NCMB314 LEC FINAL

NCMB314 LECTURE: Exam Week 18 BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Bachelo...

NCMB314 LECTURE: Exam Week 18 BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Bachelor of Science in Nursing 3YA Professor: Caroline V. San Diego MAN, RN Final Topics: Keywords: Long-term care, financing, Baby Boomers, Research Agenda on Aging community-based delivery system Trends/ Issues and Challenges on the Care of the A major public policy concern in the long-term care Older Person field is the potential burden an aging society will place Advocacy Programs related to the Care of the Older on the care-giving system and public finances. The Person “2030 problem” involves the challenge of assuring Telehealth and the Older Persons that sufficient resources and an effective service Nurse Entrepreneur system are available in thirty years, when the elderly population is twice what it is today. Much of this RESEARCH AGENDA ON AGING growth will be prompted by the aging of the Baby National: NIH Publication – Boomers, who in 2030 will be aged 66 to 84—the 2030 Problems on Caring for Aging Baby Boomers “young old”—and will number 61 million people. In - Objective: To assess the coming challenges of caring for addition to the Baby Boomers, those born prior to large numbers of frail elderly as the Baby Boom generation 1946—the “oldest old”—will number 9million people ages. in 2030. - Study Setting: A review of economic and demographic This paper assesses the economic dimensions of the data as well as simulations of projected socioeconomic 2030 problem. The first half of the paper reviews the and demographic patterns in the year 2030 form the basis literature and logic that suggest that aging in general, of a review of the challenges related to caring for seniors and long-term care services in particular, will that need to be faced by society. represent an overwhelming economic burden on - Study Design: A series of analyses are used to consider society by 2030. Then, a new analysis of burden is the challenges related to caring for elders in the year presented to suggest that aggregate resources should 2030: not be a major issue for the midcentury economy. 1) measures of macroeconomic burden are developed Finally, the paper presents four key challenges that and analyzed, represent the real economic burden of long-term care 2) the literatures on trends in disability, payment in the twenty-first century. These challenges are approaches for long-term care, healthy aging, and significant but different from macro cost issues. cultural views of aging are analyzed and synthesized, What type of economic burden might be considered and overwhelming? Existing literature never explicitly 3) simulations of future income and assets patterns of defines this but the sense is that the burden might be the Baby Boom generation are developed. considered overwhelming if: (a) tax rates need to be - Principal Findings: The economic burden of aging in 2030 raised dramatically, (b) economic growth is retarded should be no greater than the economic burden due to high service costs that preclude other social associated with raising large numbers of baby boom investments, or (c) the general well-being of future children in the 1960s. The real challenges of caring for the generations of workers is worse than that of current elderly in 2030 will involve: workers due to service costs and income transfers. 1) Making sure society develops payment and insurance The discussion has significant implications for public systems for long-term care that work better than policy and for private actors focused on developing an existing ones, effective care system for the mid–twenty-first century. 2) Taking advantage of advances in medicine and Public policy goals related to an aging society must behavioral health to keep the elderly as healthy and balance the need to provide adequate services and active as possible, transfers with an interest in maintaining the economic 3) Changing the way society organizes community and social well-being of the nonelderly. The economic services so that care is more accessible, and challenges discussed are such that public and private 4) Altering the cultural view of aging to make sure all progress that begins in the near future will make the ages are integrated into the fabric of community life. future burden substantially easier to handle. - Conclusions: To meet the long-term care needs of Baby Boomers, International: UN Program on Aging social and public policy changes must begin soon. - The UN Programme on Ageing is part of the Division for Meeting the financial and social service burdens of Inclusive Social Development (DISD), United Nations growing numbers of elders will not be a daunting task Department of Economic and Social Affairs (UNDESA). if necessary changes are made now rather than when - It is the focal point within the United Nations system on Baby Boomers actually need long-term care. matters related to ageing. As the focal point, its primary J.A.K.E 1 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 action is to facilitate and promote the Madrid International - However, by 2002, based on national reports received Plan of Action on Ageing, including designing guidelines from governments, only about 85 countries had