Case study on elder J and future needs.

1. Ferris State University
Sarah McCormick
Case Study Evidence-Based
Service Plan Presentation

2. Assessment
 Elder J is an 87 year old female, widowed, and living alone
 Hispanic
 Resides in Texas
• Current Health Issues
• Background
 COPD
 Chronic Bronchitis
 Coronary Artery Disease
 Feeding Tube
2

3. Formal Care
• Current Providers
 Registered Nurse (RN) provided through a home health care agency
• Number of Service Days
 Currently twice a week
• Care Provided
 Vitals, wound care, and check of medications
3

4. Informal Care
• Who is providing the informal services?
 Neighbors
 Family members
4

5. Types of Informal Services
• List of instrumental activities of daily living (IADLs) provided
 Shopping
 Medication preparation
 Finances
 Housework (maintence and lawn care)
• Other services
 Setting up appointments
 Transportation
5

6. Providers & Specialist
• Primary Care Provider
 General Internist
 Seen once a month and as needed
• Psychologist
 Once every 3 months
 For Depression and Anxiety
• Gastroenterologist
 Once every 2 months
 For Feeding tube
6

7. Funding Received
• Financial resources
 Social Security
 Estimated at $1,097.00
• Medicare Advantage
• Friends
 Borrows money from friends when needed
7

8. Service/Funding Eligibility
 3. Social Security - Old Age, Survivors, Disability, and Health Insurance Programs
(OASDHI) (Income)
 4. Medicaid (Medicaid/Health)
 5. Medicaid- Nursing Facility Program (Spousal Impoverishment) (Medicaid/Health)
 6. Community Based Alternatives (CBA) (Medicaid/Health)
 7. Medicaid Primary Home Care (PHC) (Medicaid/Health)
 8. Medicaid Day Activity and Health Services (Medicaid/Health)
 9. Supplemental Nutrition Assistance Program (SNAP) (Nutrition Assistance)
 10. Merck Patient Assistance Program (Pharmaceutical - Company Program)
 11. GSK Access (Pharmaceutical-Company Care
 12. Rx Outreach (Pharmaceutical Discount Card
 13. Medicare (Health)
 14. Medicare Savings Program-Qualified Medicare Beneficiary ( QMB)
Benefits Checkup
Website
https://www.benefitscheckup.org
2. Medicare Prescription
Drug Coverage for
People with Limited
Incomes and Resources
1. NCOA Reverse
Mortgage
Counseling Service
8
National Council on Aging. (n.d.). Can I get help? Retrieved April 18 2015,
from https://www.benefitscheckup.org

9.  15. Adult Day Care
 16. Emergency Response Services (ERS) Program
 17. Residential Care (RC) Program
 18. Respite Care
 19. Senior Citizens Program
 20. Health Centers for Primary Health Care and Dental Services
 21. Donated Dental Services
 22. AUDIENT (An Alliance for Accessible Hearing Care)
 23. Chronic Disease Self-Management Program
 24. Texas Health Information Counseling and Advocacy Program
 25. Community Care for Aged/Disabled (CCAD)
 26. Tax Credit for the Elderly and Disabled
 27. Homestead Exemption
 28. Property Tax Exemption for the Elderly and Disabled
 29. Property Tax Deferral
 30. National Flood Insurance Program
 31. Fair Plan (Insurance)
 32. VA Death Pension
 33. VA Pension-Aid and Attendance and Housebound Benefits
 34. Housing Loan Programs for Veterans
 35. State Veterans Benefits
 36. Elderly Nutrition Program-Congregate or Group Meals
 37. Elderly Nutrition Program-Home Delivered Meals
 38. Senior Farmers’ Market Nutrition Plan
9
(Continued)
National Council on Aging. (n.d.). Can I get help? Retrieved April 18 2015,
from https://www.benefitscheckup.org

10. (Continued)
 39. The Emergency Food Assistance Program (TEFAP)
 40. Low Income Home Energy Assistance Program (LIHEAP)
 41. Neighbor to Neighbor Texas Utility Assistance Program
 42. Weatherization Assistance Program
 43. Lifeline (Utility)
 44. Specialized Telecommunications Assistance Program
 45. Safelink Wireless
 46. Lite-Up Texas Program
 47. Assurance Wireless
 48. ReachOut Wireless
 49. USDA Housing Repair Program
 50. Alzheimer's Association
10
Benefits
National Council on Aging. (n.d.). Can I get help? Retrieved April 18, 2015,
from https://www.benefitscheckup.org

