Services for the Elderly

Services for the Elderly

Rehabilitation

·        Can classify approaches to rehabilitation by patterns of disability:

o   Localised injury or isolated disability: involvement of one discipline may be appropriate

o   Expectation of return to premorbid function: but more than one discipline necessary (eg fractures)

o   Where optimal recovery depends on well integrated team approach (eg amputation, stroke)

o  Progressive deteriorating conditions where the aim is to maintain optimum ability, with regular review of goals, and emphasis on emotional, social and environmental factors rather than specific rehabilitation techniques (eg Parkinson‟s)

·        Can classify rehabilitation by types of people: 

o  Impaired physical function, but not obviously ill ® disability management

o  Chronic illness without manifest disability ® education and anticipatory care

o  Those with a combination of illness and disability

·        Can classify rehabilitation by approaches:

o  Medical: specific control of disease and impairment

o  Prevention: Of secondary disability (eg pressure areas, constipation) 

o  Restoration: Using physiotherapy, occupational therapy and nursing interventions to ­ function

o  Adaptation: Equipment, modification of living environment, and family adjustment

·        Also need to assess the strengths and abilities of the individual and carers

·        Goal Setting:

o  Central task in management of disability 

o  Needs accurate assessment of pre-morbid and current function (eg using formal assessment tools). Is often unrealistic to aim for future function better than pre-morbid function

o  Goals must be meaningful and appropriate to the problems and circumstances

o  Goals should be agreed by negotiation with older person, the carer and the rehab team

o  Goals should include: who, will do what, under what circumstances, and to what degree of success

·        Barriers to Rehabilitation: 

o  Unidentified medical problems: don‟t want to over or under-medicate. Check for malnutrition, anaemia, fluid and electrolyte abnormalities

o  Cognitive impairment: If they can‟t concentrate or remember, their involvement is compromised.

o   Always screen for impairment 

o  Depression: Unwell and disabled people have a high prevalence of usually treatable depression. Diagnosis can be complicated due to overlapping symptoms (eg fatigue, apathy, psychomotor retardation and sleep disturbance) 

o  Communication problems: Screen for poor eyesight and hearing 

o  Low expectations and ageism: decline is not always as inevitable or severe as thought. Patients, carers and professionals can all have misconceptions and unrealistically low expectations 

o  Right to dependency: some old people may not participate because they feel they should be looked after

·        Common rehabilitation interventions: physiotherapy (especially musculo-skeletal problems and mobility), occupational therapy (therapy to ­function in tasks, ¯impairment), doctors (diagnosis, prescribing, prognosis, co-ordination), nursing (implementing therapies, assessing disease, function and well being), speech language therapy (including swallowing), dieticians, appliances, adaptations, daily living aids, advice, education, counselling, encouragement, listening

·        Whether inpatient or outpatient setting is assessed on the basis of: level of dependency (especially night care), degree of complexity of disability, speed of response needed, housing and domestic circumstances, availability of in or outpatient services

Rest Home and Hospital Care

·        6% of the population over 65 live in institutions (about 25,000), 24.5% of those over 85

·        Rest homes are licensed by the Ministry of Health and payments are made by the Ministry of Health

·         Access to funding by an individual is dependent on a needs assessment done by an HHS or other assessment unit and an asset test done under contract from the Ministry of Health by WINZ

·        Maximum weekly fee paid is $636: average rest home fees are around $550 per week and hospital fees around $1100

·        If receiving the subsidy, you loose super and get and allowance of $27 per week

·        Needs assessment assigns a Support Need Level (SNL) from 1, little help needed, to 5, 2 person help needed – levels 1 and 2 general aren‟t funded to be in rest homes

·        Comorbidity common in rest homes, plus evidence of mental illness (in addition to stroke and dementia)

·        Other health issues include vitamin D supplementation, immunisation (including of staff), and loss of continuity of care on shifting into a rest home

·        Also broader issues are maintenance of privacy, whether sexual needs can be met, encouragement of health promotion activities such as exercise, appropriate recreation, monitoring dietary intake, provision of alcohol and attitudes to smoking