N212 GERO EXAM 1 REVIEW HIGHLIGHTED MOMEMNTS./EXAM 1 – LEGAL ETHICAL & GERO ASSESSMENT + COGNITIVE & NEURO FUNCTIONEXAM 1 – LEGAL ETHICAL & GERO ASSESSMENT + COGNITIVE & NEURO FUNCTION

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 Medicareinsured 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 EXAM 1 – LEGAL ETHICAL & GERO ASSESSMENT + COGNITIVE & NEURO FUNCTION • 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 EXAM 1 – LEGAL ETHICAL & GERO ASSESSMENT + COGNITIVE & NEURO FUNCTION Should conflict occur, most AMD statutes specifically provide immunity for physicians who follow, in good faith, the wishes of a patient Nurses’ Ethical Code and End-of-Life Care  Role of HCP is to o maintain pt autonomy o maintain/improve health o do no harm Key Principles • Autonomy or self-determination = INFORMED CONSENT • Beneficence (doing good) • Bene = good • Nonmaleficence (avoiding evil) • Mal = bad/evil • Justice (allocation of resources) • Fair • Veracity (truthfulness) • Vera = truth KNOW THE BE