Long-Term Care Transitions Quiz

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Questions and Answers

Which strategy is essential for minimizing risks during care transitions?

Relying solely on caregiver education

Limiting family involvement in the care process

Implementing medication management strategies (correct)

Increasing the frequency of patient transfers

What is a significant challenge faced by older adults waiting for long-term care placement?

Increased family support during waiting periods

Improved access to community services

High costs of private long-term care facilities

Extended waiting periods leading to hospital admissions (correct)

Which of the following is a key component of effective multidisciplinary communication?

Timely communication among interprofessional teams (correct)

Avoiding communication about patient transitions

Conducting meetings infrequently

Isolating team members from one another

What role do nurses play in the transition of care for older adults?

They are responsible for thorough discharge planning Signup and view all the answers

What statistic highlights the urgency for capacity building in Ontario's long-term care facilities?

The older adult population is expected to double in the next 30 years Signup and view all the answers

What is a primary goal of person-centred care in long-term care settings?

To enhance residents' autonomy and decision-making Signup and view all the answers

Which of the following best describes supportive living options?

Living arrangements that include both personal care and social support Signup and view all the answers

How does the culture in long-term care homes need to change according to the recent perspective?

From institution-focused to resident-focused care Signup and view all the answers

Which type of care provides continuous health support for older adults requiring extra assistance?

Assisted living or retirement homes Signup and view all the answers

What percentage of long-term care homes are publicly owned?

46% Signup and view all the answers

What is a significant challenge faced by long-term care facilities?

Ensuring person-centred care and reducing dependence Signup and view all the answers

Which of the following options is NOT considered an independent living option?

Supporting housing Signup and view all the answers

What differentiates long-term care from other support services for older adults?

24-hour specialized care for those unable to perform ADLs Signup and view all the answers

What is meant by the term 'aging in place'?

Remaining in one's home for as long as possible. Signup and view all the answers

Which factor most influences an older adult's decision to change their living situation?

Changes in health status and care needs. Signup and view all the answers

How do older adults with increased health needs typically transition through residential options?

Gradually, moving through various settings based on their care needs. Signup and view all the answers

What is a primary psychological concern associated with hospitalization in older adults?

Feelings of isolation and anxiety. Signup and view all the answers

What is one possible outcome of caregiver stress in the context of aging adults?

Emotional fatigue and burnout. Signup and view all the answers

Which of the following represents a shift in caring roles for nurses in transitions of care?

Increasing their involvement in patient education and support. Signup and view all the answers

What is a common challenge faced in long-term care facilities for older adults?

Difficulty in managing the diverse care needs of residents. Signup and view all the answers

What differentiates delirium from dementia in older adults?

Delirium is typically reversible while dementia usually is not. Signup and view all the answers

What is the primary objective of hospice palliative care?

To improve the quality of life for patients and families Signup and view all the answers

Which component is included in the four essential aspects of end of life care?

Care coordination by a dedicated professional Signup and view all the answers

How does a palliative care approach adjust as a patient's condition changes?

It increases as the probability of cure decreases Signup and view all the answers

What is a key goal of the Canadian Hospice Palliative Care Association (CHPCA)?

To enhance the quality of life and dying process Signup and view all the answers

What aspect of care does a hospice palliative care philosophy emphasize?

Treating all aspects of patient suffering Signup and view all the answers

Which of the following is NOT a characteristic of hospice palliative care?

Focuses on curing disease Signup and view all the answers

What aspect of care is prioritized in pain and symptom management within hospice palliative care?

Identification and relief of all types of suffering Signup and view all the answers

What role do care coordinators play in end of life care?

They manage care coordination and facilitate resources Signup and view all the answers

What is the recommended approach for managing shortness of breath in terminally ill patients?

Implement a combination of pharmacological and non-pharmacological interventions Signup and view all the answers

What should caregivers avoid doing if a patient shows difficulty swallowing?

Forcing the patient to eat or drink Signup and view all the answers

Which of the following is a key aspect of pain management for patients with malignancies?

Titrating doses based on the patient’s comfort level Signup and view all the answers

How can caregivers best support patients experiencing dry eyes at end of life?

Leave soft indirect lights on in the room Signup and view all the answers

What symptom might indicate a need for immediate attention in an end-of-life setting?

Irregular and shallow breathing Signup and view all the answers

When managing respiratory secretions, what intervention should not be forgotten?

Combining pharmacological and non-pharmacological strategies Signup and view all the answers

What is an inappropriate method of providing comfort to a patient with cool skin?

