Winter 2013 journal

Winter 2013

peer-reviewed excellence in life care planning since 2006

Vol. XIII No. 4

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American Association of

Nurse Life Care Planners

Journal of Nurse Life Care Planning ®

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Topics in

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HOME MODIFICATIONS

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AANLCP

Journal of Nurse Life Care Planning

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peer-reviewed excellence in life care planning since 2006

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JOURNAL OF NURSE LIFE CARE PLANNING

Winter 2013 Table of Contents 138 A System-Based Approach to

Home Modifications for the Catastrophically Injured

Frank Gucciardo MS, PT, CAPS, CGP

147 Wheelchair Access to Housing

and Architectural Modifications (part 1) Keith Sofka ATP (retired)

151 Telecaregiving: Using Technology

for Safety & Peace of Mind

Kimberly Gully, MS, CCC, CCM, CBIST

Departments 132

Editor’s Note

Wendie A. Howland RN-BC MN CRRN CCM CNLCP LNCC

134

Information for Authors

135

Contributors to this Issue

136

Letters to the Editor

137

Ethics in Action: Credentialing issue

AANLCP Journal of Nurse Life Care Planning

Vol. XIII No. 4

Journal of Nurse Life Care Planning is the official peer-reviewed publication of the American Association of Nurse Life Care Planners. Articles, statements, and opinions contained herein are those of the author(s) and are not necessarily the official policy of the AANLCP® or the editors, unless expressly stated as such. The Association reserves the right to accept, reject, or alter manuscripts or advertising material submitted for publication.

The Journal of Nurse Life Care Planning is published quarterly in Spring, Summer, Winter, and Fall. Members of AANLCP® receive the Journal subscription electronically as a membership benefit. Back issues are available in electronic (PDF) format on the association website. Journal contents are also indexed at the Cumulative Index of Nursing and Allied Health Literature (CINAHL) at ebscohost.com.

Please forward all email address changes to AANLCP® marked “Journal-Notice of Address Update.”

Contents and format copyright by the American Association of Nurse Life Care Planners.

All rights reserved. For permission to reprint articles, graphics, or charts from this journal, please request to AANLCP® headed “Journal-Reprint Permissions” citing the volume number, article title, author and intended reprinting purpose.

Neither the Journal nor the Association guarantees, warrants, or endorses any product or service advertised in this publication nor do they guarantee any claims made by any product or service representative.

Ꮬ In order to make safe and effective judgments using NANDA-I nursing diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.

Other diagnoses may be relevant depending on patient needs.

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Editor’s Note As we go to press we have just returned home from the wonderful city of Philadelphia and

American Association of Nurse Life Care Planners 3267 East 3300 South #309 Salt Lake City, UT 84109 Phone: 888-575-4047 Fax: 801-274-1535 Website: www.aanlcp.org Email: info@aanlcp.org

an another great AANLCP annual conference. One of the highlights was the long-anticipated birth of the Core Curriculum for Nurse Life Care Planning. So many people put so much work, time, and, yes, tears into this work. We hope you are proud of it, will give the editors generous and constructive feedback on improvements for the next edition, and rest assured that the second edition will have a much shorter gestation pe-

2013 AANLCP Executive Board President Joan Schofield BSN RN MBA CNLCP President Elect Nancy Zangmeister RN CRRN CCM CLCP CNLCP MSCC Treasurer Peggie Nielson RN CNLCP MSCC Secretary Shirley Daugherty RN CLCP MSCC LNC Past President Anne Sambucini RN CCM CDMS CNLCP MSC-C

riod than the first!

Remember too that you can get your copy at a deep discount by purchasing it directly from our organization and increase the percentage of the sale price that comes to the Association very substantially. Think about others: how many of your attorney clients would benefit from having a copy in the office; how many of our case manager colleagues would like to know more about nurse life care planning?

Pass along the URL on page 133 to help sup-

The American Association of Nurse Life Care Planners

promotes the unique qualities the Registered Nurse delivers to the Life Care Planning process. We support education, research, and standards

related to the practice of

Nurse Life Care Planning.

port your professional organization.

Cordially, Wendie Howland

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Vol. XIII No. 4

Get yours today!

$125 nonmembers $75 members Telephone orders until 2/15/14 888-575-4047 $12 S&H

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Vol. XIII No. 4

All authors must disclose any relationship with facilities, institutions, organizations, or companies mentioned in their work.

AANLCP® invites interested nurses and allied professionals to All accepted manuscripts are subject to editing, which may involve only minor changes of grammar, punctuation, paragraphsubmit article queries or manuscripts that educate and inform ing, etc. However, some editing may involve condensing or rethe Nurse Life Care Planner about current clinical practice methods, professional development, and the promotion of Nurse structuring the narrative. Authors will be notified of extensive Life Care Planning within the medical-legal community. Submit- editing. Authors will approve the final revision for submission.

The author, not the Journal, is responsible for the views and conted material must be original. Manuscripts and queries may be clusions of a published manuscript. addressed to the Editorial Committee. Authors should use the following guidelines for articles to be considered for publica- Submit your article as an email attachment, with document title tion. Please note capitalization of Nurse Life Care Plan, articlename.doc, e.g., wheelchairs.doc

Information for Authors

Planning, etc.

All manuscripts published become the property of the Jour-

Text nal. Manuscripts not published will be returned to the author.

Manuscript length: 1500 – 3000 words Queries may be addressed to the care of the Editor at: whowland@howlandhealthconsulting.com • Use Word© format (.doc, .docx) or Pages (.pages) • Submit only original manuscript not under consideration • • • • •

by other publications Put the title and page number in a header on each page (using the Header feature in Word) Set 1-inch margins Use Times, Times New Roman, or Ariel font, 12 point Place author name, contact information, and article title on a separate title page, so author name can be blinded for editorial review Use APA style (Publication Manual of the American Psychological Association)

Art, Figures, Links

Manuscript Review Process Submitted articles are peer reviewed by Nurse Life Care Planners with diverse backgrounds in life care planning, case management, rehabilitation, and the nursing profession. Acceptance is based on manuscript content, originality, suitability for the intended audience, relevance to Nurse Life Care Planning, and quality of the submitted material. If you would like to review articles for this journal, please contact the Editor.

AANLCP® Journal Committee for this issue

All photos, figures, and artwork should be in JPG or PDF format ( JPG preferred for photos). Line art should have a minimum resolution of 1000 dpi, halftone art (photos) a minimum of 300 dpi, and combination art (line/tone) a minimum of 500 dpi.

Wendie Howland MN RN-BC CRRN CCM CNLCP LNCC

Each table, figure, photo, or art should be on a separate page, labeled to match its reference in text, with credits if needed (e.g., Table 1, Common nursing diagnoses in SCI; Figure 3, Time to endpoints by intervention, American Cancer Society, 2003) Live links are encouraged. Please include the full URL for each.

