Observations
Insights
SOCIAL / ACTIVITIES Day Programs: Social Models, Medical Models For people who need car. People with social experience, self pay program Importance of Friendship/Camaraderie Staying Active in Community Healthy and feel young with energy. Most Participants Between Social and Secondary
NON - ADHERENCE Types of Non-Compliance: Home-Care, PT, hospitals, Diet, Medication, Exercise
Non-Compliance is not limited to just medications.
Common Cases on Non-Compliance: Cardiac Patients, Elderly, Snow Ball Cases, Psych Patients, Diabetes
GOVERNMENT REGULATION/ INVOLVMENT PRI Form: Patient Review Instrument- Medical Different levels of care are available for the elderly. Some are more scoring that determines the level of care a patient appropriate than others. The PRI determines where a person fits in the needs. Specifically for nursing homes etc. system.
HEALTH Staying in Shape Diet: Staying healthy by creating habits. Part of a group on the same diet.
When you surround yourself with people that may be struggling with different health problems, you become more aware of how that can affect your life. This is a motivation to do what you can to maintain your health. Caring about body shape and trying to stay in shape. A healthy diet supports her active lifestyle.
AT DOCTORS OR HOSPITAL Cutting Corners in Hospitals Snow Ball Cases Discharge summary
Process of Distributing medication in hospital
Nurse to Patient Ratio... 6/8 to 1
When someone is constantly sick and coming into the hospital for the same reasons. They often dont follow proper care when they leave the hospital. A patient cannot be discharged from hospital until a doctor has filled out a form on what medication is taken at home after hospital. All medication must be taken acording to the hospitals schedule. Distribution booths are located on each floor. After the doctor initially issues electronic prescription, the pharmacy reviews the patients medical charts to make sure the medication will be okay. The nurse then puts the patients name into the distribution booth, and the pills are dispensed, individually wrapped with a barcode. In the patient's room, the nurse scans the patients bracelet and then scans the medication to make sure it is the right pills. When the medication is taken, the time is recorded and any changes or problems is noted. This is a lengthy process, which doesn't factor in the time of explaining medications to the patients and dealing with any quesitons/concerns they may have. When the nurse has to get every patient their medication in a certain time frame, questions may not be given the proper attention. nurses have a lot of patients to tend to, can be difficult to make sure that each patient is fulling understanding their medication/what they must do.
COMMUNICATION People don't ask enough questions at doctors office. Says She Takes No Medications?
Patients Not Asking About Side Effects
Doctors get information based on what patients tell them. Gap Between Health and Secondary Care Grid Talking to Patients About Medication Common Patient Questions
Bringing a family member or friend to help ask questions is suggested. It is also recommended that you go to your doctors with a printed list of questions you know you should ask What does she consider to be medications? Many people are desensitized to their medications and don't consider many of them to be "medications" such as oxygen. Nurses are taught not to dwell on side effects if they are not asked about. Thinking about side effects can lead to "falsely" feeling them. Instead, nurses are told to suggest possible issues the patient could have and to let them know if any of these issues arise. Often appearance doesn't match story. There is a suggestion of nonadherence when a patient continuously sees a doctor for the same reason. A doctor can visually see that the patient isn't taking the prescribed medication. There is a disconnect between the insurance company and the patient The pharmacy gets asked a lot of questions regarding non-prescription medications. Looking for alternative over the counter medication as a substitute for seeing a doctor.
MEDICINE Knowledge of Medication History: How many medications are you on? How long have you been on them? What is the dose? Do these need to be updated? People choosing to not take medications. "Women is taking 29 pills per day. She stops taking the pills because she is tired of it."
Ways to Receive Prescriptions
Many patients have been taking the same medication for years with no change. This can lead to many complications especially with antidepressants. Some people are tired of having to take medication everyday and the time/hassle it takes. Other people decide that they want to just enjoy what life they have left, not having to deal with meds and side effects 1. Nurses from the doctor's office hand the Rx to patients then patients go to the retail pharmacy to fill the Rx. This is old fashion way. 2. The doctor's office calls in the Rx directly to the retail pharmacy. 3. The doctor's office sends the Rx to the retail pharmacy through their computer system (higher technology).
$$$ Many find it difficult to choose between buying their medications or food. Do I buy food this month? Or do I buy medication? Some only buy some of their medications and not others which can lead to complications. Social worker is bridge between patient and When a patient cannot afford medicine/doesnt have insurance, the hospital hospital calls a social worker to help patient get the proper care. Affordability of Medication
CARETAKING Respite Care: Giving rest for the caregiver.
Respite can provide much needed rest and time for the caregiver to live their lives as well. Often it is hard for a spouse to leave their loved one with someone else. Respite can help keep the caregiver sharp and ready to give care more effectively.