Applying a heating pad Signup and view all the answers

In end-of-life care, what is a common challenge associated with mouth care?

Forcing fluid intake Signup and view all the answers

What should caregivers prioritize when a patient expresses difficulty with large amounts of saliva?

Using oral, parenteral, or rectal opioids for symptom relief Signup and view all the answers

What is an effective strategy for supporting patients with reduced self-care abilities?

Tailoring care to individual patient needs Signup and view all the answers

What is a primary aspect of a good death for patients and their families?

Alignment with the clinical, cultural, and ethical standards Signup and view all the answers

What do Weismans 6 C's primarily focus on in end-of-life care?

Addressing physical, emotional, and spiritual needs Signup and view all the answers

Which of the following is NOT considered a component of pain management for dying patients?

Sole reliance on emotional support Signup and view all the answers

What impact does loss of control have on patients nearing the end of life?

Can lead to shame and feelings of being a burden Signup and view all the answers

What type of services are included in end of life care?

Bereavement services following the death Signup and view all the answers

Which factor is crucial for the interprofessional team when providing care at the end of life?

Facilitating the patient's and family's wishes Signup and view all the answers

How crucial is the management of psychological pain in the context of end-of-life care?

It is essential as emotional needs can intensify the total pain experience Signup and view all the answers

What is one of the primary roles of a nurse in providing end-of-life care?

To ensure safe conduct for patients and families during the dying process Signup and view all the answers

What is anticipatory grief characterized by?

Preoccupation with the loss before it occurs Signup and view all the answers

Which symptom is commonly associated with acute grief?

Crisis with waves of distress Signup and view all the answers

What characterizes persistent or complicated grief?

Experiences resurging on significant dates Signup and view all the answers

Which behavior may indicate anticipatory grief in an individual?

Planning for life after the person is gone Signup and view all the answers

Which type of grief is also known as pathological grief?

Dysfunctional grief Signup and view all the answers

What emotional responses are common for those experiencing anticipatory grief?

Irritability and impatience Signup and view all the answers

Which statement best describes shadow grief?

Grief that resurfaces occasionally but does not persist Signup and view all the answers

Which of the following may NOT indicate symptoms of acute grief?

Consistent feelings of joy Signup and view all the answers

What is the correct definition of grief?

An emotional response to a specific loss experienced by an individual. Signup and view all the answers

When loss is experienced, who may be affected by grief?

Friends and family members connected to the deceased or lost item. Signup and view all the answers

What role does a nurse play in supporting a patient experiencing grief?

To help the patient explore and express their feelings about the loss. Signup and view all the answers

Which statement best describes the concept of loss?

Loss can encompass the end of dreams, health, and relationships. Signup and view all the answers

What are advance directives in the context of end-of-life care?

Legal documents that allow patients to communicate their treatment preferences. Signup and view all the answers

Which physiological change might indicate that death is imminent?

A sudden decrease in body temperature and blood pressure. Signup and view all the answers

What is the primary focus of mourning practices in different cultures?

To express collective support through shared rituals. Signup and view all the answers

What is meant by bereavement?

The period of mourning that follows the experience of loss. Signup and view all the answers

What defines a good death in the context of end of life care?

In general accord with patient’s and family’s wishes Signup and view all the answers

How do individuals at the end of life maintain control over their circumstances?

Through maintaining independence and bodily functions Signup and view all the answers

What is a crucial component of the 6 C's framework in caring for the dying?

Continuity of care to ensure support throughout the dying process Signup and view all the answers

What is the primary goal of addressing psychological pain in end-of-life care?

To ensure total pain experience is not intensified Signup and view all the answers

What area of need should not be overlooked in comprehensive end-of-life care?

Psychological support Signup and view all the answers

Which of the following situations illustrates a stigmatized death?

A person succumbing to HIV/AIDS in a social context that judges them Signup and view all the answers

What is often required for patients and families during the end-of-life phase?

Enhanced understanding of emotional and spiritual care needs Signup and view all the answers

Which statement best describes the role of care providers in end-of-life care?

They should integrate emotional and spiritual care into physical care Signup and view all the answers

What is a Substitute Decision Maker (SDM)?

A designated individual who makes health care decisions if one is unable to Signup and view all the answers

Which of the following is NOT a requirement for eligibility for Medical Assistance in Dying (MAiD)?

Being a resident of Canada for at least five years Signup and view all the answers

Which safeguard is included in the MAiD process?

A second opinion on the request Signup and view all the answers

What role can nurses play in the MAiD process?