Barbara Bate

Editing and Permissions The author must accompany the submission with written release from: • Any recognizable identified facility or patient/client, for the use of their name or image • Any recognizable person in a photograph, for unrestricted use of the image • Any copyright holder, for copyrighted materials including illustrations, photographs, tables, etc.

Journal Editor

Reviewers for this issue RN CCM CNLCP LNCC MSCC

Becky Czarnik MS RN CLNC LNCP-C Linda Husted MPH RN CNLCP LNCC CCM CDMS CRC Shelly Kinney MSN RN CCM CNLCP Victoria Powell RN CCM LNCC CNLCP MSCC CEAS

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Contributing To this Issue Frank Gucciardo (“A System-Based Approach to Home Modifications for the Catastrophically-Injured”) is the CEO and founder of Frangeli© Consulting and Design, offering consulting and architectural design services exclusively to medically-compromised clients and caregivers. Trained professionally as a physical therapist, in 2003 he opened a full service design/build construction firm focusing completely on home renovation needs of the catastrophically injured client. His company offers the unique ability to translate the medical chart into an “as built” environment by designing accessible environments with appropriate materials to foster independence. Mr. Gucciardo has been invited to speak at many facilities, universities, and other groups on topics of residential accessibility. Frangeli Consulting and Design is able to serve medically compromised clients nationwide.

Kimberly Gully (“Telecaregiving”) is the Executive Director for Rehab Without Walls, home and community program in the Southern California Region. She is the President of the Medical Speech Language Pathology Council of California (MSCC), an organization she has been associated with for over 25 years. She has been an administrator and manager in the field of healthcare for over 20 years and enjoys mentoring and sharing her career experiences with others. During her career, she has worked as a therapist, manager and case manager in a variety of settings including public schools, acute rehab, inpatient, skilled nursing, outpatient, day treatment, transitional living center and home and community.

She lectures at local, regional and national conferences. Her primary areas of interest are traumatic brain injury, patient advocacy, technology and case management.

Keith Sofka (“Technology Corner: Home Modifications for Access, Part 1”) is a principal of Caragonne and Associates, Ajijic, Jalisco, MX. He has practiced the provision of assistive technology services for the past 30 years. Mr. Sofka provides consultation to hundreds of companies, schools, Government Agencies and individuals. A major focus of Mr. Sofka’s work has been to provide recommendations for and implementation of school and workplace reasonable accommodation recommendations for individuals and organizations. This work typically includes housing and commercial building access as well as transportation, mobility and completion of daily living needs as well as modifications to the individual worksite. He has also taken training and practiced in other areas of assistive technology including custom seating and positioning for individuals with severe orthopedic involvement. His work has always been focused on ways to use technology to increase the independence of the individual.

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Letters to the Editor

New CNLCPs

Evidence-based practice

We are pleased to announce that the following nurses have completed the requirements for the CNLCP credential. Thank you for printing this in the Journal of Nurse Life Care Planning.

Thank you JNLCP! The Fall issue (XIII.3), specifically the Evidence Based Practice article, fits into my scope of practice and educational endeavors.

Excellent!

Glenda Evans-Shaw BSN RN-BCPHN CCM CNLCP CNLCP Certification Board glenda@auttercreek.com

Please join us in offering congratulations to the new CNLCP Class of 2013 and to recertifying CNLCPs. For information on obtaining certification by examination or reciprocity, please go to the Certified Nurse Life Care Planner Certification Board website at http://www.cnlcp.org/page5.asp Ed.

New Certification Aguilar, Adam Allen, Sherrie Goodwin, Catherine M. Ingram, Olivia Lundin, Isabel Mulcahy, Mary Louise Wright Zaborowski, Susan

Certification By Reciprocity Goodrich, Patrice Loomis, Michele Salerno, Mary

Recertification Bunce, Sheryl Dwyer, Jovita

Flynt, Joanna Hall, Anna Howland, Wendie Hritz, Andrea Husted, Linda Jance, Carol Liberatos, John Mathis, Cheryl Matthews, Amy Pallister, Alisa Poe, Silvia Robarge, Joyce Sandoval, Theresa Slim, Beverly Soenderby, Kathleen Thiese, Sandra Turnipseed, Libby

Karen Wilbanks, RN, CCM, CRRN, CLCP, MSAA

Editor’s note: We received considerable positive feedback on David Dillard’s article on search techniques. One suggestion to facilitate access to search databases was to connect with your college or university alumni association to find out whether membership entitles you to ongoing access to the libraries at the college or university.

Another option is to contact Wright University (Ohio) Friends of the Libraries, who offer different access levels to all proprietary databases in their system for a reasonable fee. Contact them at http://libraries.wright.edu/support/friends/

Ꮬ Letters on any topic are welcome and may be sent to the Editor at whowland@howlandhealthconsulting.com. Letters may be edited for brevity.

Barberries, early snow

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Ethics in Action

Possible invalid credential This scenario came from a nurse life care planner. The comments are from a group of nurse life care planners who were asked to share their opinions. Nothing in this column is to be taken as legal advice.

Q.

An attorney client has asked me to vet the qualifications of an opposing NLCP. In so doing I discovered that he lists a doctorate degree from a for-profit school which was shut down for fraud soon after he obtained his degree. He holds a diploma from a hospital school of nursing but no degrees in nursing. Other than disclosing this to my attorney client, do I have any other ethical duty to report this? To whom? What could be the consequences to his practice?

A.

“Forged or altered documents or credentials as required for the application for original license, application for renewal of license or application for certificate of prescriptive authority; Practice nursing as defined by this chapter under cover of any diploma, license, or record illegally or fraudulently obtained or signed or issued unlawfully or under fraudulent representation.” Does not apply to advanced “degrees.”

The LCPlanner finding out this information should report this nurse to the state board and can do so anonymously. They should consider reporting to the CNLCP Cert Board as well as this is inappropriate action by the nurse if this is a CNLCP. That said, it could certainly be an oversight on the part of the nurse who “obtained” the degree and he should be directed to remove the credential or prove his

doctorate. I would not expect him to lose his license and if he still has the requirements for the CNLCP this should not be taken away from him.

I'm not sure of the age of your CNLP but in the 70's there were more diploma nursing programs than two-year associate degree programs. There was a bridge PhD nursing program but I thought one had to be a BSN to enter it. It seems further investigation is needed.

I would suggest you verify with the Board of his residence that he holds an RN (if his PhD is suspect, so might this be) and that he holds a valid LCP credential. If that is all true, then the PhD issue is moot because a PhD is not required to be an RN or LCP. I would disclose to your attorney client your findings and that his PhD is suspect. The best path, in my opinion, is that your responsibility ends there.