11. Current Unmet Needs
 Transportation
11
 Dental
 Eye Care

12. Future Needs
• What unmet need(s) do you project
for this person five or ten years from now?
• Respiratory Therapy
 Oxygen
 Home Ventilator
• Everyday Caregiver
• Transportation
• Palliative Care
12

13. Respiratory Therapy
• Specific needs and requirement’s to fulfill the position?
Respiratory therapists care for patients who have trouble
breathing and those elders with diseased lungs (BLS, 2014). An
example is elder J’s COPD and chronic bronchitis.
• Education
 Associate's degree
 License requirement (varies by State)
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Respiratory
Therapists [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,
2015, from http://www.bls.gov/ooh/healthcare/respiratory-therapists.htm
13

14. Respiratory Care Equipment
• Ventilator
The equipment needs to be able to supply supplemental oxygen, have a simple
interface, be equipped with power failure options such an internal battery, and
be compact in size (Kacmarek, Stoller, & Heuer, 2013, p. 1038).
• Example
 The Carina home ventilator (Draeger Medical)
 For invasive or noninvasive
 100-V or 240-V
 2 hour internal battery
 10-hour external battery
Kacmarek, R. M., Stoller, J. K., & Heuer, A. J. (2013). Egan's fundamentals of respiratory care
(10th ed.). St. Louis, Mo.: Elsevier/Mosby.14

15. Funding for Respiratory Care
• Who covers this service?
 Medicare: Part B
 Under the category Durable Medical Equipment
• Elder J’s Medicare Cost
 20% of the Medicare-approved amount
 $0 for home health services
Centers for Medicare & Medicaid Services. (2005, July 5). National Coverage Determination
(NCD) for Durable Medical Equipment Reference List (280.1). Retrieved April 19, 2015,
from http://www.cms.gov/medicare-coverage-database/details/ncd-
details.aspx?NCDId=190&ncdver=2&NCAId=3&ver=5&NcaName=Air-
Fluidized+Beds+for+Pressure+Ulcers&bc=ACAAAAAAIAAA&
15

16. Nurses Aide
• Specific needs and requirement’s to fulfill the position?
Nursing assistants and orderlies help provide basic care (BLS, 2014).
• Nurses Aide (CNA)
• Education
 State-approved education program
 Competency exam
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Nursing Assistants
and Orderlies [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,
2015, from http://www.bls.gov/ooh/healthcare/nursing-assistants.htm
16

17. Nursing
• Specific needs and requirement’s to fulfill the position?
 Registered Nurse (RN)
“Assess patient health problems and needs, develop and
implement nursing care plans, and maintain medical records.
Administer nursing care to ill, injured, convalescent, or disabled
patients. May advise patients on health maintenance and disease
prevention or provide case management” (BLS, 2014).
• Education
 Associate’s degree
 Licensing varies by State
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Registered Nurses
[Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19, 2015, from
http://www.bls.gov/ooh/healthcare/registered-nurses.htm
17

18. Nursing Care Equipment
• Supplies
 Hospital bed
 Stethoscope
 Pulse Ox
 Weight scale
 Syringes for tube feeding
 Gauze
 Personal Protection (gown, mask,
gloves)
 Bag-mask resuscitator
 Biohazard bags and sharps container
 Disinfectant cleaners
 IV pole holder
 Feeding pump
 Enteral nutrition (liquid meal
replacement)
18

19. Funding for Nursing Care
• Who covers this service?
 Medicare: Part B
 Under the category Durable Medical Equipment
• Elder J’s Medicare Cost
 20% of the Medicare-approved amount
 $0 for home health services
19 Centers for Medicare & Medicaid Services. (n.d.). Home health services. Retrieved April 22,
2015, from http://www.medicare.gov/coverage/home-health-services.html

20. Transportation
• Who covers this service?
“Transportation is provided by the Regional Transportation Authority, including the RTA
“B” Rideline for persons with disabilities that are not able to use the regular fixed rural
services” (Area Agency on Aging, 2014).
 Corpus Christi Regional Transportation Authority (CCRTA), www.ccrta.org
 CCRTA B-Line Paratransit Service
 Reservations Line, 361-289-5881, B-Line reservations may be made Monday –
Friday, 7:00 a.m. 6:00 p.m., Saturday – 8:00 a.m. –5: p.m. and Sunday from 12:00
p.m.– 4:00 p.m., 24 hr. in advance of trip. B-Line is a shared ride public transportation
service for people with disabilities and individuals with age-related conditions that
prevent them from using fixed route services. Individuals must meet eligibility
requirements as determined through an application (Aging and Disability Resource,
n.d.).
Area Agency on Aging of The Coastal Bend, & Coastal Bend Council of Goverments. (2014,
February 13). Transportation. Retrieved April 19, 2015, from
http://www.aaacoastalbend.org/?id=27
20
Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging &
Resource Directory 2014-2015. Retrieved April 19, 2015, from
http://www.cctexas.com/Assets/Departments/Parks-and-
Recreations/Files/2014CoastalBendAging_DisabilityResourceDirectory_web.pdf

