HOME CARE Elderly Ila

8/18/2019 HOME CARE Elderly Ila

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HOME CARE& Assessmento f Community-DwellingElderly

James T. Birch, Jr., MD, MSPH

Assistant Clinical ProfessorDepartment of amil! Me"icine#an"on Center on A$in$ %in cooperation ith Holl!Cranston, MD'


2/27

Steps to Attainin$ O()ecti*es T!pes of Home +isits

n"ications for Home +isitsManfaat & -elemahanE /ipmentPatient AssessmentSafet! iss/es


3/27

T!pes of Home +isits• Pera atan pen!a0it

-eti0a seoran$ pasien terlal/sa0it 1 f/n$sional ter$an$$//nt/0 men$/n)/n$i !an0es 2/nt/0 pen!a0it a0/t ata/0ronis

Pera atan men)elan$ a)alHospice care, "/0/n$an th"(er"/0a, persiapan 0ematian,"/0/n$an /nt/0 0/n)/n$anan$$ota 0el/ar$a


4/27

T!pes of Home +isitsPen$0a)ianDila0/0an /nt/0 pasien!an$ m/n$0in ata/ti"a0 menerimala!anan 0esehatan .

Ph!sical e3am, homesafet! e*al/ation,patient safet!e*al/ation can (econ"/cte" at this t!peof *isit.


5/27

T!pes of Home +isitsHospital follo 2/pDapat mem(ant/ /nt/0mence$ah 0em(ali 0er/mah sa0it se(el/m

a0t/n!a.Mem(ant/ /nt/0memasti0an (ah apasien menerima sem/a0e(/t/han, )asa "anmen$i0/ti )a" alpen$o(atan.


6/27

n"ications for Home +isitsAn! con"ition creatin$ ph!sicalimpairment or limitation of mo(ilit!4#ac0 of transportationPermasalahan "$ (e(an 0el/ar$aS/specte" el"er a(/se or ne$lectPol!pharmac! or me"ication complianceiss/es-e$a$alan pert/m(/hanRef/sal to 0eep o5ce *isit appointments

Recent histor! of falls at homePs!chiatric illness or (eha*iorall!"i5c/ltE*al/ation of nee" for placemento/tsi"e of home


7/27

ManfaatPenin$0atan pera atan me"is "en$anter/n$0apn!a 0e(/t/han pera atan0esehatan !an$ ti"a0 "i0etah/i-emamp/an /nt/0 menilai "esainlin$0/n$an "an implementasi inter*ensi"i r/mah !an$ mence$ah )at/h "an

ce"era "iri lainn!aMenin$0at0an a asan masalahpsi0ososialPenin$0atan h/(/n$an pera at2pasien


8/27

ManfaatPen$0a)ian Home-based mem(eri0an pel/an$(a$i lansia /nt/0 tetap tin$$al "i r/mah%Cleveland Clinic Journal of Medicine ,May 2001)

Pen$0a)ian "ila0/0an "lm lin$0/n$an !$ familiar(a$i lansia

Tin$0at 0ep/asan la!anan !an$ le(ih tin$$i


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-er/$ian Time intensi*e#ess technolo$icals/pport

inancial iss/esPro*i"er safet!


10/27

E /ipment Essential

6. Stethoscope7. Otoscope1Ophthalmosco

pe8. Sph!$momanometer9. Ton$/e "epressors:. ;on2sterile %or sterile'

$lo*es. Disposa(le

thermometers?. Re@e3 hammer1t/nin$

for06 . rine "ipstic0s66. Prescription pa"

Optional6. l/cometer7. Dictaphone8. #aptop comp/ter9. Patient e"/cation

materials:. Tape meas/re. Disposa(le s/t/re

remo*al 0it?. S/(lin$/al nitro$l!cerin6 . l/cometer66. Porta(le o3imetr! /nit67. Porta(le EC


11/27

E /ipmentAnticipate the nee" for proce"/res

6. De(ri"ement7. nna (oot application8. Dressin$ chan$e9. Phle(otom!:. S/t/re remo*al


12/27

Assessin$ the Patientse the ;HOMESF mnemonic

%)em(atan 0ele"ai' to help recall the

areas of foc/s for the home *isit mmo(ilit!; ;/tritionH Home En*ironmentO Other PeopleM Me"icationsE E3aminationS Safet!, Spirit/al health, Ser*ices


13/27

Assessin$ the Patient2MMOB # TG

6. Assess AD#s an" iAD#s7. As0 for a to/r of the home8. O(ser*e $ait an" am(/lation thro/$h

hall a!s, (e"room, an" ne$otiatin$ stairs9. As0 the patient to act o/t their ro/tines

%$ettin$ in an" o/t of (e", openin$me"ication (ottles, performin$ personalh!$iene'

:. Direct correcti*e inter*entions here"e ciencies are note"


14/27

Assessin$ the Patient

;2 ; TR T O;6. -a)i tentan$ pilihan ma0anan7. As0 for permission to loo0 in the

refri$erator, c/p(oar"s, an"1or pantr!8. As0 a(o/t foo" preparationI ho

prepares it Ho often "oes thepatient eat "/rin$ the "a! Ho isshoppin$ for foo" accomplishe" Hois it "eli*ere"


15/27


H2HOME E;+ RO;ME;T6. Safe nei$h(orhoo"7. Pro3imit! to ser*ices8. Am(ient temperat/re %are the heatin$

an" air con"itionin$ controls accessi(le

an" eas! to rea" '9. tilitiesI r/nnin$ ater an"

temperat/re


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O2OTHER PEOP#E6. Social s/pport s!stemI famil!mem(ers, nei$h(ors, frien"s7. Emer$enc! help8. "enti cation of person ho ill ser*e

as s/rro$ate for the patient9. Assessment of care$i*er

stress1(/rno/t


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Assessin$ the PatientM2MED CAT O;

6. ather all of the patientKs me"ications in thehome %me"icine ca(inet, refri$erator, "ra ers,co/nters, etc.'