For the next issue: I had an incident about a year and a half ago with an attorney I no longer work with. This attorney took a case regarding the daughter of a good friend from law school. I questioned the ethics myself, but took on the case. I could not find the merit the attorney claimed his friend stated was obvious. The daughter had a severe neurological condition that had complications which were par for the course with this condition. When I wrote my report and told him the news, he was less than pleased. We parted ways. Bottom line, is it ethical for attorneys to take cases for friends? How would you deal with such a request?

Your opinions and questions are welcome and will be held in confidence; please email to whowland@howlandhealthconsulting.com.

Opinions given are those of their authors and are not to be taken as the official position of the AANLCP, its board, or the JNLCP.

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A System-Based Approach to Home Modifications for the Catastrophically Injured Frank Gucciardo MS, PT, CAPS, CGP It’s Sunday afternoon in

Consider this very common situation: A catastrophi-

midtown Manhattan and I am star-

cally injured client needs to return to a split level

ing at a sign-in sheet for a sympo-

house on uneven terrain. Nothing is level, the client

sium on traumatic brain injury, a

is wheelchair bound and the burden of care is heavy.

sign in sheet that I simply cannot

How is the life care planner going to map out this transition to home and at the same time cost out a

fill out accurately. They want

solution that seems so hard to come by?

my professional designation, primary

Where do you start, whom do you

line of work, and how I engage the client with a TBI. This should be simple, just check the right box; but there’s nothing that quite matches, “I’m a physical therapist turned builder, who now owns a consulting and architectural design firm that only works for the special

There are few builders with good experience in working for the special needs clientele.

needs population.”

trust, and how do you serve this client and their family in a time of tremendous crisis and upheaval? These clients feel lost at sea holding onto a plank of wood with no hope of seeing land, and many times they look to you to be the lighthouse.

However, a Nurse Life Care Plan-

Ꮬ

ner most likely does not have archi-

At the end of the conference, all of

tectural design or construction experience.

my marketing material left at the back of the room is gone. That is because my company fills

This falls outside of your expertise, and now you

a gaping void in the continuum of care that every-

must deal with the construction industry. There are

one serving the medically compromised client

few builders with good experience in working for

knows about, but for which most have not identified a reliable way to get their client’s needs met.

Frank Gucciardo is the CEO and founder of Frangeli© Consulting and Design, offering consulting and architectural design services exclusively to medically-compromised clients and caregivers. He may be contacted at 866-618-7685

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the special needs clientele. As a result you are left to

Categories The choice of professionals will de-

either perform an internet search of common resi-

pend on the severity of the disability. A qualified

dential projects or seek out a reputable building

building consultant would be appropriate for simple

company to help with pricing; in either case they

“ramp and rail” projects. A medical residential de-

will most likely not take into account the fact that

signer would act as a stand-alone expert witness and

using standard pricing for routine renovations will

be directly hired by the attorney for more complex

underfund the modifications required in special-

cases requiring significant accessible design serv-

needs cases.

ices, geographical cost analysis of the project, and a

For example, suppose a bathroom space must be en-

medically justified rationale for proposed modifica-

larged to accommodate the client, equipment, and

tions to defend opinions during testimony.

caregiver safely. This means plumbing, framing and

Simple “Ramp and Rail” Projects

electrical all must move, greatly increasing the price

The first category of building consultants would

of construction. Furthermore, if the bathroom is en-

provide you with basic pricing on common applica-

larged then that typically means that the adjacent

tions, such as door widening, modular ramp installa-

room is made smaller. This, in turn, may affect liv-

tions, and mechanical lifting devices, e.g., stair lift

ing space for other members of the family, requiring

or vertical platform lift. A simple bathroom modifi-

other changes to be made, and this then cascades

cation such as removing a bathtub and directly re-

into a larger job with larger associated costs. These

placing it with a shower stall or some minor modifi-

subsequent hidden but key costs would be missed

cations to a kitchen would also qualify as a “ramp

without a knowledgable individual or firm providing

and rail” project. The building consultant may or

a proper analysis.

may not actually visit the property and would pro-

This article will assist the Nurse Life Care Planner:

vide a report that includes pricing and some generic

Discern when to engage a modification specialist

drawings or pictures. The building consultant would

•

Identify two distinct home modifications categories

testimony should not be expected. The Nurse Life

•

Identify the appropriate professional to assess the hard damages for each

$400.00 and $800.00 to obtain accurate pricing by a

•

Understand how the overall process of meeting the needs of the complex client should be met

•

not act as an expert; defense of these estimates in

Care Planner should expect to budget between

reputable professional.

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When choosing a building consultant to hire, you

tion experience is strongly recommended as a pri-

should seek out a reputable builder with significant

mary qualifier during the selection process.

construction experience. A professional designation

The Complex Case

by the NAHB (National Association of Home Build-

A catastrophically injured client who is involved in a

ers) would be a good qualifier. A CGR (Certified

complex, high profile case with the potential to go to

Graduate Remodeler) would be ideal; CAPS (Certi-

trial requiring a defensible opinion on hard damages

fied Aging in Place) from NAHB would be preferred

needs a higher-level professional. Most of the time,

but is not always necessary. You can search on the

a builder, even with CGR and CAPS designations,

NAHB website for these certifications and then work backwards to find a builder, as there are other support roles in

will not be able to provide the Nurse Life

Caveat:

Care Planner the necessary information needed in these cases. This

The CAPS expert must have the set of designation was not may also obtain CAPS but who skills and the expertise necescreated to teach building sary to generate a defensible may not have the skill sets and professionals to experience needed to cost a solution with associated damassist the catastrophically ages during testimony. project accurately. injured meet their One caveat: The CAPS desigThis is because a builder, by special nation was not created to teach profession an installer of mateenvironmental building professionals to assist rials, is not typically qualified to needs. the catastrophically injured meet design the space based on the mediᏜ their special environmental needs; it the construction industry who

cal needs of the client. Merriam-Webster

was designed to assist the Baby Boomers and

defines a builder as: one that contracts to build

their parents to gracefully age in place in their

and supervises building operations. The analysis

homes. For simple “ramp and rail” applications,

required to discern the functional needs of the client

CAPS designation can be a starting point. CAPS

and creating a solution that will allow for the maxi-

designation is also obtained by manufacturer repre-

mal amount of independence in the least restrictive

sentatives and other non-builders who do not have

environment while at the same time crafting a repro-

the experience in estimating costs of home modifica-

ducible method of providing care at the lowest skill

tions. This is why a significant amount of construc-

set possible simply falls outside of the professional continued next page

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scope of the general builder, regardless of construction experience.

What about the VA

The conundrum of home modifications and associ-

Housing Adaption Grant?

ated costs for a complex, high profile case must be

Resist the temptation to use the Veterans Administration’s Special Housing Adaption grant for defensible costs. In fiscal year 2014 this amount is only $67,5552, simply not the answer for the catastrophically injured individual as it will most certainly underfund needs in this category of hard damages.

solved by an expert who is able to defend why the solutions are needed.