21. Transportation (Continued)
• Other Options
 Medical (Medicaid) Transportation Program: 877-633-8747 Medical care
transportation for people receiving Medicaid, 48 hr. notice required.
 Mobility Options Project: 361-883-8461, 877-988-1999, www.cbcil.org
 Texas Department of Transportation Corpus Christi District Office, 361-808-
2351, www.txdot.gov
 Transportation Coordination Network (TCN) of the Coastal Bend, 361-664-
7826, www.tcncb.org Coordinates public transportation network of resources
in the Coastal Bend Region
Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging &
Resource Directory 2014-2015. Retrieved April 19, 2015, from
http://www.cctexas.com/Assets/Departments/Parks-and-
Recreations/Files/2014CoastalBendAging_DisabilityResourceDirectory_web.pdf21

22. Transportation Equipment
• Wheel cheer accessibility
• Defibrillator
• Bag-mask resuscitator
22

23. Funding for Transportation
• Who covers this service?
 Government subsidies
 State assistance (varies by state)
 Community service members (faith based, non-profit)
National Association of Area Agencies on Aging (n4a), & U.S. Administration on Aging (AoA).
(n.d.). Transportation Options for Older Adults. Retrieved April 19, 2015, from
http://www.eldercare.gov/Eldercare.NET/Public/Resources/Brochures/docs/Trans_Optio
ns_Panels.pdf
23

24. Palliative Care
• Palliative Care Team
 Registered Nurse (RN)
 Physician
 Pharmacist
 Allied Health Professional’s
 Specialist
• Who covers this service?
 Medicare Part B (coverage is limited)
 Medicaid (coverage is limited)
 The term “Palliative” is not used by either resources24
Offered early in the process of a chronic
disease, focused on reliving symptoms,
and improving the quality of life (Beers,
2006, p. 223).
Beers, M. H. (2006). The Merck manual of health & aging (2006 ed.). New York:
Ballantine Books.

25. Future Service Plan Model
Electronic
Monitoring
Electronic Health
Record (EHR)
Telehealth
25
.
 This service approach requires teamwork and use of technology. It starts
with the social worker equipped with the knowledge of resources and
insurance coverage. Once needs are determined a team is assembled.
 All services including medications are covered under one insurance
policy so that provider and patients can focus on healing.
 Each provider will work on the basis of prevention of
further decline, teaching in a language and format best suited to
the patients learning needs. Also included is maintaining cognitive
health and fall prevention.
 If services are needed outside of the home the social worker will
set-up the most safe and convenient transportation along with a companion
such as a nurse aid or volunteer.
 The monthly required medications will be delivered directly to the
patients home in an easy to understand pill box along with a
telecommunicated explanation from the pharmacist.
 Weekly check-ins with the patient through a video conference with
the whole team to discuss progress, changes, questions, and concerns.

26. Ideal Future Service Plan
Looking Ahead 10 Years
Social Worker
Home Health Aide
Physician
Respiratory
Therapist
Physical
Therapist
DentistPastor
Psychiatric
Technician
Pharmacist
Volunteers
Optometrist
26
• What Type of Providers are Needed?
“The interdisciplinary team is put into place the second multiple
chronic diseases are diagnosed. The primary care physician contacts
the social worker, who then functions to create a team, the provider’s
only provide in-home care and a set number of patients in the
neighborhood”(McCormick, 2015).

27. Health Care Worker Requirements
• What preparation would they need?
 Geriatric training
“In 1997 the John A. Hartford Foundation funded eight national programs to
develop geriatric interdisciplinary team training (GITT) programs for students in
nursing, social work, and medicine in order to foster the skills needed for
effective team care” (IOM, 2008, p. 159).
 Licensing (will vary by job title and state requirement)
 Certification (will vary by job title and state requirement)
Retooling for an aging America: Building the health care workforce (Online-Ausg. ed.) (Institute
of Medicine of the National Academies, Comp.). (2008). Washington, DC: National
Academies Press.
27