developed for policy development and implementation; advocating some form of national strategies and the nature and means to mainstream ageing issues into development effectiveness of these strategies varied considerably from agendas; engaging in dialogue with civil society and the country to country. The Johannesburg Plan of private sector; and information exchange. Implementation (JPOI) adopted at the 2002 World Summit - Expert Group Meeting on Global ageing and the data on Sustainable Development (WSSD), through paragraph revolution 162 b, recommitted member States to “take immediate - Population ageing has profound implications for many steps to make progress in the formulation and elaboration facets of human life. An ageing population will affect of national strategies for sustainable development and to everything from economies, labor markets to health and begin their implementation by 2005.” social care. This prospect requires a better understanding - During the preparatory process for the 2002 WSSD, the of the implications and possibilities posed by population International Forum on NSDS was held in Accra, Ghana in ageing as well as the situation of older persons 2001, which led to the launch of the Guidance in themselves. While the older population is growing at an Preparing a National Sustainable Development Strategy. It accelerated speed, many gaps in ageing related statistics defined National Sustainable Development Strategy and data exist, affecting the ability to develop targeted (NSDS) as “a coordinated, participatory and iterative policies and programmes that address ageing related process of thoughts and actions to achieve economic, challenges. environmental and social objectives in a balanced and - Recently, demand for evidence based data and statistics integrative manner”. Most importantly, NSDS is a call for on older persons has been generated by the negotiations an institutional change. It aims at a transition from the on the Post-2015 Development Agenda. In order to traditional static putting-a-plan-on-paper exercise implement a comprehensive Post-2015 Development towards the establishment of an adaptive system that can Agenda, efforts to define a strategic framework for continuously improve. It should be a process which statistics under the so called ‘transformative agenda for “encompasses situation analysis, formulation of policies statistics’, point at integrating and broadening the scope and action plans, implementation, monitoring and regular of statistics and data collection. The agenda introduces review. It is a cyclical and interactive process of planning, innovations to incorporate non-traditional sources that so participation and action in which the emphasis is on far have not been utilized in official statistics. These managing progress towards sustainability goals rather developments provide an opportunity for addressing the than producing a ‘plan’ as an end product.” gaps and needs posed by ageing. - Every country needs to determine, for itself, how best to - In this context, the Focal Point on Ageing is organizing an approach the preparation and implementation of its Expert Group Meeting on “Global ageing and the data national sustainable development strategy depending revolution – the way forward in the post-2015 environment” upon the prevailing political, historical cultural, ecological in New York on 7-9 July 2015. The meeting aims at circumstances. A "blueprint" approach for national exploring how and which new and non-traditional data sustainable development strategies is neither possible nor sources can support the policy and programme desirable. The particular label applied to a national development on ageing issues. The outcome of the EGM sustainable development strategy is not important, as seeks responds to the need for sound ageing related long as the underlying principles characterizing a national statistics and data as well as the needs that will arise from sustainable development strategy are adhered to and that the targets contained in the Sustainable Development economic, social and environmental objectives are Goals and the Post-2015 environment. balanced and integrated. Description - Today, when incorporating the 2030 Agenda for - The concept of National Sustainable Development sustainable development and its 17 SDGs into national Strategy (NSDS) was proposed in 1992 in Agenda 21 (§ context, although countries do not necessarily label them 8.7) where countries were called upon to integrate as “national sustainable development strategies”, all the economic, social and environmental objectives into one underlying core principles are deeply embedded in the strategically focused blueprint for action at the national national implementation of SDGs worldwide. As seen at level. the Voluntary National Reviews at the High Level Political - The NSDS “should be developed through the widest Forum on Sustainable Development, issues such as possible participation”. And it “should be based on a country ownership and strong political commitment, the thorough assessment of the current situation and integration of economic, social and environmental initiatives”. In the Programme for the Future objectives across sectors, territories and generations; Implementation of Agenda 21 adopted at the 19th Special