N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
Chapter 3, 4, 27
The Joint Commission (TJC)
• Standards established and used by TJC to review healthcare facilities
• considered the industry standard
• JOINT COMMISSION** – COVERS HOSPITALS
Centers for Medicare and Medicaid Services (CMS)
• Medicare pays only skilled care:
• nursing, physical therapy, occupational therapy, and speech therapy—for Medicare-
insured persons in long-term care facilities
• Medicaid pays for both intermediate and skilled care for indigent persons
Older Americans Act (OAA)
increase states’ responsibilities for maintaining an effective long-term care ombudsman program
Categories of Elder Abuse
• Domestic elder abuse - maltreatment by someone who has a special relationship with the older
adult, such as a family member or caregiver
• Institutional elder abuse - in residential institutions such as nursing facilities, paid caregiver
• Self-neglect or self-abuse
7 Types of Elder Abuse*****
1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Financial / material exploitation
5. Self-neglect
6. Neglect
7. Abandonment
• Must report to the State.
s/s abuse - bruises, weight loss, unkept appearance, malnutrition
OBRA - Nursing Facility Reform
nursing facility reform is to protect and promote the rights of residents to enhance quality of life
OBRA’s 3 Major Parts
• Provision of service requirements
• Quality of care****
• Resident rights****
• Unnecessary drug use and chemical or physical restraints
• Urinary incontinence
• Facility survey and certification
• Standard annual survey to review the quality of care
• If care is substandard, facility may be given extended survey
• Enforcement **** mechanisms and sanctions
Page 1 of 15
N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
, N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
• The Department of Health and Human Services (DHHS)**** and the states may apply
sanctions or penalties for failure to meet requirements and standards
IDPH?? – Illinois department of public health – nursing homes
Autonomy and Self-Determination
The right to self-determination**** is based on the doctrine of informed consent***.
The Patient Self-Determination Act – PSDA = INFORMED CONSENT
NEXT OF KIN IN ORDER
• Spouse
• Oldest Child
o Other child in order
• Parent
• Siblings
• Grandparents /Aunt/uncle /Cousins
DNR: specific order from physician which instructs health care providers not to use or order specific
methods of therapy such as CPR
Advance Medical Directives
• AMDs: documents that permit people to put in writing - wishes and preferences regarding
healthcare
• indicate their decisions if the time should come when they are unable to speak for themselves
• permit people to designate someone to convey their wishes in the event they are unable
Living will***
written expression of wishes regarding medical treatments
Pain and comfort measures**
Can be revoked verbally
Designation of health care agents (Surrogate)
Appointment of a trusted person to express wishes regarding the withholding or withdrawal of life
support
Durable Power of Attorney
• Legal instrument to designate someone else to make health care decisions at a time in the future
when he or she may be rendered incompetent**
Must be legally changed
General Power of Attorney
• Does not cover medical decision making
Conflicts between Directives and Family Desires
Page 2 of 15
N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
Chapter 3, 4, 27
The Joint Commission (TJC)
• Standards established and used by TJC to review healthcare facilities
• considered the industry standard
• JOINT COMMISSION** – COVERS HOSPITALS
Centers for Medicare and Medicaid Services (CMS)
• Medicare pays only skilled care:
• nursing, physical therapy, occupational therapy, and speech therapy—for Medicare-
insured persons in long-term care facilities
• Medicaid pays for both intermediate and skilled care for indigent persons
Older Americans Act (OAA)
increase states’ responsibilities for maintaining an effective long-term care ombudsman program
Categories of Elder Abuse
• Domestic elder abuse - maltreatment by someone who has a special relationship with the older
adult, such as a family member or caregiver
• Institutional elder abuse - in residential institutions such as nursing facilities, paid caregiver
• Self-neglect or self-abuse
7 Types of Elder Abuse*****
1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Financial / material exploitation
5. Self-neglect
6. Neglect
7. Abandonment
• Must report to the State.
s/s abuse - bruises, weight loss, unkept appearance, malnutrition
OBRA - Nursing Facility Reform
nursing facility reform is to protect and promote the rights of residents to enhance quality of life
OBRA’s 3 Major Parts
• Provision of service requirements
• Quality of care****
• Resident rights****
• Unnecessary drug use and chemical or physical restraints
• Urinary incontinence
• Facility survey and certification
• Standard annual survey to review the quality of care
• If care is substandard, facility may be given extended survey
• Enforcement **** mechanisms and sanctions
Page 1 of 15
N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
, N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
• The Department of Health and Human Services (DHHS)**** and the states may apply
sanctions or penalties for failure to meet requirements and standards
IDPH?? – Illinois department of public health – nursing homes
Autonomy and Self-Determination
The right to self-determination**** is based on the doctrine of informed consent***.
The Patient Self-Determination Act – PSDA = INFORMED CONSENT
NEXT OF KIN IN ORDER
• Spouse
• Oldest Child
o Other child in order
• Parent
• Siblings
• Grandparents /Aunt/uncle /Cousins
DNR: specific order from physician which instructs health care providers not to use or order specific
methods of therapy such as CPR
Advance Medical Directives
• AMDs: documents that permit people to put in writing - wishes and preferences regarding
healthcare
• indicate their decisions if the time should come when they are unable to speak for themselves
• permit people to designate someone to convey their wishes in the event they are unable
Living will***
written expression of wishes regarding medical treatments
Pain and comfort measures**
Can be revoked verbally
Designation of health care agents (Surrogate)
Appointment of a trusted person to express wishes regarding the withholding or withdrawal of life
support
Durable Power of Attorney
• Legal instrument to designate someone else to make health care decisions at a time in the future
when he or she may be rendered incompetent**
Must be legally changed
General Power of Attorney
• Does not cover medical decision making
Conflicts between Directives and Family Desires
Page 2 of 15
N212 GERO FINAL EXAM Review: Key Concepts on Elder Care and Dementia
