Contemporary attention to ethics, aging, and long-term care traces its beginnings to the mid-1980s with the path-breaking initiatives of The Retirement Research Foundation. This chapter establishes the ethical concepts, particularly feminist ethics of care, within the context of long-term care, and addresses issues seen from a commitment to critical gerontology. It explores what it means to be a practitioner, a resident, or both in long-term care settings; how these notions influence conceptions of autonomy; and how a different way of understanding autonomy, as well as the ethical principles of beneficence, non-maleficence, and justice, broadens the scope of justifiable action. The chapter suggests how injustices fester in long-term care policy and practice and critiques the standard paradigm for analyzing ethical problems in long-term care. It helps the readers to understand the examples of ethical conundrums that long-term care facilities face.
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This chapter presents a variety of programs and services that are available to consumers in the community. It explores the background and historical development of selected community-based programs and services. The chapter describes ownership types, services provided, and clients served in selected community-based programs and services. It provides licensing and regulatory issues that impact providers and consumers of community-based programs and services. The chapter explains the financing of community-based programs and services. It talks about a model for providing a variety of long-term care (LTC) health services and social supports in a single location, accessible to lower income older adults. The chapter then discusses some challenges and opportunities relative to the administration and management of community-based programs and services. The programs of all-inclusive care for the elderly (PACE) have been successful in integrating both acute and LTC service delivery and financing.
Geriatric rehabilitation is an increasingly important intervention in the continuum of long-term care. An interdisciplinary team is required to manage complex medical issues and rehabilitation needs. This chapter focuses on rehabilitation in postacute care (PAC) settings that include long-term acute-care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies (HHAs). It explains an overview of the development of the field of rehabilitation and a discussion of two conceptual models for disability, namely, International Classification of Functioning, Disability, and Health (ICF) and Institute of Medicine (IOM). The chapter helps the readers to understand the rehabilitation interventions and modalities and the Medicare funding for rehabilitation services for older adults. Orthopedic surgeons may supervise the rehabilitation of patients with musculoskeletal problems that have been corrected by surgery, such as hip fractures, knee and other joint replacements, and broken backs.
This chapter discusses critical importance of adequate nurse staffing to providing quality patient care. It describes crisis in nurse staffing shortages due to workforce dynamics, insufficient geriatric emphasis in nurse’s training/curriculum, nurse’s poor orientation and lack of ongoing training. The chapter analyzes issues contributing to nurse’s reluctance to work in long-term care (LTC), specifically nursing homes. It evaluates how LTC industry recruits, retains, and values nurses to promote staff retention and satisfaction. The chapter also describes several practical strategies; “best practice” staff retention programs are profiled to assist LTC facilities to create and sustain positive work environments, thus creating high staff and resident satisfaction. Job dissatisfaction is a major cause of nurse turnover, and turnover significantly increases the nursing shortage. The process of discovering resources and recognition, which significantly affects the nurses’ job retention and satisfaction, is important to unlocking the nursing-shortage crisis that nursing homes currently suffer from.
This chapter describes quality of care and financial issues associated with poor care transitions, and includes the American Geriatrics Society recommendation to improve transitional care. It presents some conditions identified as having quality gaps in caring for older adults when transitioning in both directions between nursing facilities and the emergency department. The chapter explores the relationship between delirium and dementia and the importance of early screening in health care settings and during care transitions. It discusses conflicts related to emotional reality of moving an older adult from a familiar environment to any long-term care (LTC) setting. The chapter defines relocation stress syndrome (RSS) and its effects. It also describes strategies to identify and minimize the risks associated with older adult relocation; addresses problems from a clinical standpoint; creates interventions and care plans that facilitate positive outcomes; and increases staff awareness, sensitivity, tolerance, and creativity on the topic of care transitions.
This chapter provides some direction on where we go from here with health literacy and focuses on the field of health literacy and a working conceptual framework of health literacy. It highlights theories from the fields of adult learning and educational and social gerontology that may guide future health literacy practice and research with older adults. Transformational learning is that which brings about a shift in how people see themselves in relation to the community/world around them. The stress process is the most prevalent social framework to examine the aspects of aging and health. In terms of older adults, level of health literacy may either increase or decrease the impact of stress. Thus, higher levels of health literacy may buffer the “life strains” of aging. The concept of “linked lives” is the most useful tool to examine and understand the actions and interactions of family members over time.
This chapter focuses on explaining the different modalities located within the radiology department and what can be expected as part of the examination process for the geriatric patient population. Diagnostic radiography uses x-ray radiation to visualize the internal structures of the human body. The patient’s body part being examined will be positioned so that it is between the x-ray tube emitting the beam and the image receptor capturing the image. Bone densitometry is conducted to measure the bone mineral content of the body and assess bone strength. Mammography is medical imaging of the breast and its primary goal is to detect breast cancer. Once described as “inside out” imaging, nuclear medicine is a way to record radiation being emitted by the patient’s body. Another imaging modality within the radiology department that does not use ionizing radiation to obtain images of the body is ultrasound.