broad participation and effective partnerships, the Session of the General Assembly (23-28 June 1997), development of capacity and enabling environment, as member States reaffirmed the importance of NSDS and well as the mobilization of means of implementations set a target of 2002 for the formulation and elaboration of remain at the center of policy debates at all levels. NSDS that reflect the contributions and responsibilities of all interested parties. J.A.K.E 2 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Ageing, Older Persons and The 2030 Agenda For mostly associated with the concentration of Sustainable Development economic resources and a tradition of political - The 2030 Agenda for Sustainable Development sets out a participation (UNDESA 2007). As older persons universal plan of action to achieve sustainable continue to constitute an ever-greater proportion of development in a balanced manner and seeks to realize the total population, they have the potential to be the human rights of all people. It calls for leaving no one more influential in society. This can have important behind and for ensuring that the Sustainable Development implications for social, economic and political Goals (SDGs) are met for all segments of society, at all outcomes in those countries (progressive but also ages, with a particular focus on the most vulnerable— regressive), as older persons tend to vote in greater including older persons. Preparing for an ageing numbers than young people (Goerres 2009), and are population is vital to the achievement of the integrated increasingly forming their own associations such as 2030 Agenda, with ageing cutting across the goals on lobbying groups, political parties and grassroots poverty eradication, good health, gender equality, organizations (UNFPA and HelpAge International). economic growth and decent work, reduced inequalities 4) Social capital: Many older persons tend to be actively and sustainable cities. Therefore, while it is essential to involved in community and civic life through address the exclusion and vulnerability of—and volunteering, governance of public institutions, and intersectional discrimination against—many older participation in community-based institutions. This persons in the implementation of the new agenda, it is can contribute to strengthening social capital in terms even more important to go beyond treating older persons of facilitating cooperation and improving interactions as a vulnerable group. Older persons must be recognized within and between groups based on shared values, as the active agents of societal development in order to trust and solidarity (OECD 2007). Older generations achieve truly transformative, inclusive and sustainable are also often the important sources of historical development outcomes. The current brief acknowledges memory and wisdom, guardians of culture, and the importance of a life-course approach to ageing and repositories of social traditions and rare knowledge calls for protecting and promoting the rights of older and skills, which can critically complement those of persons in the implementation of the 2030 Agenda. young people. - Older persons are important actors in communities, making key contributions in the following interrelated TRENDS/ ISSUES AND CHALLENGES ON THE CARE OF THE areas: OLDER PERSONS 1) Economic development: Older persons make Educational Trends in Gerontological Nursing substantial contributions to the economy through - Opportunities in gerontological nursing are somewhat participation in the formal or informal workforce correlated with education level. Many levels of (often beyond retirement age), taxes and preparation are available for nurses in gerontology such consumption, and transfers of assets and resources as: to their families and communities,6 and their broader Special education in caring for adults during basic retention in the workforce (among those who wish or preparation (LPN, RN associate degree, diploma RN, need to continue working) has the potential to or RN BSN level. enhance labour productivity.7 Today more older Post baccalaureate nurses choose a Clinical Nurse persons are contributing to an entrepreneurial Specialist (CNS) or Geriatric Nurse Practitioner (GNP) ecosystem (Lee 2017), while embracing new Online programs for graduate or post-master’s study technologies,8 by providing services through digital and complete clinical hours in their own geographic platforms, car or accommodation sharing and peer- location to-peer lending. In the contexts affected by absence Certifications in gerontology currently available from of breadwinners, migration, disease outbreaks and the American Association of Colleges of Nursing conflicts, older persons’ work can be the only source (AACN) of monetary or in-kind income to sustain families. Working in long-term care facilities such as nursing 2) Unpaid care work: Older persons, particularly older homes, assisted living, independent living centers, or women, play a vital role in providing unpaid care for adult day care, or in an acute care hospital. spouses, grandchildren and other relatives, including those with disabilities (UNFPA and HelpAge Gerontologic Nurse International 2012). Furthermore, with changes in Currently hold an active family structures, the HIV/AIDS