Call Girls Raipur Just Call 9630942363 Top Class Call Girl Service Available
5 HUS 133 Where People Live
1. Adulthood and Aging, 6e
John C. Cavanaugh
Fredda Blanchard-Fields
Chapter five
Where People Live:
Person-Environment Interactions
2. Describing Person—Environment Interactions
Learning Objectives
• What is the competence and environmental press
model?
• What is the congruence model?
• What are the major aspects of stress and coping
theory relating to person—environment
interactions?
• What are the common themes in the theories of
person—environment interactions?
4. Describing Person—Environment Interactions
Competence and Environmental Press
• Competence is the theoretical upper limit of
a person’s capacity to function.
• Environments can be classified on the basis
of the varying demands they place on the
person, a notion called environmental
press.
– Adaption Level: Where behavior and affect are
normal, slight increases in press improve
performance, slight decreases create a Zone of
Maximum Comfort.
5.
6. Describing Person—Environment Interactions
The Congruence Model
• According to Kahana’s (1982) congruence
model, people with particular needs search
for the environments that meet them best.
• Can you offer examples?
1. A person without personal transportation seeks a
house near a bus route.
2. A handicapped person needs a home adapted to
a wheelchair (no steps).
3. An elderly person may need to relocate to an
assisted-living facility.
7. Describing Person—Environment Interactions
Stress and Coping Framework
• Interaction with the environment can
produce stress (Lazarus, 1984).
• Evaluating one’s situation and surroundings
for potential threat value
– Harmful
– Beneficial
– Irrelevant
• If harmful, what is the coping mechanism
and response? Outcome positive or
negative?
8. Describing Person—Environment Interactions
Common Theoretical Themes and
Everyday Competence
• Everyday competence is a person’s
potential ability to perform a wide range
of activities considered essential for
independent living.
– Broader than just ADL or IADL
– Necessary determinate for whether an
elderly person can take care of themselves
9. The Ecology of Aging
Learning Objectives
• What is aging in place?
• How do people decide the best option?
• How can a home be modified to provide a
supportive environment?
• What options and services are provided in adult day
care?
• What is congregate housing?
• What are the characteristics of assisted living?
10. The Ecology of Aging
• Aging in Place
– Balancing environment press and competence
through selection and compensation.
– How a place becomes a home.
– Cluster housing.
12. The Ecology of Aging
• Deciding on the Best Option
– Does the individual have significant cognitive or
physical impairment requiring intervention?
• What is the severity?
– The individual needs to be an integral part of the
decision making.
– Get a physician’s diagnostic evaluation (required in
many states).
13. The Ecology of Aging
• Home Modification
– Helping people deal with tasks of daily living by
modifying the environment
• Hook for car keys near the door
• Hand rails in bathrooms
• Door handles that are easier to grasp
• Widening doorways
• Lowering countertops
• Wheelchair ramps
14. The Ecology of Aging
• Adult Day Care
– Designed to provide support, companionship, and
certain services during the day
– Goal is to delay placement in more formal care
setting.
– Three types of adult day care
• Social services, meals, recreation, and minor health
care
• More intensive health care, therapy, for serious medical
problems
• Specialize care for dementia or developmental
disabilities.
Profit (22%) or non-profit (78%)
15. The Ecology of Aging
• Congregate Housing
– Apartment complex for older adults
• Shared meals
• Affordable
– Differs from assisted living in level of services
– Residents must be capable of independent living
and:
• Not require continual medical care
• Know where they are and oriented to time
• No evidence of disruptive behavior
• Able to make independent decisions
• Be able to follow specific service plans
16. The Ecology of Aging
• Assisted Living
– Provides a supportive living arrangement for
people who need assistance with personal
care (bathing, taking medication) but are not
physically or mentally impaired to require 24-
hour care.
• Has three essential attributes
3. As much like a single family house as possible
4. Emphasizes personal control, choice, dignity, and autonomy
5. Should meet routine services and special needs
17. The Ecology of Aging
• Assisted Living (continued)
– Utilize check list to ensure the selected
facility meets specific requirements of the
individual
– Costs average about $35,000 per year.
