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Aging Wisely March 2011 - Aging Wisely

Components of a Geriatric Assessment: Functional Areas


In previous posts, we have covered The Benefits of a Geriatric Care Management Assessment and The Nutritional Components of an Elder Assessment.

A major area of any geriatric assessment is a review of the client’s functional status. A functional assessment reviews the client’s abilities to perform daily tasks. These can generally be divided in to ADLs (Activities of Daily Living, such as bathing, dressing, grooming/hygiene, eating and transferring/mobility) and IADLs (Instrumental Activities of Daily Living, such as cooking, household maintenance, driving, using a telephone, shopping, financial management). The assessment also reviews cognitive status and any potential limitations there, which may affect functioning, safety and awareness.

The care manager reviews current daily routines, abilities and challenges with:

* eating
* dressing
* bathing
* hygiene/grooming
* toileting/continence
* mobility & fall risk
* household cleaning & maintenance
* meal preparation
* laundry
* pet care
* transportation

In looking at these various areas, the assessor reviews the person’s:

* cognition (memory, insight, judgment, problem solving)
* psychological well-being(mood, emotions)
* social supports
* sensory systems(hearing, vision)
* physical skills (strength, movement, mobility)
* use of adaptive equipment/environmental safety

The assessment provides an excellent picture of current status, gaps/concerns as well as recommendations to ensure continued safety. By conducting a face-to-face assessment in the home environment, the care manager observes the client’s abilities within the real-life environment. Gathering information from the client, family, and providers as well as careful, expert observation enables the care manager to form a complete picture. The assessment may be conducted over a few visits during different times of day or situations for gathering accurate data.

The findings of the functional assessment result in recommendations for immediately improving quality of life and safety, as well as considerations for the future and issues to anticipate as chronic conditions impact abilities and function. The geriatric care manager may recommend community services, home care assistance, home modifications, technology for aging in place, physical or occupational therapy and other specialty services. The care manager makes specific, easy-to-follow recommendations so that the client and family has a detailed road map for accessing good help, and the care manager can also assist in implementing recommendations if desired.

CONTACT US TODAY for more information or to schedule your geriatric care management assessment. We provide elder assessments in the Tampa, Florida area (Clearwater, St. Petersburg, Pinellas, Pasco and Hillsborough counties) as well as eldercare consultations for families throughout the U.S.

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Nutritional Elder Assessment


In our professional geriatric care management assessments, we review a range of areas affecting the person’s health, safety, well-being and quality of life. One area impacting all of these is nutrition. We’d like to share a little more detail about senior nutrition and information gathered in the geriatric assessment in honor of National Nutrition Month.

To read a little more about senior nutrition needs, we invite you to read EasyLiving’s Blog on Health & Senior Nutrition. It is important to note that in addition to changing nutritional needs as we age, numerous health and lifestyle factors affect both nutritional needs and challenges in meeting those needs. Some important considerations in looking at the nutritional needs of a particular elder include diagnoses, chronic conditions especially those such as diabetes and heart disease, medications and activity level.

There are high levels of non-compliance with special diets such as those for diabetes and high blood pressure, but many times this can be improved with better education and home care support. Providing some assistance with meal planning, shopping and preparing foods that fit with the diet can help anyone make such adjustments.

Medications may affect appetite and cause nausea or digestive problems. Some foods are contraindicated with certain medications, such as blood thinners. Elderly patients and family members should always disclose any supplements or herbal remedies being taken as well.

If an elder has reduced mobility and thus activity levels, dietary needs such as caloric intake decrease. However, when the body is healing from surgery or fighting an illness, nutritional needs may increase and it is especially important to get a nutrient-dense diet. A geriatric assessment will uncover many such issues and provide recommended actions. Often the care manager will identify the importance of bringing these concerns to a healthcare professional, which may lead to seeking a nutrition consultation. Many times healthcare providers who do not see the client in the home environment may not be fully aware of the nutritional and day-to-day concerns that can have a big impact on health and clinical outcomes.

Other related areas identified within the geriatric care management assessment include the client’s abilities regarding activities of daily living (ADLs: things like dressing, bathing, grooming, eating) and instrumental activities of daily living (IADLs: things like using the telephone, driving, cooking). The professional care manager may find that the person is having difficulty in some areas that are impacting their ability to maintain good nutrition. Low vision may cause an individual to minimize cooking or eat less. Poor balance may make the person uncomfortable standing to cook for long periods. Concerns about driving may lead a person to have limited access to fresh fruits and vegetables, leading to reliance on canned and frozen foods. As the care manager visits with the client in the home, she can get a picture of daily life. Some simple modifications, support services or tools can make a big impact for the client.

Click on these links to learn more about the components of a professional elder assessment, benefits of a geriatric assessment and see some sample care management assessments.

Contact us today if you are concerned about an elder family member’s nutrition, safety, health or well-being.

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The Positive Results of a Comprehensive Geriatric Assessment


We have shared information in the past about the Benefits of a Geriatric Care Management Assessment for getting a good picture of an elder’s situation, needs, affordable senior care options/resources and projected costs.

