Lecture 9 Boxes

Question 1

Box 30.2; Amount of annual wages needed to receive SS income

Answer 1

To receive even the minimal monthly income from SS, a person must have worked enough to have earned 40 credits. Only income from which SS takes are withheld can be used toward a credit. For the current cohort of elders, this calculation has been most beneficial to white men, who are more likely to have worked the most consistently and at higher salaries than all other groups of workers. It is least beneficial to those who were low wage- earners, who never worked out of the home (ex. Housewives and homemakers), or who took time out of the job market for caregiving and child-rearing activities.

Question 2

Box 30.7; health services provided through Medicare Part A

Answer 2

Designed to partially cover the cost of acute hospitalization, semiprivate rooms, and any necessary medical services and supplies.

• There is a deductible for days 1 to 60 (each stay)
• Day 60 to 120 copay amounts increase over time
• There is no coverage after 150 days
• Deductible and copays increase every year 1
• The deductibles and copays are other paid out of pocket or reimbursed by medicare or medigap policies
• Only after a minimum of 72 H acute care hospital admission
• The first 20 days are covered at 100% if skilled care is needed the entire time
• Day 21 to 100 with daily copay of more than $100
• No coverage after 100 days
• Coverage ceases the day skilled care is no longer needed home health services requiring skilled care
• Intermittent skilled care for the purpose of rehab provided in the home
• The person must be ill enough to be considered homebound
• Medicare may pay 80% of the approved amount for durable medical equipment and supplies

Question 3

Box 30.8; Health services provided through Medicare Part B

Answer 3

Designed to cover some of the cost associated with outpatient or ambulatory services. Deductibles and copays are required in most cases.

• Physician, nurse practitioner, or physician assistant medically necessary services
• Limited prescribed supplies
• Medically necessary diagnostic
• Physical, occupational, and speech therapy for the purpose of rehab
• Limited durable medical equipment, if prescribed by a DR and for documented medical necessity
• Outpatient hospital treatment, blood, and ambulatory surgical services
• Some preventive services (many with no copay and deductible)
• DM supplies (insulin and other meds)

Question 4

Box 30.9; Medicare prescription drug plans

Answer 4

Most prescription drug plans are set ip in similar ways with deductibles and copays, however, to be a DR in medicare Part D, the insurance plan must meet the following specific guidelines. Premiums based on the plan.

Question 5

Box 31.8; Most likely to mistreat and be mistreated

Answer 5

Most like to abuse or neglect:
* Fam member
* One with emotional or mental illnesses
* One who is abusing alcohol or other substances
* History of fam violence
* Cultural acceptance of interpersonal violence
* Caregiver frustration
* Social isolation
* Impaired impulse control of caregiver

More likely to be abused or neglected:
* Cog impaired, especially with aggressive features
* Dependent on abuser
* Physically or mentally frail
* Having abused the caregiver earlier in life
* Women wither living alone or in a household with fam members
* Having been abused in the past
* Behavior that is considered aggressive, demanding, or unappreciative
* Living in an institutional setting
* Feeding deserving of abuse due to personal inadequacies

Question 6

Box 31.10; types of abuse of older adults

Answer 6

• Physical
• Sexual
• Psychological
• Medical
• Functional or material exploitation
• Discrimination
• Abandonment

Question 7

Box 31.14; examples of causes of neglect by caregivers

Answer 7

• Caregiver personal stress and exhaustion
• Multiple role demands
• Caregiver incompetence
• Unawareness of importance of the neglected care
• Financial burden of caregiving limiting resources available
• Caregivers own frailty and advanced age
• Unawareness of community resources available for support and respite

Question 8

Box 31.16; signs of mistreatment

Answer 8

The 1st stage that further evaluation may be necessary are if the histories given by the older adult and the caregiver are inconsistent or if the caregiver refuses to leave the elder alone with the nurse.

• Physical abuse: unexplained bruising or lacerations in unusual areas in various stages of healing and fractures inconsistent with functional ability.
• Sexual abuse: bruises or scratches in the genital or breast area, fear or an unusual amount of anxiety related to either routine or necessary exam of the anogenital area, and torn
  undergarments or presence of blood.
• Medical abuse: caregiver repeatedly requesting procedures that are not recommended and not desired by the care recipient
• Medical neglect: unusual delay between the beginning of a health problem and when help is sought, and repeated missed appointments without reasonable explanations.
• Psychological abuse: caregiver does all of the talking in a situation, even though the elder is capable, caregiver appears angry, frustrated, or indifferent while the elder appears hesitant or frightened, and caregiver or the care recipient aggressive toward one another or the nurse.
• Neglect by self or caregiver: weight loss, uncharacteristically neglected grooming, evidence of malnutrition and dehydration, fecal/urine smell, inappropriate clothing to the situation or weather, and insect infestation.

Question 9

Box 31.18; tips for best practice

Answer 9

• Determine if what appears as mistreatment is lack of caregiver skills
• Make professionals aware of potentially abusive situations
• Help fam develop and nurture informal support systems
• Link fam with support groups
• Teach fam stress management techniques
• Arrange comprehensive care resources
• Provide counseling for troubled fans
• Encourage the use of respite care and day care
• Obtain necessary home health care services
• Inform fam of resources for meals and transportation
• Encourage caregivers to pursue the individual interests.

Question 10

Box 32.13; Selecting a nursing home

Answer 10

• Central focus: residents and families are the central focus of the facility.
• Interactions: staff members are attentive and caring, staff members listen to what residents
  say, etc.
• Milieu: calm, active, friendly, and presence of community, volunteers, children, plants, and
  animals.
• Environment: clean/ no odor, rooms personalized, private areas, protected outside areas,
  and equipment in great repair.
• Individualized care: restorative programs of ambulation, ADLs, residents well dressed and
  groomed, residents and fam councils, pleasant mealtimes, adequate staff to severe, flexible
  meal schedules, and ethnic food preferences available.
• Staff: well trained, high level of professional skill, etc.
• Safety: safe walking areas, monitoring of residence, and restrain appropriate care,
  adequate safety equipment, and training on its use.

Question 11

Box 34.1; predictors of retirement satisfaction

Answer 11

• Good health
• Functional abilities
• Adequate income
• Suitable living environment
• Strong social support system characterized by reciprocal relations
• Decisions to retire involved choice, autonomy, adequate preparation, higher status job
  before retire
• Retire activities that offer an opportunity to feel useful, learn, grow, and enjoy oneself
• Positive outlook, sense of mastery, resilience, resourcefulness
• Good marital or partner relationship
• Sharing similar interests to spouse/significant other

Question 12

Box 34.11; tips for best practice

Answer 12

Interventions with Grandparent Caregivers:

• Early identification of at risk grandparents
• Comprehensive assessment of physical, psychosocial, and environmental factors
• Anticipatory guidance and counseling
• Referral to resources for support, counseling, and finance assistance
• Advocacy for policies supportive of grandparents who have assumed a caregiving role