We have already established that the builder as a stand-alone profession is not equipped to provide the complex case with solutions, which are required before pricing can be addressed. However, adding a physical or occupational therapist and a designer/ architect will solve this problem: The designer or architect will be able to design the project correctly based on information from the PT or OT. This information will address three critical aspects: safety,

struction documents are generated and can be submitted to the local building department’s plans reviewer for permitting purposes and at the same time bids on the project by builders are accepted.

independence, and empowering caregivers.

What about the ADA? There are some firms out there who have depth of

Pricing

knowledge in this area but they are few and far be-

Pricing simply cannot be ascertained unless an appropriate design is in place. Pricing is entirely subject to what the designer intelligently creates, based on the client’s function, caregiving needs, and how they both relate to the “as built” condition of the home; hence generic pricing is not generally possible or defensible and is not discussed here.

tween and may be difficult to find. Complicating matters further is that the architect cannot rely on the building code set forth by the ADA (Americans with Disabilities Act) as a sole reference to create a client centered design in the private residence. The ADA standards establish design requirements for the construction and alteration of facilities subject to the

Plans are generated first by a designer and/or archi-

law: places of public accommodation, commercial

tect where the issues are identified and solved, mate-

facilities, and state and local government facilities

rials are specified and the client’s input is placed into

only.

the process. It is at this point where a full set of con-

continued next page AANLCP Journal of Nurse Life Care Planning

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Since the ADA does not apply to private residences,

comes, the further away from their scope of practice

it is only used as a loose guideline when designing

and experience they are. They can certainly make

accessible spaces in the client’s home.

suggestions for a simple “ramp and rail” project but

For example, the ADA calls out for 9” toe kick

they will most likely not have the ability to provide

clearance (the space at the bottom of the cabinet

prices on their own. For more complex situations,

where it is recessed); what if our client needs a 12”

therapists should serve in an advisory capacity (un-

toe kick? Though a few manufacturers have their

less they also have actual construction experience or

own lines of ADA-compliant cabinets, but for this

have a practice with the necessary experience in working on construction documents).

client, custom milled custom cabinets must be specified, and as a result the price

Therapists and designers have widely

Therapists

climbs significantly. Furthermore, how do you now defend this pric-

the right professional to provide an opinion?

ever, when they consult together,

and designers have

ing jump during deposition or testimony if you don’t have

different areas of expertise. How-

and resulting building docu-

widely different areas of

expertise. However, when

As stated, solutions for a pri-

they consult together,

vate residence must be tailorfitted to address overall safety, maximum independence, and safe

you get something

ments are given to a builder you get something unique.

Now you have a baseline set of construction documents that can be used to obtain geographical priced estimates. It’s a

unique.

bit of a drawn-out process but if

Ꮬ

that number comes in well above the

patient handling by a care giver. The

VA grant figure, then you are well-

PT and OT will only not only give you functional details and define specific aspects of care

equipped to defend your plan.

but they will have the professional degrees and expe-

Let’s take a minute and look at an example so we

rience to justify their findings; they provide a defen-

can pull this all together in pictures: In Figure 1

sible opinion to the solution.

(next page), we have an empty room. This diagram

Like the Nurse Life Care planner, the therapist(s)will

represents an empty basement located at grade. It is a

most likely not have construction or design experi-

walk in space from the driveway with great access.

ence. Therefore, the more involved the project be-

As we discussed earlier, traditionally most Life Care continued next page

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EXISTING WINDOWS A/C SLEEVE

18"Hx32"W

(3) ELECTRICAL PANELS GENERAL NOTES: 1. A LOCAL LICENSED ARCHITECT SHALL BE USED FOR OBTAINING REQUIRED PERMITS. THESE DRAWINGS ARE FOR PLANING PURPOSED AND NOT

STEEL BEAM EL. 6'-2 3/4"

BOILERS

@ 7'-0" A.F.F.

2"x8" F.J.

HOT WATER HEATER

FOR CONSTRUCTION UNLESS SIGNED AND SEALED

BY A LICENSED ARCHITECT. tHE ARCHITECT OF RECORD ASSUMES ALL PROFESSIONAL LIABILTY

BY AFFIXING THEIR SEAL AND SIGNATURE. 2. ALL WORK TO BE DONE IN ACCORDANCE WITH ALL APPLICABLE LOCAL AND STATE CODES. 3. NO NOTE OR DETAIL OR LACK THEREOF SHALL BE CONSTRUED AS RELIEVING THE CONTRACTOR FROM THE EXECUTION OF ALL WORK IN ACCORDANCE WITH ALL STATE AND OR LOCAL CODES. THE DRAWINGS ARE INTENDED TO BE A

DUCTWORK @

GUIDELINE..

6'-2 5/16"

4. THE GENERAL CONTRACTOR IS SOLELY

2"x8" F.J.

RESPONSIBLE FOR MEANS AND METHODS OF

@ 7'-0" A.F.F.

CONSTRUCTION AND FOR SEQUENCES AND

STEEL LALLY COLUMN

STEEL LALLY COLUMN

PROCEDURES TO BE USED. 5. ALL WORKMANSHIP AND MATERIALS SHALL BE

STEEL BEAM EL. 6'-3 3/4"

STEEL BEAM EL. 6'-3 5/8"

GUARANTEED FOR A PERIOD OF ONE YEAR AFTER

WATER SERVICE

COMPLETION BY THE CONTRACTOR. THE CONTRACTOR SHALL BE RESPONSIBLE FOR ENSURING THIS GUARANTEE. 6. ALL MATERIALS SHALL BE NEW, UNLESS OTHERWISE SHOWN. ALL WORKMANSHIP SHALL BE FIRST CLASS. 7. ANY DEFECTIVE WORK AND DAMAGE RESULTING THEREFROM, SHALL BE REPAIRED AND/OR REPLACED AS REQUIRED AT NO COST TO THE OWNER & AT THE EXPENSE OF THE CONTRACTOR.

STEEL BEAM EL. 6'-5

8. ALL WORK SHALL BE EXECUTED IN SUCH A

13/16"

MANOR AS TO PROTECT THE SAFETY OF WORKMAN AND THE PUBLIC, DURING CONSTRUCTION. 9. ALL BARRIERS AND OTHER PRECAUTIONARY

!"

MEASURES SHALL BE ERECTED IN ACCORDANCE WITH THE AUTHORITIES HAVING JURISDICTION OR AS REQUIRED FOR SAFETY DURING THE ENTIRE CONSTRUCTION OPERATION. WASHER AND DRYER

OVERHEAD DRAIN

MAIN WASTE STACK

10. VERIFY ALL ITEMS TO BE REMOVED AS TO WHETHER OR NOT THEY ARE STRUCTURAL AND

GAS METERS

PROVIDE TEMPORARY SHORING AS REQUIRED.