Providing emotional support and education to patients and families Signup and view all the answers

Which of the following best describes Practitioner-Assisted MAiD?

A physician or NP administers medication that causes death at the patient's request Signup and view all the answers

What is a potential consequence of having two Substitute Decision Makers who do not agree?

The Office of the Public Guardian & Trustee will intervene Signup and view all the answers

What is required from a patient requesting MAiD regarding consent?

The patient must provide informed consent after being informed of all options Signup and view all the answers

What action can a patient take regarding their MAiD request at any time?

Withdraw their request Signup and view all the answers

What is one of the chief eligibility criteria for someone seeking Medical Assistance in Dying?

Must have a grievous and irremediable medical condition Signup and view all the answers

Who is solely responsible for administering medications intended to cause the death of a patient?

Nurse Practitioner Signup and view all the answers

If a nurse objects to participating in a MAiD procedure, what is the appropriate action they must take?

Transfer patient care to another nurse Signup and view all the answers

What should be the primary focus of care when a patient is nearing death?

Pain and symptom management Signup and view all the answers

In which settings can a patient choose to die?

Hospital, Home, Long Term Care Signup and view all the answers

What action should a nurse take if a conscientious objector's care cannot be transferred immediately?

Provide care except for MAiD-related procedures Signup and view all the answers

What overall quality should be emphasized in end-of-life care?

High-quality care focused on comfort Signup and view all the answers

Which of the following is NOT a consequence of violating the policies related to MAiD?

Mandatory counseling sessions Signup and view all the answers

What is a primary consideration for nurses focusing on the care of dying patients?

Delivering care that aligns with the patient's wishes Signup and view all the answers

What is the primary focus of hospice palliative care?

Improving quality of life for patients and families Signup and view all the answers

Which of the following is NOT one of the four components of end of life care?

Access to only hospital services Signup and view all the answers

How does the role of nurses change in hospice palliative care?

From cure to comfort and support for patients and families Signup and view all the answers

What does the Canadian Hospice Palliative Care Association aim to relieve?

Suffering and improve quality of living and dying Signup and view all the answers

What is a key outcome of the palliative care approach as the possibility of cure decreases?

Enhanced emphasis on comfort and family support Signup and view all the answers

What is one of the primary goals of hospice palliative care?

To treat all active issues and prevent new ones Signup and view all the answers

Which aspect is prioritized in the philosophy of hospice palliative care?

Quality of life and symptom management Signup and view all the answers

Study Notes

Care Across the Continuum

Care needs of older adults change as they age.
Aging in place is preferred by most older adults.
Decisions for residential changes are based on health and care needs.
Residential options range from independent living to partial and complete dependence.
Options span home ownership, assisted living, and long-term care facilities.
LTC facilities encompass 24-hour specialized care for elderly with ADLs issues.
46% of LTCs are publicly owned, 54% are privately owned.
The MOHLTC resident's Bill of Rights is relevant for LTC facilities (Box 28.6).

Learning Objectives

Understanding the concept of care across the lifespan.
Identifying the range of living situations and caregiving options available to adults.
Recognizing common physical and psychological concerns experienced by hospitalized older adults.
Describing care needs and interventions for hospitalized older adults.
Discussing caregiving and caregiver stress associated with dementia, delirium, and depression.
Identifying similarities and differences between dementia, delirium, and depression.

Residential Options

Independent Living includes home ownership, social housing, life leases, and shared housing and cohabitation.
Supportive Living includes Supportive Housing designed for older adults.
Supportive housing might offer PSW and nursing care services along with social support and recreational events.
Assisted living/Retirement Homes provide bedrooms within a facility and offer health and support programs.

Health Care Facility Options

LTC homes provide 24-hour specialized care.
LTC homes vary in size, ownership (public/private), ADLs capabilities, and location.
Review information about the MOHLTC Residents' Bill of Rights (Box 28.6).

Long Term Care

Moving from institution-focused to resident-focused care is occurring in LTC.
Emphasizing person-centered care fosters independence and autonomy of the residents.
LTC focus on individualized care, enabling older adults in controlling their life decision-making.

Transitions

Care transitions happen as older adults move between health care providers or settings.
Such transitions require clinical and communication activities.
Multiple complex changes may lead to gaps in care and compromise patient safety.
Older adults with certain risk factors (multiple/severe medical conditions, mental health conditions, limited English proficiency, low income) are more vulnerable.
Minimizing risk factors such as the minimizing number of transfers, consistent nursing care, strong adherence to medication management, and family/caregiver education and timely interprofessional communication are discussed.