pandemic and Registered nurse license in US or its territories. growing migration, grandparents have become central Hold a baccalaureate or higher degree in nursing. and indispensable to the well-being of families,9 Have practiced 2000 hours within past 3 years especially in the absence of public care and other Have had 30 contact hours of continuing education social services. applicable to gerontology/Gerontologic nursing within the 3) Political participation: With variation across contexts, past 3 years. older persons in some countries, notably in advanced democracies, can carry significant weight which is J.A.K.E 3 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Gerontologic Nurse Practitioner - Planners Certification Board. It is similar to CLCP, but with Currently hold an active RN license in the US or its additional requirements, and is definitely designed for territories= registered nurses with case management experience. Hold a master’s or higher degree in nursing. Have been prepared as a nurse practitioner in either of the Future Potential following: - Life care planner may be a concept that will be carried - A GNP master’s degree in Program into the senior population. Not only are seniors living - A formal postgraduate GNP track or program Within a longer, but they continue participating in higher risk school of nursing granting graduate-level academic activities today than in generations past. credit - The principles of life care planning could also easily be extrapolated for use with those seniors who have long- Clinical Specialist in Gerontologic Nursing term chronic health problems. Currently hold an active RN license in the United States or - A good financial planner could provide a more accurate its territories and detailed projection of health care cost over a lifetime Hold a master’s or higher degree in gerontologic nursing of disability or illness. The demand for professionals in Hold a master’s or higher degree in nursing with a gerontology and rehabilitation is likely to grow quickly with specialization in gerontologic nursing. the aging baby boomer group. Have practiced a minimum of 12 months after completion - Gerontological nurses combine their knowledge in health of the master’s degree care with some financial training to offer distinctive services to the older age group. Meet the following requirements in current practice: - If a clinical specialist must have provided a minimum Financial Gerontology of 800 hours (post-master’s) of direct client care or - Financial gerontology is a growing subfield of financial clinical management in Gerontologic Nursing within planning. FG is defined as “ the intellectual intersection of the past 24 months two fields, gerontology and finance, each of which has - If a consultant, researcher, educator, or administrator, practitioner and academic components” which combines must have provided a minimum of 400 hours the knowledge and skills associated with financial planning and asset management with expertise in meeting Life Care Planning the unique needs of older adults. - The concept of life care planning was first developed in - Certification for FG the 1980s, to meet a growing need for an informed document that presented actual estimated costs of care Chartered Advisor for Senior Living (CASL) – A person for persons who had experienced a catastrophic injury or with CASL certification assists older persons with accident. retirement savings, pension and social security - Many settlements for those persons in devastating planning, health and long-term issues, estate accidents were made arbitrarily without actual calculation planning and managing life course transitions, family and consideration of the multitudes of factors influencing relationship and living arrangement. A person must these costs, such as doctors’ visits, equipment, complete five courses that take approximately 60-80 medications, tests, cost of caregiving, and potential hours of study each. After the course the individual complications over a lifetime. must pass a computerized exam. Maintenance of the - LCP is a comprehensive document designed to help meet certification with continuing education credits. A code the long-term financial and health needs of a person of ethics must also be agreed to in writing prior to experienced catastrophic injury. being granted the designation. - Life care planners generally develop plans for insurance Registered Financial Gerontologist (RFG) – The RFG companies or awyers representing individual clients, but certifications a similar designation to the CASL, but is the ultimate goal is to promote the best outcome for the offered through the American Institute of financial person for whom the life care plan was written. Gerontology and supported by the American Society - The best life care planners have a nearly equal mix on Aging. The Individual must complete six courses, a between work for insurance carriers and work for lawyers learning requirement, and a comprehensive who present patients, thus maintaining a neutral and examination. Course content is related to wealth span professional reputation for fairness. planning, ethics, and serving the older adult. Compared to CASL courses, the curriculum appears Certification more suited to gerontologist than financial planners. - The