OVERHEAD DRAIN PIPING

!"#$%#&'()*++,-.!/+(0*1&

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GENERAL NOTES:

+ )"*+&-

14' - 2 3/8"

1. CONTRACTOR TO PROVIDE VERIFICATION

2' - 0"

GYP. BD. ON

OF ALL DIMENSIONS, METHODS AND MATERIALS OF EXISTING CONSTRUCTION &

WALLS OF BOILER

MECHANICAL/ELECTRICAL SYSTEMS.

ROOM

2. THESE DOCUMENTS ARE INTENDED TO

NOTE: PROVIDE 5/8"

CEILING

TYPE 'X' GYP. BD. @

LIFT

WALLS AND CEILINGS

REPRESENT A SPACE PLAN OF THE EXISTING CONDITIONS ONLY.

BOILER ROOM

NO OTHER

CONDITIONS ARE IMPLIED OR INTENDED.

34

30

DIRECTLY ABOVE

3. CONTRACTOR TO FIELD VERIFY LOCATION AND CONDITION OF ANY BEARING WALLS,

AND AROUND ALL

COLUMNS OR OTHER REQUIRED SHORING.

BEDROOM

HEAT PRODUCING

12' - 7 5/8"

4. CONTRACTOR SHALL REVIEW ALL HVAC,

13' - 3 3/8"

EQUIPMENT.

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29

DOMESTIC AND SERVICE PIPING,

35

ELECTRICAL CIRCUITING, SECURITY ETC., CLST.

PRIOR TO SUBMISSION OF PRICING.

GARAGE

5. CONTRACTOR SHALL REVIEW ALL PROPOSED MECHANICAL/ELECTRICAL

33

CHANGES AND UPGRADING WITH THE OWNER PRIOR TO START OF WORK.

PROVIDE FRESH AIR VENTING 28

AS PER LOCAL CODE

32

HEATING:

1' - 1 1/2"

THE CONTRACTOR SHALL SIZE HEATING

SHALL BE HARDWOOD OR TILE

IS PROHIBITED.

ACCORDANCE WITH THE ACCA MANUAL J.

AREA OF 6'-2" CLG. HGT. 24

CLOSET

BATH 25

ALL CEILINGS SHALL BE 2'x2' ACCOUSTICAL

LIGHT & VENTILATION:

LIVING AREA

26

UNLESS OTHERWISE NOTED. CARPETING

BUILDING LOADS CALCULATED IN HATCHED AREA INDICATES

1. LIGHT AND VENTILATION

10' - 10"

NOTE: ALL FLOORING

AND COOLING EQUIPMENT BASED ON 31

REQUIREMENTS SHALL COMPLY WITH NYS RESIDENTIAL CODE SECTION R303.

KITCHEN

PROVIDE ARTIFICIAL LIGHTING CAPABLE

19

OF PRODUCING AN AVERAGE ILLUMINATION OF 6 FOOTCANDLES OVER

CEILING TILE WITH T-

THE AREA OF THE ROOM AT A HEIGHT

GRID UNLESS

#$%& 1' - 1 5/8"

OTHERWISE NOTED.

OF 30" ABOVE THE FLOOR LEVEL.

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2. ARTIFICIAL VENTILATION AND LIGHTING

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MAY BE USED AND SHALL COMPLY WITH NYS RESIDENTIAL CODE SECTION R303.1 TO PROVIDE A MINUMUM OF .35 AIR CHANGE PER HOUR.

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AANLCP Journal of Nurse Life Care Planning

&'()%"*+,-./%' 0#*%

#)"*,-*, ,/5/,+

!"#$%& !"#$% .,/01.2.,3*41

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!"#!$#%"!&'$(%&()*'+,

9:1;<+0=>?@9A!+>=;+B:=+=;B;=9;C;+:9DE+F9D;!!+!@A9;0+>90+!;>D;0+GE+>+D@C;9!;0+0;!@A9+&=:B;!!@:9>D

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Planners will bring in three builders, who will do their

ment needed by the client and considering existing

best with answers and associated ballpark pricing, but

condition of the “as built” and the rest of the family

we now know that this is not the best course of action.

dynamics, it was very clear that the proposed half bath

What if we had this plan (Figure 2) in place when the

to full bathroom conversion was not the safe answer.

builders came on site? As you can see there is a clear

In fact, the solution could not be found inside the foot-

direction for the builders to generate a cost estimate.

print of the home. As result, a set of conceptual design

However, and more importantly, if the design team in

documents were developed that showed a sizable addi-

is in place you’ll have very clear rationale for why

tion was required to meet the client’s needs, to be added to the back of the home. The calculated

things are spaced and laid out as they are. As a result the costs of the project are highly defensible because the solu-

needs, the client’s functional abil-

care all of which are assessed by

$200,000.

rate figure was

tions are based on equipment

ity and the necessary burden of

cost of this proposed addition at nearly

The accu-

Not only would the earlier cost

only determined after

plan be wrong for a life care

first understanding the

qualified professionals.

Case Study A 74 year old client with a TBI

medical needs and

functional limitation

and a right above the knee amputa-

of the client.

tion had his home assessed by a family friend who was a registered architect. The architect proceeded to look to the obvious solu-

plan, but there would have been a shortfall of nearly $170,000, or approximately 570% in missed hard damages. If the VA grant figure had been used there would have been approximately

275% in missed hard damages. In

Ꮬ

both cases, figures grossly underfunded the client’s suit. The accurate figure was only de-

tion in the house which allowed for a half bath to be

termined after first understanding the medical needs

converted into a full bathroom. The initial proposed

and functional limitation of the client. It was based on

solution would have priced out somewhere between

objective findings which would hold up to scrutiny

$30,000 and $37,000 in this region of the country.

during testimony because the guess work was replaced

However, after our company went through medical

with a systematic method of determining the damages

discovery, discerned the functional ability of the client,

by professionals with experience working with the dis-

necessary care required, and durable medical equip-

abled. continued next page

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Locating a Design Firm and Pricing Services Be sure to perform due diligence when vetting a de-

designed. Therapists can also be found on their re-

sign or architectural firm to bring into a case. Not

Physical Therapy Association) or the AOTA (Ameri-

every design or architectural design firm will qualify

can Occupational Therapist Association).

as the professional who can best serve the client.

spective associations’ websites, the APTA (America

Home modification consultation is a relatively new

“Trust but verify” when interviewing firms. We often

but growing area for PT and OT, and so you are

hear similar answers when asked if a firm has expe-

likely to need to do some research in your local area

rience working with a client with a disability: “Why,

to find an appropriate therapist. The OT profession

yes, we are well-versed in ADA compliance” as they

in particular is gravitating towards the field, and the

riffle through their code books in the background

Nurse Life Care Planner will find that some OTs will

while they have you on hold. If a firm continues to

also have CAPS designation as well.

cite their competent knowledge of the ADA code as their sole qualification, then that could be considered a red flag.

