Figure 5.3 Demographic characteristics of nursing home residents
Figure 5.4 Major factors influencing resident satisfaction
Figure 5.5 The communication enhancement model
5 HUS 133 Where People Live
Adulthood and Aging, 6eJohn C. CavanaughFredda Blanchard-Fields Chapter five Where People Live: Person-Environment Interactions
Describing Person—Environment InteractionsLearning Objectives• What is the competence and environmental press model?• What is the congruence model?• What are the major aspects of stress and coping theory relating to person—environment interactions?• What are the common themes in the theories of person—environment interactions?
Describing Person—Environment Interactions Person—Environment interactions conceptualized (Kurt Lewin, 1936) B = f(P, E) Where: B = Behavior P = Person E = Environment
Describing Person—Environment InteractionsCompetence and Environmental Press• Competence is the theoretical upper limit of a person’s capacity to function.• Environments can be classified on the basis of the varying demands they place on the person, a notion called environmental press. – Adaption Level: Where behavior and affect are normal, slight increases in press improve performance, slight decreases create a Zone of Maximum Comfort.
Describing Person—Environment InteractionsThe Congruence Model• According to Kahana’s (1982) congruence model, people with particular needs search for the environments that meet them best.• Can you offer examples? 1. A person without personal transportation seeks a house near a bus route. 2. A handicapped person needs a home adapted to a wheelchair (no steps). 3. An elderly person may need to relocate to an assisted-living facility.
Describing Person—Environment InteractionsStress and Coping Framework• Interaction with the environment can produce stress (Lazarus, 1984).• Evaluating one’s situation and surroundings for potential threat value – Harmful – Beneficial – Irrelevant• If harmful, what is the coping mechanism and response? Outcome positive or negative?
Describing Person—Environment InteractionsCommon Theoretical Themes and Everyday Competence• Everyday competence is a person’s potential ability to perform a wide range of activities considered essential for independent living. – Broader than just ADL or IADL – Necessary determinate for whether an elderly person can take care of themselves
The Ecology of AgingLearning Objectives• What is aging in place?• How do people decide the best option?• How can a home be modified to provide a supportive environment?• What options and services are provided in adult day care?• What is congregate housing?• What are the characteristics of assisted living?
The Ecology of Aging• Aging in Place – Balancing environment press and competence through selection and compensation. – How a place becomes a home. – Cluster housing.
The Ecology of Aging• Deciding on the Best Option – Does the individual have significant cognitive or physical impairment requiring intervention? • What is the severity? – The individual needs to be an integral part of the decision making. – Get a physician’s diagnostic evaluation (required in many states).
The Ecology of Aging• Home Modification – Helping people deal with tasks of daily living by modifying the environment • Hook for car keys near the door • Hand rails in bathrooms • Door handles that are easier to grasp • Widening doorways • Lowering countertops • Wheelchair ramps
The Ecology of Aging• Adult Day Care – Designed to provide support, companionship, and certain services during the day – Goal is to delay placement in more formal care setting. – Three types of adult day care • Social services, meals, recreation, and minor health care • More intensive health care, therapy, for serious medical problems • Specialize care for dementia or developmental disabilities. Profit (22%) or non-profit (78%)
The Ecology of Aging• Congregate Housing – Apartment complex for older adults • Shared meals • Affordable – Differs from assisted living in level of services – Residents must be capable of independent living and: • Not require continual medical care • Know where they are and oriented to time • No evidence of disruptive behavior • Able to make independent decisions • Be able to follow specific service plans
The Ecology of Aging• Assisted Living – Provides a supportive living arrangement for people who need assistance with personal care (bathing, taking medication) but are not physically or mentally impaired to require 24- hour care.• Has three essential attributes3. As much like a single family house as possible4. Emphasizes personal control, choice, dignity, and autonomy5. Should meet routine services and special needs
The Ecology of Aging• Assisted Living (continued) – Utilize check list to ensure the selected facility meets specific requirements of the individual – Costs average about $35,000 per year. – Not offset by Medicare• Specialty Care Assisted Living
Living in Nursing HomesLearning Objectives• What are the major types of nursing homes?• Who is most likely to live in nursing homes?• What are the key characteristics of nursing homes?• What are special care units?• How can a nursing home be a home?• How should people communicate with nursing home residents?• How is decision-making capacity assessed?• What are some new directions for nursing homes?
Living in Nursing HomesTypes of Nursing Homes• Two levels of care are defined in federal regulations. – Skilled nursing care consisting of 24-hour care, including medical and other health services – Intermediate care also 24-hour but at a less intensity
Living in Nursing HomesWho is Likely to Live in Nursing Homes?• Characteristics of People Most Likely to Be Placed in a Nursing Home – Over age 85 – Female – Recently admitted to a hospital – Lives in retirement housing rather than being a homeowner – Widowed or divorced – Has no children or siblings nearby – Has some cognitive impairment – Has one or more problems with IADL
Living in Nursing HomesWho is Likely to Live in Nursing Homes?• Health issues and functional impairment – Average resident has significant mental and physical problems – Main reason for placement (80%) – One third of residents have mobility, eating or incontinence problems. – 30 to 40% show signs of clinical depression.
Living in Nursing HomesCharacteristics of Nursing Homes• The competence-environmental press model – Goal is to find the optimal level of environmental support for people of low levels of competence – In selecting a nursing home relatives should keep the following in mind: • Level of skilled nursing care • Be mindful if facility is primarily Medicare or Medicaid • Is the director and upper staff fully licensed? • Is the care plan put in place by professionals? • Ask questions about staff educational levels and staff turnover.
Living in Nursing HomesSpecial Care Units – Does the facility have well-designed special care units for people with dementia? – Special care units must have the right level of environmental support to provide additional care when the person’s competence level continues to decline. – Memory aids should be built into the unit. – Special care for severely cognitive impairment residents
Living in Nursing HomesCan a Nursing Home Be a “Home?”• What can be done to foster the sense of “home?” – Being included in the decision and selection of a specific nursing home – Having prior knowledge of, and positive experience of a specific facility – Defining the home in terms of family and social relationships rather than place, objects, or total autonomy – Establish a continuity between home and nursing home – Reminiscing about home may facilitate adjustment
Living in Nursing HomesHow Not to Communicate with Residents• Patronizing speech• Infantilization or baby “talk”• Inappropriate use of first names• Terms of endearment—“Honey,” “Sweetie”• Assumption of greater impairment than may be the case• Cajoling to demand compliance to persuade with flattery or gentle urging especially in the face of reluctance
Living in Nursing HomesDecision-Making Capacity and IndividualChoices• How well can a nursing home resident make decisions regarding their care? – Cognitive impairment – Patient Self-Determination Act (PSDA) – Provide written information at time of admission concerning their right to make treatment decisions – Living will – Patients normally give the decision to family members.
Living in Nursing HomesNew Directions for Nursing Homes• The Eden Alternative – The ten principles of the Eden Alternative. – Use of pets and other approaches seem to make stronger associations between current and former living situations. • Research (Coleman et al. 2002) does not support this view. • Quality of Life difficult to assess using traditional methods. • Further research needed in this area.
Living in Nursing HomesNew Directions for Nursing Homes• Green House Project – Radical departure from the idea of large residential facilities – Encourages residents to participate in their care through helping with daily tasks – Personal dignity is maintained and quality of life is improved.
Living in Nursing HomesNew Directions for Nursing Homes• The Pioneer Network – Similar values – Older persons are valuable to society. – Treating all people with dignity – Everyone deserves that.