– Not offset by Medicare
• Specialty Care Assisted Living
18. Living in Nursing Homes
Learning Objectives
• What are the major types of nursing homes?
• Who is most likely to live in nursing homes?
• What are the key characteristics of nursing homes?
• What are special care units?
• How can a nursing home be a home?
• How should people communicate with nursing home
residents?
• How is decision-making capacity assessed?
• What are some new directions for nursing homes?
19. Living in Nursing Homes
Types of Nursing Homes
• Two levels of care are defined in
federal regulations.
– Skilled nursing care consisting of 24-hour care,
including medical and other health services
– Intermediate care also 24-hour but at a less
intensity
20.
21. Living in Nursing Homes
Who is Likely to Live in Nursing Homes?
• Characteristics of People Most Likely to Be
Placed in a Nursing Home
– Over age 85
– Female
– Recently admitted to a hospital
– Lives in retirement housing rather than being a
homeowner
– Widowed or divorced
– Has no children or siblings nearby
– Has some cognitive impairment
– Has one or more problems with IADL
22. Living in Nursing Homes
Who is Likely to Live in Nursing Homes?
• Health issues and functional impairment
– Average resident has significant mental and
physical problems
– Main reason for placement (80%)
– One third of residents have mobility, eating or
incontinence problems.
– 30 to 40% show signs of clinical depression.
23.
24. Living in Nursing Homes
Characteristics of Nursing Homes
• The competence-environmental press
model
– Goal is to find the optimal level of environmental
support for people of low levels of competence
– In selecting a nursing home relatives should keep the
following in mind:
• Level of skilled nursing care
• Be mindful if facility is primarily Medicare or Medicaid
• Is the director and upper staff fully licensed?
• Is the care plan put in place by professionals?
• Ask questions about staff educational levels and staff
turnover.
25. Living in Nursing Homes
Special Care Units
– Does the facility have well-designed special
care units for people with dementia?
– Special care units must have the right level of
environmental support to provide additional
care when the person’s competence level
continues to decline.
– Memory aids should be built into the unit.
– Special care for severely cognitive impairment
residents
26. Living in Nursing Homes
Can a Nursing Home Be a “Home?”
• What can be done to foster the sense of “home?”
– Being included in the decision and selection of a
specific nursing home
– Having prior knowledge of, and positive experience of a
specific facility
– Defining the home in terms of family and social
relationships rather than place, objects, or total autonomy
– Establish a continuity between home and nursing home
– Reminiscing about home may facilitate adjustment
28. Living in Nursing Homes
How Not to Communicate with Residents
• Patronizing speech
• Infantilization or baby “talk”
• Inappropriate use of first names
• Terms of endearment—“Honey,” “Sweetie”
• Assumption of greater impairment than may
be the case
• Cajoling to demand compliance
to persuade with flattery or gentle urging especially in the face of reluctance
29.
30. Living in Nursing Homes
Decision-Making Capacity and Individual
Choices
• How well can a nursing home resident
make decisions regarding their care?
– Cognitive impairment
– Patient Self-Determination Act (PSDA)
– Provide written information at time of admission
concerning their right to make treatment decisions
– Living will
– Patients normally give the decision to family
members.
31. Living in Nursing Homes
New Directions for Nursing Homes
• The Eden Alternative
– The ten principles of the Eden Alternative.
– Use of pets and other approaches seem to make
stronger associations between current and former
living situations.
• Research (Coleman et al. 2002) does not
support this view.
• Quality of Life difficult to assess using
traditional methods.
• Further research needed in this area.
32. Living in Nursing Homes
New Directions for Nursing Homes
• Green House Project
– Radical departure from the idea of large residential
facilities
– Encourages residents to participate in their care
through helping with daily tasks
– Personal dignity is maintained and quality of life is
improved.
33. Living in Nursing Homes
New Directions for Nursing Homes
• The Pioneer Network
– Similar values
– Older persons are valuable to society.
– Treating all people with dignity
– Everyone deserves that.
Notas do Editor
Figure 5.1 Behavior and emotional outcomes
Figure 5.2 Percentage of Medicare enrollees
Figure 5.3 Demographic characteristics of nursing home residents
Figure 5.4 Major factors influencing resident satisfaction