Certified Life Care Planner (CLCP) designation may be Certified Senior Advisor (CSA) - The CSA is a earned through 128 continuing education hours, designation offered by the society of Senior Advisors. successful completion of a sample life care plan, and The curriculum includes a large number of topics in passing an examination (MediPro Seminars, 2004). The aging, chronic illness, end of life, and long-term care CNLCP (Certified Nurse Life Care Planner) designation is as well as Medicaid and financial planning. It is self- offered by the American Association of Nurse Life Care study program that takes 2-6 months to complete. To J.A.K.E 4 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 obtain the CSA, the person must also pass a secured, age 65 was about $1,800, and increased to about $5,500 computerized, final comprehensive examination at age 79. online that consists of 150 multiple choice questions - Long-term care insurance may cover any one or all of the within 3 hours. following types of care. Nursing Home care Recent trends in health promotion & disease prevention Assisted living activities, such as: Hospice Improved nutrition, Home health Decreased smoking, Adult day care Increased exercise, and Respite Early detection & treatment of risk factors such as Caregiver training hypertension & elevated serum cholesterol levels. Home health care coordinators Trends in Long-Term Care Emerging Models of Care - Long-term care is the “broad range of medical, custodial, A Shift to Different Living Facilities social, and other care services that assist people who - One of most significant changes in care for older adults is have an impaired ability to live independently for an the shift away from nursing homes. As they have known extended period”. The National Council on aging traditionally. Some predict that the only nursing homes estimates that 6.4 million people all over the age of 65 and that will survive will be excellent ones. 50% of those over age 85 will need long-term care. - The institutional look of the older nursing home that was Thirteen million persons in United States currently report modeled after the hospital, with long hallways and a having long-term health needs. This number is expected to sterile-looking environment, is becoming unacceptable to grow to 22 million in the next decades. The nation spent many older adults as a place to live out their final days. $ 183 billion on long-term care services in 2003 (American - Newer long-term care facilities promote private rooms, Health Care Association & National Center for Assisted residents’ choices and control, and a more home-like Living, 2005). In 2005, Medicaid spent nearly $95 billion on environment that mirrors assisted living facilities of today. long-term care. Persons must pay for many long-term care expenses from their savings and assets before being Continuing Care Retirement Communities (CCRCs) eligible for Medicaid. This has prompted new sources of - Growing trend for older adults, services by promoting funding for future long-term health care needs. aging in place through offering various levels of care on a continuum that might include independent living, assisted Long-Term Care Insurance living, skilled care, and home health services all on one - Long –term care insurance is designed to cover individuals campus. The trend will be to bring services to the CCRCs needing health care outside of the hospital, including versus transferring persons to the next level of care on the diagnostics testing, rehabilitation, and custodial care. continuum (for example, sending them to the “nursing Reasons for purchasing long-term care insurance include home” when their care demands increased). worrying about being a burden to their family, staying - Green Houses- a movement to replace nursing homes financially independent, having more choices for care if with more home-like environments, started through the needed( such as remaining in the home), preserving their vision of a physician named Bill Thomas, consist of 10-12 assets, and providing peace of mind. residents in a home setting who enjoy private rooms and - The cost of long-term insurance premiums (at age 65) share a common living space. This designed provide a full ranges from $1,000-$2,650 per year, depending upon a range of care services, but in a friendly atmosphere that number of factors including health status and history. The reminds one of home. average stay in a nursing home is 2 years. The average - Geriatric Care management – Another emerging trend in cost for a private room in a nursing home in 2003 was gerontological nursing is the role of the geriatric care $181.24/day (National Council in aging, 2005). This manager. The professional geriatric care manager (PGCM) average cost increase to $194/day by 2006 (over is a specialist who helps families care for older adults $70,000/year), though costs vary widely by geographic while encouraging as much independence as possible. area. Assisted living facilities average $2,691/month for a PGCMs may come from a variety of backgrounds such as one-bedroom unit. Financial analysts predict that if social work, psychology. Sociology, geriatrics, and nursing, nursing home care costs rise a bit faster than inflation, by nurses have emerged as natural leaders in this growing 