The ideal situation would be to locate a designer or architectural design firm that has both a front end rehabilitation team and building component, either

Ask the following questions when you screen design

directly attached or closely associated.

firms:

Unfortunately, these “one-stop shopping” firms are

• •

• •

“What percentage of your work is commercial vs. residential?”

“How many of these types of accessible projects for the special needs population have you worked on over the past month / past quarter / past year?”

“How many of these accessible projects have been in private residences?”

“What types of diagnoses have you worked with in the past?”

uncommon and there is no way of easily identifying them through any known national organization. A Nurse Life Care Planner may look to what is commonly known as a “Design/Build” firm, which is construction business model that combines the design work with the building professions; however, you will still need to arrange the therapist(s) consul-

If the answers do not meet your expectations or

tations.

match your client’s medical condition and needs,

A law firm should expect to budget roughly $6,500

keep looking.

to $9,000 (pricing will depend on the scope of work)

If you are happy with the firm, then bring in the

to retain a qualified expert. The expert should pro-

treating OT and PT to ensure a tailor-fitted solution

duce a report that includes conceptual drawings,

and to provide an opinion on the solution when it is

photographs of specific examples of parts of the pro-

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Nursing Diagnoses to Consider

Vol. XIII No. 4

NANDA-I Nursing Diagnosis, 2012-2014

‣ Readiness for Enhanced Self-Health Management (Domain 1, Health Promotion; Class 2, Health Management) ‣ Impaired Wheelchair Mobility Limitation of independent operation of wheelchair within environment (Domain 4, Activity/Rest; Class 2: Activity/Exercise) ‣ Impaired Physical Mobility Limitation in independent purposeful physical movement of one or more extremities (Domain 4, Activity/Rest; Class 2: Activity/Exercise) ‣ Impaired Transfer Mobility Limitation in independent movement between two nearby surfaces (Domain 4, Activity/Rest; Class 2: Activity/Exercise) ‣ Readiness for Enhanced Resilience: A pattern of positive responses to an adverse situation or crisis that can be strengthened to optimize human potential (Domain 9: Coping/Stress Tolerance; Class 2: Coping Responses) ‣ Risk for Injury: At risk of injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources (Domain 11: Safety/ Protection, Class 2: Physical Injury)

ject, geographical pricing to establish hard damages, and an expert opinion that provides the medical rationale based on the individual client’s function and caregiving needs. This medically-driven design firm should be hired directly by the law firm and not by the Nurse Life Care Planner. The Nurse Life Care Planner should be qualified to determine whether the necessary solutions are “ramp and rail” or complex, and be able to communicate how and when to engage the appropriate professional.

The field of design specifically for the catastrophic client is in its infancy. This process will take effort to find the right professional to assist in getting your and your client’s needs met, especially for the complex case. However, obtaining the appropriate expertise will mean that the difference in the final product will be heads and shoulders above what is being done currently. You can advocate for your clients by using a new and more effective process to tackle a typically difficult home modification challenge for the catastrophically injured. They truly need the best our collective professions can offer.

Ꮬ

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From Technology Corner Wheelchair Access to Housing and Architectural Modifications (part 1) Keith Sofka ATP (retired) Depending upon the

needs of an individual in a private setting. This is

disability of the individ-

important because as a law, the ADA does not apply

ual, a life care plan must

to individuals in their own homes. On the other

often include an esti-

hand, the ADA architectural requirements can offer a

mated cost for providing

useful go-to for baseline information.

home access. The life

Whatâ&#x20AC;&#x2122;s the problem with ADA rules?

care planner should de-

ADA requirements for architectural access are in-

cide what modifications would provide adequate ac-

tended to assure access to the broadest range of indi-

cess and what these will cost. Unfortunately, usually

viduals with disabilities without causing obstacles or

there is little or no course work related to accessible

hazards for able-bodied users or individuals with

housing in training programs preparing for a Life

other types of disabilities. For example, consider

Care Planning credential or in continuing education

curb cuts. When these were first installed in cities,

later.

blind cane users found the smooth swale down to the

Some professions spend a great deal of time on ac-

ramp difficult to detect; they would suddenly find

cessibility needs. However, even they focus on spe-

themselves in traffic without the customary warning

cific needs and do not teach pricing.

drop between the sidewalk and the street. After con-

Conversely, most professionals familiar with the design and pricing of construction projects often have limited knowledge of access needs of individuals

siderable testing, tactile detectable warnings and a visual color difference were added to all curb cuts built after 2001.

with disabilities. Even a construction professional with an intimate knowledge of the Americans with Disabilities Act (ADA) would probably not have the knowledge base to determine the specific access

Keith Sofka has practiced the provision of assistive technology services for the past 30 years. Mr. Sofka provides consultation to hundreds of companies, schools, Government Agencies and individuals. He can be contacted at ksofka@gmail.com

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In addition, strict adherence to ADA standards can

to both rental units and dwellings for sale. If the

create an environment just as inaccessible to a par-

builder received any Federal funding for the project

ticular individual as a unmodified environment. For

then a certain percentage of the dwellings must be

instance, the ADA developed the 1:12 standard ratio

accessible. There may already be an accessible unit

for ramps after studies using a sample of generally

in the housing development.

fit, young male war veterans. Many people with dis-

Rental or ownership?

Next, is the home owned or rented? If it is a single

abilities may find a 1:12 ramp too difficult to use.

residence rental then it may not be modifiable. Be-

The individual’s specific abilities and needs must be

fore you can consider access modifications to a

the primary focus in planning access. Access

rental, you’ll need permission from the

should be planned throughout the house

The ADA

– particularly areas where the family congregates. Consider more

pected displacement due to sale

standard ratio for

exit, bathroom, and bedroom.

The family room, kitchen,

access modifications.

remain the possibility of an unex-

developed the 1:12

than just accessible entry and

and halls may also require

owner; even so, there will always

ramps after studies

or other circumstances. If more suitable choices aren’t avail-

using a sample of gener-

Consider that the current

ally fit, young male

wheelchair will eventually be

war veterans.

replaced, that all of us tend to gain weight as we age, and that the person

Ꮬ

always be usable. As well, consider the climate – icy ramps are treacherous for wheelchair users and ablebodied people alike. Who will maintain the exterior areas?

Federal requirements?

First, is the home part of a multi-unit development?

Certain Federal requirements related to access apply

be considered. However, locating an available accessible rental unit might be better.

Purchasing a home that will be

modified for access requires other considerations. Not all single-family

may need a power wheelchair at some point.

So a doorway that is just wide enough now may not

able, then modifications may

homes are alike. Some can be readily modified and others may cost tens of thousands of dollars to make accessible. If simple access criteria are used when looking for a home, the job of modifying it can be made easier. For instance, a “slab” type dwelling1 is typically all on one level without even minor transition points between rooms. This makes for an ideal wheelchair accessible home.

