed, deviant behavior DV later in life with partners or other family members |
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types of mistreatment
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NEGLECT (70-80% of cases)
financial/material exploitation emotional abuse physical abuse sexual abuse abandonment violation of personal rights DV in later life |
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ex of physical neglect
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pressure ulcers and repeated falls are the main ones
.... need to differentiate btwn neglect and problems of getting older - significant changes over time?? |
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are all pressure ulcers preventable?
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NOOOOOOO
skin starts to fail/break down in later life regardless what's impt is what caregiver did when these were discovered look to see if plan of care is increased with each event |
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normal bruising pattern in OA
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90% on extremities - places that stick out on body
significantly more likely to know how bruise happened if it occured on trunk |
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abused bruising pattern in OA
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normal bruising pattern but also arms, palms, thumbs, back and back of head
90% can tell you how they got their bruises, even those with memory problems and dementia! (stories) bruises tend to be large |
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interventions for EM
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prevention
recognition of risk factors routine screening assessments meticulous documentation (including photos) effective and safe interviewing assessment of danger level reporting multidisciplinary interventions f/u |
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cost of EM to all of us
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human
monetary resources human resources system resources increased mortality in OA |