28. Bureau of Labor Statistics. (2014, January 8). Occupational Outlook Handbook. Retrieved April
22, 2015, from http://www.bls.gov/ooh/
28
Provider’s Preparation
Title Education Licensing Certification
Dentist Doctorate or professional
degree
Varies by state
written & practical exam
Home HealthAide High School Diploma Certificate
Nurse Associate’s degree Varies by state
Optometrist Doctorate or professional
degree
Varies by state
Pharmacist Doctorate or professional
degree
Varies by state
Must pass 2 tests
PhysicalTherapist Doctorate or Professional
degree
Varies by state
Physician Doctorate or professional
degree
Varies by state
Psychiatric technician Associates degree Varies by state
RespiratoryTherapist Associate's degree Varies by state
Social worker Bachelor’s degree Varies by state Varies by state

29. Health Care Model
• What type of health care model does this idea fit into?
 PACE (Program of All-inclusive Care for the Elderly)
The patient is the main focus. The goal is aimed at keeping the patient in
their home. It consists of a professional health care team, with services
being met in the home, community, or PACE center (Centers for Medicare, n.d.).
 Who covers the services?
 Medicaid
 If you do not qualify for Medicaid, but have Medicare you are charged a monthly
premium for long-term care and a premium for Medicare Part D drugs
29
Centers for Medicare & Medicaid Services. (n.d.). PACE. Retrieved April 22,
2015, from http://www.medicare.gov/your-medicare-costs/help-paying-costs/
pace/pace.html

30. Roadmap to Service
• Feasibility Consideration
 These are services that are currently fragmented, but in the future as the number of
elders rise this will become an option as the cost-savings become apparent and a
better quality of life is achieved
• Demand for Service
 The statistics currently show long-term care services provided in the home is the
preference among majority of elders
• Potential Stakeholders Actions to Make It Happen
 Proactive action will be seen in the near future, through policy change, provider
support, and patient or family demand
30

31. 31
Aging and Disability Resource Directory Committee. (n.d.). The Coastal Bend Aging & Resource
Directory 2014-2015. Retrieved April 19, 2015, from
http://www.cctexas.com/Assets/Departments/Parks-and-
Recreations/Files/2014CoastalBendAging_DisabilityResourceDirectory_web.pdf
Area Agency on Aging of The Coastal Bend, & Coastal Bend Council of Goverments. (2014,
February 13). Transportation. Retrieved April 19, 2015, from
http://www.aaacoastalbend.org/?id=27
Beers, M. H. (2006). The Merck manual of health & aging (2006 ed.). New York: Ballantine Books.
Bureau of Labor Statistics. (2014, January 8). Occupational Outlook Handbook. Retrieved April 22,
2015, from http://www.bls.gov/ooh/
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Nursing Assistants
and Orderlies [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,
2015, from http://www.bls.gov/ooh/healthcare/nursing-assistants.htm
References

32. 32
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Registered
Nurses [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,
2015, from http://www.bls.gov/ooh/healthcare/registered-nurses.htm
Bureau of Labor Statistics, & U.S. Department of Labor. (2014, January 8). Respiratory
Therapists [Occupational Outlook Handbook, 2014-15 Edition]. Retrieved April 19,
2015, from http://www.bls.gov/ooh/healthcare/respiratory-therapists.htm
Centers for Medicare & Medicaid Services. (n.d.). Home health services. Retrieved April 22,
2015, from http://www.medicare.gov/coverage/home-health-services.html
Centers for Medicare & Medicaid Services. (n.d.). PACE. Retrieved April 22, 2015, from
http://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
Centers for Medicare & Medicaid Services. (2005, July 5). National Coverage Determination
(NCD) for Durable Medical Equipment Reference List (280.1). Retrieved April 19, 2015,
from http://www.cms.gov/medicare-coverage-database/details/ncd-
details.aspx?NCDId=190&ncdver=2&NCAId=3&ver=5&NcaName=Air-
Fluidized+Beds+for+Pressure+Ulcers&bc=ACAAAAAAIAAA&
References

33. 33
Kacmarek, R. M., Stoller, J. K., & Heuer, A. J. (2013). Egan's fundamentals of respiratory
care (10th ed.). St. Louis, Mo.: Elsevier/Mosby.
National Association of Area Agencies on Aging (n4a), & U.S. Administration on Aging
(AoA). (n.d.). Transportation Options for Older Adults. Retrieved April 19, 2015,
from
http://www.eldercare.gov/Eldercare.NET/Public/Resources/Brochures/docs/Trans_
Options_Panels.pdf
National Council on Aging. (n.d.). Can I get help? Retrieved April 18, 2015, from
https://www.benefitscheckup.org
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, & Centers for Medicare &
Medicaid Services. (2015, January). Medicare Hospice Benefits. Retrieved April
19, 2015, from https://www.medicare.gov/Pubs/pdf/02154.pdf
References