One of the things we find when we do assessments is that information is disjointed and there may not be a consistent record of information or health history. We often help families to confirm information with different providers and pull the information together in to an accurate health and personal record. The problems we see are a big part of the reason why there is great emphasis lately on electronic personal health records, and why we have been using these for our clients for years.

The other important feature of a comprehensive assessment is the review of multiple aspects of the person and their situation. We invite you to review some of the components of the geriatric assessment. In addition to the health history and current medical situation as mentioned above, a key element is reviewing the person’s functional status and daily living challenges. This can aide in anticipating problems, such as falls or poor nutrition and dehydration. The expert care manager assessing someone in the home environment observes carefully and may notice slight changes and warning signs that are otherwise hard to notice. For example, a client may have had some minor falls they have not mentioned to family members, or may be having difficulty reaching in the kitchen and thus limiting their cooking/diet. Vision changes or fear of falling may have led to the individual “sponge bathing” because of concerns in the bath or shower.

Much can be uncovered during a professional assessment, including listening to the client’s concerns, desires and worries. We talk to the client, as well as get appropriate input from family members, caregivers and providers. Our care managers provide dignified support and look toward solutions that will work for all involved. Often, we are able to provide not only a better picture of the situation and recommendations, but help clients and families agree on the best options to assist. Each assessment is individualized, there is no one-size-fits-all in eldercare and caregiving. The professional geriatric care manager offers creative, custom solutions for better outcomes.

Since we get asked most frequently about care assessments, we will be covering some additional aspects in other posts. In honor of March being National Nutrition Month, our next post will offer some information on how we assess nutrition and its impact/interaction with health status and well-being.

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Resources & Services After Hospital Discharge: What Can You Expect?


We have previously shared some of the challenges patients face after hospital discharge, which often result in avoidable problems and unnecessary readmissions. If someone you care about is in the hospital, visit our Tips and Checklist for Hospital Discharge.

One challenge family caregivers most often face when a loved one is in the hospital is navigating the healthcare system and learning what resources are available to help. This is one reason why a professional patient advocate such as our geriatric care managers can be so helpful. We get many calls from families wondering what type of support their loved one can expect after they leave the hospital, what services are available and what insurance will cover for in-home care or rehabilitation.

Most Medicare recipients will either leave the hospital for inpatient rehabilitation (skilled nursing and therapy, typically provided at a Skilled Nursing Facility i.e. nursing home) or return home and receive some therapy or nursing services under Medicare while they recuperate. The choice depends on patient and family preference, patient’s condition and intensity of need, supports at home and a variety of factors (including doctor and case manager recommendations/opinions).

When considering these options, keep in mind the many factors involved in the recovery period. Older patients, especially those with multiple conditions, may benefit from the supports and therapeutic regime in inpatient rehabilitation, though most people prefer the idea of returning home as soon as possible. In an inpatient setting, most patients will receive daily therapy and have round-the-clock nursing services, which may be especially useful for an older patient who lives alone and wishes to regain much strength and independence. Typically, Medicare pays for up to 20 days of inpatient rehabilitation after a three day hospital stay (if it is considered medically necessary) and up to an additional 80 days with a copay (see our Medicare 2011 Fact Sheet for Medicare copays and costs) that is often covered by supplemental insurance. If you have a Medicare Advantage or private insurance plan, your coverage may differ and you may have to select a preferred provider to get full coverage.

For more information on Medicare’s coverage for home health services and in-home therapy, see our article. When leaving the hospital, it is important to plan ahead and set up services to cover custodial needs and fill the gaps that are not met through Medicare skilled home health coverage. For example, transportation home from the hospital; someone to pick up prescriptions, groceries and personal items; personal care and safety assistance during the key first 24 hours; help preparing healthy meals according to dietary needs; reminders about medications; transportation to after-care and appointments. EasyLiving, Inc. offers all of these home care services in Pinellas County, Florida.

Good senior nutrition is key to a healthy recovery. Make sure to ask your doctor about dietary restrictions, how medications might affect appetite and advice about taking medications with meals (before or after, does the medication sometimes cause stomach upset?, are any foods contraindicated?). If a person is having difficulty healing or with weakness, or has had recent weight gain or loss, a consultation with a nutritionist may be in order. He or she can analyze your current diet, create a personal meal plan and discuss supplements.

Medications frequently change during a hospital stay. Make sure you are maintaining good records of past medical history and medications, a current list and instructions for medications, and alerting physicians (and home care providers) of these updates. Aging Wisely uses Caregiver’s Touch, a dynamic online portal for clients and caregivers that serves as a central, accessible location for personal health records. This tool reduces inconsistencies and provides immediate access to information and improved communication. Contact us today to learn how we can help organizing and creating your personal health record.

Your loved one may need help adjusting to a new medication regime. If he or she receives Medicare skilled home health care, the nurse can assist with setting up a medication box and patient teaching. Private duty home care medication management and reminders may be needed on an ongoing basis, or for initial assistance in adapting to the new routine.

today to learn more about resources and services to help after hospital discharge, for Florida geriatric care management, Clearwater home health services, and patient advocacy.

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