EISEP: EISEP assists older people (aged 60 and older) who need help with everyday activities to take care of themselves (such as dressing, bathing, personal care, shopping, and cooking), want to remain at home, and are not eligible for EISEP can provide much needed services that can help with non-adherence. Medicaid.The EISEP Program receives State and local funding. In addition, EISEP clients are required to cost share according to a sliding scale reflecting their income and the cost of the services they receive Family members that want to take care of their parents/grandparents that live in a different state. They call different care services, but it is difficult to Long Distance Caregiver communicate your needs when in a different state. It can be frustrating and stressful when you cannot be directly there to care for a loved one. Assisted Living vs. Assistive Living Having an opportunity to express the difficulties of caregiving and to see that many people share the same fear/anxiety of seeing a loved one struggling is Support Networks very important for a caregivers emotional stability. Having these support systems, whether it be a formal group, some friends, or other family members, allows the caregiver to share the pressure he/she has.
EDUCATION Lack of insurance coverage for things such as an annual physical. Annual Lack of preventative care: Recent inclusion of the physicals could help catch illnesses sooner and keep people healthier in the annual physical for people with medicare. long run. Save money in the future by spending money now. "Like preventative maintenance on a car." Center of aging and youth teaches classes on fall prevention. Steps can be Two biggest issues for elderly are falls and taken to make a house safer. Sliding down the stairs one step at a time can dementia. be very dangerous. Training and Education for Caregivers To make the caregivers more professional, to help the elderly better Dr form NYU that developed the three tier method that the Dept. of Aging and Dr. Mary Mittelman's Method Youth uses for successful care-giving. The method includes: Education and Training, Support Network and Respite She may not be directly impacted by medical non-adherence. However, she is Outlier a bridge to those that are directly affected. As an outlier, Mrs. Brewster provides us insight into others she comes in contact with. While she may be in good health, she is in many social settings Provides Insight on Others Around Her that have her interacting with others that may be more relevant in the context of non-adherence. Once one medical issue becomes a problem, others can be triggered. too little on prevention especially with older people, you can get very sick when your immune system is comprimised. The department is committed to helping people expand their knowledge base, share their understanding and continuously improve themselves and their community. Staff education Education Department in Hospital Nursing professional development Patient and family education Community education Continuing medical education
TRANSPORTATION Elderly need transportation to get food, medications, go to the doctor, getting social interaction. Many people may need help throughout the process of Transportation Services: Buses or other forms of leaving your home to getting into a vehicle. Even if a bus is a possible form of transport to allow our elders to get basic things transportation, many elderly cannot manage the physical exertion that it takes. like food and medications. Some local non-profits offer transportation to the doctors, pharmacies, and grocery store. These are all volunteer based and receive no government funding, availability depends on where you live. Take people to the place they need, but need to pay and not as convenient as CENTRO "Call a Bus" driving a car. Drives Car as main form of transportation. In good health condition? Doesn't want to rely on others. This was the intervewee's opinion that had a big impact on us. If there was a transportation system that allowed all elderly to get their medications, this would help both those individuals as well as the caretakers in their lives. It Transportation: May be a place for government to would also be beneficial for the elderly to get to the pharmacy so the step in and provide an organization. pharmacist can explain each medication to them. The woman at the department of aging and youth stated that she believed the pharmacist to be the best person to explain medications.
EMERGENCY DNR form. Do Not Resuscitate
File of Life
Family members worry that their loved one's wishes will not be followed. Calling the ER overrides a patients documents saying DNR. It is suggested by the department of aging and youth that worried caregivers pin the FILE OF LIFE artifact onto the elders shirt. This ensures that an emergency respondent has first hand sight of the patients wishes. This is a way for an older person to have a list of all their important information such as medications, medical history, and their DNR. There is a magnetic one for the fridge, and a small wallet sized version. The woman at the department of aging and youth recommends a caretaker pinning it to their loved one's shirt if they are worried about something bad happening while they aren't there. This makes it impossible for an emergency respondant to not see it.
MIND SET Care is changing: People are living longer and are The amount of people in the elderly community is rising everyday. We are either staying healthy or are becoming very sick trying to support a massive population with a system designed for one that is with more complex illnesses. much smaller. We are keeping people alive for much longer. When is it not okay to continue Medical Ethics: How long do we continue care. someones life with artificial means? How do we make that choice? Similar wording, similar context but completely different message with both. People associate Compliance with something that they are doing wrong. Non-Compliance vs. Non-Adherence Compliance is more of a harsh word. Adherence is softer and more friendly to the user. Caregivers, such as a wife taking care of a husband, feel a moral obligation to be constantly taking care of their loved one. This becomes unhealthy for Value System, "Till Death Do Us Part" them, causing an imbalance in the care-taking. It is this kind of situation that respite helps with. When the caretaker has time for his/herself, their mindset is then better off when they return to their care-giving.