7. E*al/ate the t!pe, amo/nt, an" fre /enc! ofme"ication /se, notin$ the or$ani ation an"metho" of "eli*er! %self2a"ministere" or helpfrom famil!1frien"s'

8. Re*ie in"ications for me"ications9. Consi"er potential for "r/$2"r/$ or "r/$2foo"

interactions:. Assess patient compliance


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Assessin$ the PatientE2E3amination

6. oc/se" e3amination (ase" on patientKsnee"s

7. +ital si$ns8. Car"iop/lmonar! & ne/rolo$ic e3am9. S0in1 o/n" assessment:. Mo(ilit!1 mmo(ilit! assessment


19/27

Assessin$ the PatientS2SP R T A# HEA#TH 1 SER+ CES 1 SA ETG

6. Per/se the home for reli$io/so()ects1rea"in$ materials. This co/l"initiate a "isc/ssion of spirit/alit! as ahealin$ an" copin$ strate$!

7. Coor"inatin$ the home *isit ith homehealth a$encies an" ha*in$ their n/rsespresent can facilitate comm/nication an"cooperation (et een patient, ph!sician,an" other a$encies. L/estions can (eans ere", or"ers clari e", priorities an"perspecti*es "isc/sse", etc.


20/27

Safet! iss/es6. tilitiesI r/nnin$ ater

an" temperat/re4 hotater temperat/re

9?o

C %67o

'7. Cl/ttere" hall a!s,"es0s, an" co/ntertops%(arriers to the /se ofcanes, al0ers, or

heelchairs '8. #i$htin$ %stairs,

hall a!s, etc.'


21/27

Safet! iss/es6. Seat ele*ator in (athroom7. Ta(les, chairs, an" other f/rnit/re

%st/r"! an" ell2(alance" '8. #oc0s on "oors an" in"o s4 ease of

escape in case of re or otheremer$enc!

9. As0 I Nhat n/m(er "o !o/ "ial incase of emer$enc! F


22/27

Safet! iss/es6. Electrical cor"s an" appliances7. loorin$, thro r/$s, non2slip s/rfaces

in t/(1sho er, an" (athroom @oor8. Smo0e "etectors, re e3tin$/ishers

%(atteries '9. B/rners on sto*e easil! left on:. Pets


23/27

Personal Safet! Ta0e a map an" !o/r cell phoneContact the patient or care$i*er hen!o/ are en ro/te for a *isit

f !o/Kre $oin$ to a 0no n hi$h crimearea, sche"/le *isits in the A.M., a*oi"

earin$ a hite coat, /se alternati*ecarr!in$ *ehicle instea" of the (lac0(a$F %i.e shin$ tac0le (o3'

f !o/ /estion !o/r safet!, -EEPDR + ;


24/27

mpro*in$ E5cienc!#imit $eo$raphical area to (e co*ere"Plan a half2"a! of ro/tine home *isits%appro3. 9 patients' in one $eneralnei$h(orhoo"Start ith the a""ress f/rthest a a!an" or0 to ar"s o5ce or home

Doc/ment the reason for the home*isit an" histor! an" e3amination asme"icall! appropriate


25/27

S/mmar!s assistance a*aila(le to compensate

for the patientKs f/nctional limitationsDetermine $oals of treatment an" theirris0s

mplement inter*entions herein"icate"A""ress ps!chosocial iss/esBe prepare" for minor proce"/res

tili e strate$ies to impro*e e5cienc!se the home *isit chec0list

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http://www.aafp.org/afp/991001ap/1481.htmlhttp://www.aafp.org/afp/991001ap/1481.htmlhttp://www.aafp.org/afp/991001ap/1481.htmlhttp://www.aafp.org/afp/991001ap/1481.htmlhttp://www.aafp.org/afp/991001ap/1481.html


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S/mmar!ho/se calls are a *ital part of

me"ical care, a lin0 to the past,an" a /ni /e opport/nit! forser*ice, commitment, an"compassion.F

; En$l J Me", Dec 6>,6??=4 88=%7:'I 6>6:27


27/27

A""itional Referencesn in, B.-., Jerant, A. . The Home +isit.

American Family Physician !ol" #0$%o"

& '(c ober 1, 1***) Me!er, .S., i((ons, R.+.4 ; En$l J Me",Dec 6>,6??=4 88=%7:'I 6>6:27S a$ert!, D.#. Ho/se Calls in Primar!

Care4 -ansas Re!nol"s Pro$ram inA$in$, ni*. of -S School of Me"icine

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HOME CARE Elderly Ila