Nursing Implications

Nurses play crucial roles in minimizing care gaps during transitions.
Strategies to reduce risks include minimizing transfers, consistent nursing care, medication reconciliation, family/caregiver education, discharge planning, and timely interprofessional communication.
The role of nurses is critical in easing the transition for older adults.
Key strategies include managing gaps in care, and preventing risk for older adults.
See Box 26-8 for more details related to key services helpful for care transitions.

Trends & Issues in LTC

Ontario's long-term care homes have 626 facilities and the number of beds is approximately 77,536 and 723 convalescent beds.
Home care or retirement home options are limited in rural areas.
Waiting list for long-stay beds is around 35,308.
Regulations and staffing issues are key challenges.
Challenges related to appropriate staffing, workloads, staff burnout, and compromise patient safety.
The COVID-19 pandemic severely affected the LTC sector.
The CAF report highlighted the issues related to gaps in care and staffing.

Acute Care Hospitalization

Hospitalizations create challenges for older adults (OAs).
OAs often experience a decline in quality of life, independence, and functionality after a hospital stay.
Loss of ability to perform ADLs independently is a significant impact.
Statistics show that a high number of patients (80%) lose mobility independence in acute care units.
33% of those over 75 years of age lose the ability to perform ADLs.
Age-related changes, chronic conditions and acute care stays increase the risk for older adults.
Some older adults are discharged from hospitals before they are ready creating further decline and complications.

Consequences of Hospitalization

Deconditioning, frailty, and failure to thrive are consequences of hospitalization.
Delirium is an acute state of confusion, often caused by hospitalization.

Minimizing Risks during Hospitalization

Specialized care, attention to risks, and nursing interventions are crucial to minimize hospitalization risks.
Nurses take steps such as completion of a thorough orientation to the unit, addressing patient and family questions and concerns.
The holistic approach includes a history, physical assessment, and monitoring of functional status for all patients.
Patient safety and appropriate care are stressed upon.

Hospital Risks

Delirium, falls, dehydration, malnutrition, urinary incontinence, healthcare-associated infections, and skin breakdown are key hospitalization risks.
Interprofessional teams are recommended for holistic patient care. Nurses work with other professionals to help their patients.

Functional Decline & ACE Units

Functional decline is a common occurrence, often resulting in a worse functional status following hospitalization.
ACE units are specialized to address those issues.
Key goals include patient-centered care, interprofessional team management, medical review, discharge planning, and assessments/interventions for common geriatric syndromes.
Such syndromes encompass falls, incontinence, confusion, and skin integrity. Review common syndromes for detail in subsequent pages.

Discharge Planning

Discharge planning should start after arrival.
The goal is for a smoother transition to home and to prevent further deterioration in their functional status compared with the time of admission into the facility.
ACE strategies consider patient's health status, prognosis, medical conditions and self-care abilities, along with social support, and financial resources.
All pertinent services should be in place before discharge.

Delirium, Dementia & Depression

Cognitive impairment can affect older adults.
Common cognitive impairment includes delirium, dementia, and depression.
Delirium is an acute confusional state and is prevalent and often preventable in older adults.
50% of hospitalized older adults experience delirium and the prevalence in LTC facilities varies from 6% to 40%.
Nurses are crucial to identify and mitigate risk factors.
Nurse complete assessments about the baseline mental status, and identify if there are changes in mental status.
Treatment needs a comprehensive assessment, identification-of the root cause of the delirium, and then interventions to treat the identified root cause.
Differentiating delirium from dementia can be challenging because of similar characteristics.

Dementia

Dementia is an irreversible, progressive state that affects memory, cognitive ability and intellectual abilities.
Key features include aphasia, apraxia, agnosia, and disturbances in executive functioning.
Various types of dementia exist, with Alzheimer's disease being the most common, accounting for 60–80%
Diagnosis is often challenging, and sometimes takes several years.

Depression

Depression is not a normal part of aging, and should always be assessed when there is suspected decline, as ignoring it can severely impact other health issues and overall increase risk to the individual.
Depression is a spectrum of mood disorders, and it can often be challenging to diagnose and treat in older adults.
When depression is not treated, it can lead to a diagnosis delay.
The importance of early diagnosis and treatment for recovery is key.

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Description

Test your knowledge on key concepts related to long-term care for older adults. This quiz covers essential strategies, challenges, and communication components in effective care transitions. Understand the goals of person-centred care and the role of nurses in facilitating these transitions.