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Terrain and grade The height above grade should also be considered.

Grade is the height of the terrain around the home.

Generally there is at least a single eight inch step above grade (up) into the home. Remember that for every foot up you add 12 feet to the length of the ramp, so a single eight inch step would require an eight foot ramp. This ramp can often be disguised as a part of the walkway leading to the door. Adding soil or regrading that part of the yard and then repouring that part of the walkway would provide easy access while maintaining the “look” of the home.

Doors and halls Check width of doors and hallways. If the house is crowded and doorways are very narrow, it may not be a suitable candidate for access modifications.

Sometimes closets or other obstructions are directly adjacent to the room entry and there really is no My general rule about acceptable height above grade

place to widen the door. Doorways that are too nar-

is that it not exceed thirty inches. At this point the

row, even if the wheelchair can pass through the

ramp becomes too long: it’s unwieldy both as a

opening, are a daily nuisance to the wheelchair user

physical object to put in the yard and as a barrier for

– resulting in scraped knuckles and constant irrita-

the wheelchair user. If you haven’t tried to propel

tion. The hallway above is approximately 28” wide,

yourself in a wheelchair up a thirty foot ramp, you

taking into account the radiator and the newel post.

should try it. It is a demanding exercise.

The distance between the front door and the stairs is

For more information about ramps, see a related article in JNLCP XI.3, page 438-440.

only 21”, with the open door brushing the bottom step. This house was not suitable for remodeling. continued next page

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Bedrooms and storage space

measured so that there are no surprises when the lift-

Generally, the home should be large enough for each

equipped van is brought home for the first time. Ac-

person to have a bedroom plus one more. Wheel-

cess directly from the home to the garage should

chairs, other medical equipment and supplies need a

also be considered. This may count as one of the

place to be stored. The person may require a therapy

exits although it is important to check local building

area as well. Multiple bedroom homes in new con-

codes because many require another exit besides the

struction also tend to be more spacious. This allows

garage door.

room for that sixty-inch turning radius in every

Ꮬ

room where the wheelchair is expected to travel and also sufficient wall space to widen door to permit easy entry and exit.

Covered access and exit

Part II in the next issue will conclude this article with information on what to look for when purchas-

If the home is in an area with frequent snowfall, a

ing an easy-to-modify home, and will include re-

garage may be a necessity. The garage should be

sources for research and further information.

Nursing Diagnoses to Consider

NANDA-I Nursing Diagnosis, 2012-2014

‣ Impaired Physical Mobility Limitation in independent purposeful physical movement of one or more extremities (Domain 4, Activity/Rest; Class 2: Activity/Exercise) ‣ Fatigue: An overwhelming sense of exhaustion and decreased capacity for physical and mental work at the usual level (Domain 4, Activity/rest; Class 3: Energy Balance) ‣ Impaired Home Maintenance: Inability to independently maintain a safe growth-promoting immediate environment (Domain 4, Activity / Rest; Class 5, Self-Care)

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Telecaregiving: Using Technology for Safety & Peace of Mind Kimberly Gully, MS, CCC, CCM, CBIST One of the big challenges

giving in their careers. As with the services offered,

individuals face, whether with cata-

pricing varies from $20 per month for data collection

strophic injury, chronic or acute ill-

and message sending only to $7-$16 per hour for

ness, or aging in general, is regaining

telecaregivers performing real-time monitoring up to

or maintaining independence. Pro-

24/7. Setup and hardware costs vary from company

viding remote support via telecaregiving is a

to company depending on intensity of

creative and cost-effective way to link people who require caregiver services for interactive support, using electronic devices such as intelligent sensors, speakers, microphones, monitors and cameras.

This is delivered or monitored remotely by specially trained caregivers, and can provide real time interaction for individuals

services, number of sensors, and fac-

Telecaregiving has the potential to result in significant savings over an individual’s lifetime without compromising safety, security or privacy

requiring supervision.

Ꮬ

tors unique to each individual.

Reactive monitoring systems are generally designed to record data to analyze trends and/or to send text message, e-mail, or telephone alerts to identified individuals when something happens outside of the preset pa-

rameters. Proactive caregiving

There are many companies providing

systems use a remote caregiver watch-

various levels of remote monitoring services,

ing an individual’s activities on a real time live

from day to day monitoring using strategically

monitor for four to 24 hours a day. Both types are

placed monitors, sensors, etc. (reactive systems) to 24/7 observation and caregiving (proactive systems) depending on the specific needs of the person. (See Table 1) The telecaregivers are highly-trained indi-

viduals; many of them have provided hands-on care-

Kimberly Gully is the executive director of Rehab Without Walls®, a subsidiary of ResCare® along with Rest Assured®.

During her career, she has worked as a therapist, manager and case manager in a variety of settings including public schools, acute rehab, inpatient, skilled nursing, outpatient, day treatment, transitional living center and home and community. Her primary areas of interest are traumatic brain injury, patient advocacy, technology and case management. She may be contacted at kimberly.gully@rescare.com,

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designed to help individuals remain in their home, providing assistance to safely achieve and maintain their highest level of independence. Each has proto-

Vol. XIII No. 4

Table 1. Sample resources for remote systems

Sensors and monitors only - reactive

• Care Innovations- Quiet Care

cols for action in the event something unusual oc-

http://www.careinnovations.com/produc

curs. Individuals may start with a more reactive

ts/quietcare-assisted-living-technology

monitoring approach and transition to a proactive service or vice versa, depending on the individual needs and resources available.

• GrandCare Systems http://www.grandcare.com/activity/

• Lively http://www.mylively.com/ • SimplyHome http://simply-home.com/promodocs/Si

Privacy and independence The specter of “big

mplyHome%20Brochure%20Reduced %20Size.pdf

brother watching” is in the forefront of many minds when caregivers, patients, and families hear that cameras, sensors, and monitors would be part of a day-to-day caregiver option. In a 2010 article,

Live 24-hour observation - proactive

• Rest Assured •

http://www.restassuredsystem.com/ Sengistix http://www.sengistix.com/

Brewer et al. review a study conducted by Purdue University in conjunction with Rest Assured®, a 24hour proactive service. They found that it was perceived to be an acceptable option both for overnight care and for providing safety, security and privacy for developmentally disabled adults residing in community settings. According to the study, the lower cost of a remote telecaregiver, as compared to an onsite attendant, was attractive. While savings varied from case to case, it was thought that when used appropriately telecaregiving had the potential to result in significant savings over an individual’s lifetime without compromising safety, security or privacy.

In another 2010 article, Taber-Doughty, et al. studied four developmentally disabled individuals and suc-

cessful completion of specific activities of daily living using either onsite staff or telecaregivers for prompting. The study found that while both methods of prompting were effective, the individuals were able to complete tasks with a higher degree of independence with telecaregiver support. Telecaregiving as a viable option for people with disabilities is one solution to controlling caregiver costs and a projected shortfall of caregivers as the population ages and life expectancies increase.

