Geriatric Care Management - Assignment Example

Geriatric Case Management Assessment The acceleration of the aging of the population particularly in developing countries has necessitated increasing concern and effort into geriatric care. A considerable portion of the population is categorized as elderly and is significantly more susceptible to conditions such as cardiovascular disease, chronic respiratory diseases, and diabetes, making the management of their care critical to their health. For this reason, it is necessary that care managers dedicated to the elderly conduct assessments and develop care plans aimed at ensuring the provision of quality healthcare. This essay discusses quality of life as a component of geriatric case management assessment while exploring some of the care settings available to the elderly. Geriatric Case Management Assessment Old age brings with it increased frailty resulting from social, physical, environmental, and mental factors. The continued safe and independent living of the elderly at risk from these factors requires complex intervention which caregivers achieve through comprehensive need assessment for the patients. The assessment is then followed by equally comprehensive care plans to ensure improved efficiency in the delivery of the care services. Geriatric assessment is, therefore, an evaluation aimed at uncovering the multiple health problems facing the elderly, identifying the resources available to solve them, and developing a coordinated care plan focusing on the solution of these issues (Cress, 2015). The primary goal of the assessment is to aid in the creation of a care plan, a function such evaluations have achieved according to the Gerontological Society of America which confirms the assessments’ usefulness in the improvement of health among older patients. The geriatric case management assessment tools, which include the EASY Care tool according to the Journal of Age and Ageing (Craig, 2015), often focus on the family or caregiver or the patient’s quality of life. Quality of Life Assessment Quality of life (QOL), particularly among geriatric patients, contributes significantly to their overall health and well being. Essentially, QOL consists of social interactions to maintain connections to other people and reference groups, cultivation of a sense of spirituality, engagement in activities that enhance physical wellbeing and give the patient a sense of purpose, and participation in activities that stimulate the mind such as learning (Cress, 2015). The implication of these aspects of QOL to the overall well being of geriatric patients and the understanding that improved quality of life is a fundamental component of a patient’s needs has led to increased focus among geriatric care providers on the improvement of the same. The assessment measures eleven outcomes which fall under the spiritual, emotional, and intellectual holistic quality of life areas. Under the first category, the care manager attached to the patient determines the client’s spiritual well being by evaluating their perception of whether or not their spiritual needs are met and their understanding of what gives their life meaning. Further, an evaluation of the patient’s relationships gives the caregiver insight into their emotional well being while their frequency of engagement in meaningful activity and activities they enjoy together with the choices they make regarding their life and care aids in the evaluation of their intellectual well being (Cress, 2015). Care Settings While major aspects of the above assessment remain the same across different settings, it slightly differs in both element and execution depending on the setting in which the patient or client receives the services. Traditional care settings for geriatric patients include extended care facilities and their own homes (Cassel & Walsh, 2012). Such settings are gradually being replaced by long-term care settings which include skilled nursing facilities, advanced home care services, and assisted living facilities. The application of assessment models based on the quality of life may differ slightly across different settings, but it remains similar in a majority of their components. For instance, according to Merel (2015), geriatric patients benefit more from a holistic approach, with the efficiency of the assessment tools preferred. QOL is a significant component of this holistic approach making it a priority for geriatric care management assessment in traditional settings. Similarly, efficiency in the assessment of the quality of life of the patients is of essence in long-term care settings. Therefore, the emphasis on efficiency is a key similarity of the two settings. The indicators of QOL in each setting differ, marking the key difference in geriatric assessment between traditional and long-term settings. Cress (2015) identifies individuality, meaningful activity, spiritual well being, and enjoyment as the key indicators of a patient’s quality of life in geriatric care management assessment in nursing homes, which are examples of traditional settings. In such settings, QOL assessment focuses primarily on the concerned patient’s interpersonal interactions, their choices, verbal and nonverbal expression of enjoyment and pleasure, participation in behaviors they find interesting, and religion or whichever means they find meaning in their lives. In long-term settings, the assessment incorporates other indicators of quality of life seemingly ignored in traditional settings. In managed care organizations, for instance, the assessment introduces a financial dimension in the evaluation, with the organizations incorporating financial counseling as part of their services. Furthermore, the assessment in long-term settings, particularly in advanced home services and care homes require the participation of more medical practitioners compared to the traditional settings. Zubair (2017) confirms this premise in his consideration of the assessment in care home settings as multidisciplinary which requires the input of other practitioners in addition to the primary case manager. The two types of settings, therefore, differ in the determinants of the quality of life and the number of staff involved in the assessment. Skilled Nursing Facilities Skilled nursing homes are an example of long-term care settings. Most nursing homes provide skilled services and special facilities specifically suited for different purposes, among them geriatric care. While such facilities make geriatric care easier and more specialized, they operate amid both specific challenges stemming from their area of specialization and general ones observed across all healthcare facilities. One such challenge, which touches on both legal and ethical aspects of healthcare, is the administration of medication. In its first issue last year, the European Journal of General Practice noted an alarming increase of inappropriate medication especially in long-term care settings for elderly residents (Storms, 2017). This trend is considerably alarming particularly given the delicate condition of geriatric patients. Solutions to the problem exist, however, in the form of medication monitoring systems to eliminate the possibility of inappropriate medication. Other challenges unique to skilled nursing facilities include their capacity to provide quality care to the resident patients given the rapid decline in their health status and the high nursing staff turnover which often leaves such institutions grappling with labor shortages. Finally, the constant progress in technology means that now, new processes and equipment with the possibility of extending life are available. These advancements lead to questions and doubts on their application which some see as simply lengthening the dying process and therefore lowering human dignity while others consider it a lifeline which allows them more time with their loved ones. Either way, the application of such technology presents an ethical dilemma. Assessment in geriatric care management is crucial in the determination a patient’s needs and their fulfillment. One key component of such assessments is the subject’s quality of life. QOL, whose application in geriatric assessment differs across traditional and long-term care settings, is a critical component of overall health and well being. References Cassel, C. K., & Walsh, J. R. (2012). Geriatric Medicine: Volume II: Fundamentals of Geriatric Care. New York, NY: Springer New York. Craig, C., Chadborn, N., Sands, G., Tuomainen, H., & Gladman, J. (2015). Systematic review of EASY-care needs assessment for community-dwelling older people. Age and ageing, 44(4), 559-565. Cress, C. J. (2015). Care Planning and Geriatric Assessment. Handbook of Geriatric Care Management. Burlington, Massachusetts: Jones & Bartlett Learning. Merel, S. E. (2015). Geriatric Medicine, An Issue of Medical Clinics of North America, E-Book. New York City: Elsevier. Storms, H., Marquet, K., Aertgeerts, B., & Claes, N. (2017). Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review. European Journal of General Practice, 23(1), 69-77. Zubair, M., Chadborn, N. H., Gladman, J. R., Dening, T., Gordon, A. L., & Goodman, C. (2017). Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study. BMJ open, 7(10), e017270. Read More