Individuals with and without disabilities want to be able to age in place; the average age of the general population is increasing and more people survive devastating medical situations. Determining how much support an individual will need will direct procontinued next page

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viders, caregivers and other support personnel to the

•

Vol. XIII No. 4

cannot interact appropriately with strangers

most appropriate, cost effective, and least restrictive

who may try to enter the home or sell some-

environment to maintain independence for as long as

thing •

possible.

training on specific areas that may result in

Other considerations Telecaregivers provide

decreased supervision

effective services focusing on areas such as self-care,

•

safety awareness, household tasks, problem solving.

•

Telecaregiving is an innovative way to

independence. People who could bene-

Telecare-

fit from this type of service might

have difficulty following rules about electric-

support as an

ardous physical situa-

to in-home care

tions

services

have conditions requiring treatment or monitoring, such as

Ꮬ

affordable care, and support when they need it, where they need it, in the comfort of their

alternative or supplement

ity, fire, water and haz-

•

pervision with the compassionate,

remote monitoring and

appliances safely •

provide individuals who require su-

givers provide

include, but are not limited to,

do not use household

do not know how to use any type of technology

skills that are needed to regain or maintain

•

have difficulty remembering if they have prepared meals or taken medications

Telecaregiving promotes the development of life

those who:

are not receptive to or able to benefit from

homes. Being able to provide this 24 hours a day, 7 days a week, every day of the year allows individuals freedom with built-in safety and provides peace

of mind to family and other members of the survivors support network. Based the

seizures, irregular blood pressure, insulin checks, or other medication manage-

person’s specific needs, telecaregivers provide web-

ment

based remote monitoring and support as an alterna-

•

are fearful of being alone

tive or supplement to in-home care services. Services

•

are at risk for or is fearful of physical or fi-

can be adjusted easily: as little as a few “drop in”

nancial exploitation

visits per day, a few hours a day several days a week,

do not know when, who or how to call for

or any combination that allows the person to con-

•

help or assistance in an emergency

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tinue to remain at home or in any environment that

social interactions with both familiar and unfamiliar

is optimal for the highest level of independence.

people, placing her at high risk for physical exploi-

Case studies Sally is a woman in her forties who

tation. She also had difficulties with managing her

was involved in an accident involving her and her

medication.

significant other. Each of them sustained life-

Sally received a customized plan of care, a reactive

changing neurological injuries with difficulty func-

plan that addressed each of her challenges to allow

tioning. Sally’s injuries were more severe than those

her to continue to live alone in her home without a

sustained by her significant other. She was awarded

full-time live-in caregiver to monitor her on a daily

a substantial amount of money, placing her at risk

basis. Use of the telecaregiver system allowed Sally

for financial exploitation. She required supervision

the peace of mind and freedom to live as a member

due to her inability to make good choices related to

Nursing Diagnoses to Consider

continued next page

NANDA-I Nursing Diagnosis, 2012-2014

‣ Readiness for Enhanced Self-Health Management:A pattern of regulating and integrating into daily living a therapeutic regimen for treatment of illness and its sequelae that is sufficient for meeting specific health-related goals and can be strengthened (Domain 1, Health Promotion; Class 2, Health Management) ‣ Deficient Knowledge: Absence or deficiency of cognitive information related to a specific topic (Domain 5,Perception/Cognition; Class 4: Cognition) ‣ Impaired Memory: Inability to remember or recall bits of information or behavioral skills (Domain 5,Perception/Cognition; Class 4: Cognition) ‣ Parental Role Conflict: Parent experience of role confusion and conflict in response to crisis, interruption of family life due to home care regimen (Domain 7, Role Relationships; Class 3, Role Performance) ‣ Nonadherence/noncompliance: Behavior of person and/or caregiver that fails to coincide with the health–promoting or therapeutic plan agreed on by the person (and/or family and/or community) and healthcare professional. In the presence of an agreed–on, health-promoting, or therapeutic plan, person’s or caregiver’s behavior is fully or partially nonadherent and may lead to clinically ineffective or partially ineffective outcomes (Domain 10: Life Principles; Class 3, Value/Belief/Action Congruence) ‣ Readiness for Enhanced Decision-Making A pattern of choosing courses of action that is sufficient for meeting short and long-term health-related goals and can be strengthened (Domain 10, Life Principles; Class 3, Value/Belief/Action congruence)

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of society while keeping her safe from harm from

care needs. Proactive telecaregiving is an innovative

those who could attempt to exploit her.

approach to providing high quality caregiving in the

Helen is an elderly woman in her seventies who had

home with the privacy of living alone. Regardless of

a series of unfortunate events including concussion

the system selected, each individual needs to have a

and subsequent stroke. Having been an independent

customized care plan based on specific needs. Fur-

widow, Helen was resentful when her primary care

thermore, those plans must be flexible, to be modi-

physician informed her she would need to have

fied based on the changing needs of that person.

someone live with her full time if she wanted to re-

As there are more people needing assistance to live

main in her home. Helen accepted this, but as she

safe and productive lives, we are faced with the real-

progressed in her recovery, it became more difficult

ity of who will care for all of these people? How

for her to feel like herself with someone living in her

much will it cost? Where will they live? Life care

home, even family members.

planners can look at remote caregiving options as a

Helen’s family heard about remote caregiving op-

solution worth considering as we look at creative

tions and presented the idea to her. While she ini-

ways to use technology to leverage our limited re-

tially was not thrilled about the idea of someone

sources in a safe and cost-effective manner.

watching her on camera, she desperately wanted to

References

have what she called “alone time.” Helen’s family

Brewer, J.L., Taber-Doughty, T. & Kubik, S. (2010) Safety As-

worked out a proactive plan so she was monitored during certain critical times of day – lunch, dinner, and evening hours when she tended to get a bit more forgetful. Telecaregivers worked with her five days a week for six hours over the course of these identified

sessment of a home-based telecaresystem for adults with developmental disabilities in Indiana: a multi-stakeholder perspective. Journal of Telemedicine and Telecare 16, 265-9.

Brewer, J.L., Taber-Doughty, T. & Kubik, S. (2010) Standard care and telecare services: comparing the effectiveness of two service systems with consumers with intellectual disabilities.

Journal of Telemedicine and Telecare 54, 843-859.

times, a schedule she and her family found acceptable.

Summary

Ꮬ

Reactive monitoring is a valuable and useful service that provides useful information needed to make appropriate decisions for day-to-day and longer term

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Planning Ahead Vol XIV-1 SPRING

Technology Updates Vol XIV-2 SUMMER

LCP Across All Ages Vol XIV-3 FALL

Psych Aspects in LCP

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