2026 a room in a nursing home could cost $ 177,000 per field. The educational background knowledge of the aging year; another cost projected the cost to increase to process make this role an excellent fit for nurses who seek $ 200,000 per year by 2030. a position that affords independence and autonomy while - Long-term care insurance can be purchased at anytime, using their skills. but premiums increase with age. In, 2005, the annual - PGCM perform the following: premiums for a low-option policy for a person who was Conduct assessments Develop care plans that address pertinent problems J.A.K.E 5 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 Arrange, interview for, and monitor in-home as continuing care retirement communities (CCRCs), caregivers or other services independent living facilities, and assisted living design and Act as a consultant for caregivers who live near or far build attractive, contemporary living areas within a fiscally Review financial, health-related, or legal issues responsible budget. The ideal team takes into Provide referrals to other geriatrics specialists consideration the mission and needs of the community Intervene in times of crisis and understands the unique limitations and desires of Act as an advocate and/ or liaison between families their older clientele. A great deal of thought and effort and service providers goes into designing an environment that will be attractive Coordinate or oversee care and functional for older adults, and marketable for the institution. Attention to details such as positioning of Assist with transitions in living arrangements, including recommending the most appropriate garden areas and windows to best use the space and settings and helping facilitate the move  Provide sunlight is essential, and the savvy builder carefully plans education and links to resources all aspects of the environment with consideration to older residents. Offer counseling and support Some PGCMs also offer guardianship, caregiving, and ADVOCACY PROGRAMS RELATED TO THE CARE OF THE /or financial services. OLDER PERSON - The role of an advocate in health and social care is to Community Living Designs support a vulnerable or disadvantaged person and ensure - another fascinating trend related to gerontological that their rights are being upheld in a healthcare context. - Nursing is the emergence of companies completely - Health and social care advocacy means supporting devoted to the strategic planning, engineering, people who are unable to ensure their best interests are architecture, building, and marketing of community living being taken care of. In the medical profession, activities designs that are tailored to today’s older adults. Older related to ensuring access to care, navigating the system, adults who choose to live in senior communities expect to mobilizing resources, addressing health inequities, have access to transportation and needed services such influencing health policy and creating system change are as health care, appropriate housing, and opportunities for known as health advocacy. socialization. Baby boomers are predicted to live in suburban communities versus urban or rural areas (Frey Advocacy services 2007), so the need for age-appropriate and friendly - Advocacy services support the rights of anyone receiving retirement communities is projected to increase. or seeking to receive aged care services, and empower Lehning,Chun, and Scharlach (2007) stated that: older people to make informed decisions about their care. - An aging – friendly community has three primary - An aged care advocate can assist things like: characteristics: 1) age is not a significant barrier to the interacting with the aged care system maintenance of life-long interests and activities; 2) supports and accommodations exist to enable individuals transitioning between aged care services with age-related disabilities to meet basic health and knowing and understanding their rights social needs; and 3) opportunities exist for older adults to making decisions about the care they receive develop new sources of fulfillment and engagement. options for having their aged care needs better met - In spite of the need for such communities, shortfalls in resolving concerns or complaints with the aged care public policy and lack of creativity in architecture have led provider about the services they receive to structural barriers related to best use of land, housing speaking with their service provider at their direction policies, transportation, and opportunities for involvement Increasing their skills and knowledge to advocate for in the larger community. There remains a general lack of them self. concern and investment of suburban communities in - Who can access advocacy services? Anyone who is providing housing for the aging portion of their citizens. receiving or seeking to receive government-funded aged This has created a gap in service that potentially can be care services, including family and representatives, are filled by forward thinking companies who recognize the entitled to access advocacy services. This includes plight of long-term care in this area and stand ready to people who: assist. live in an aged care home - One such example of a company developed to assist receive aged care services in their own home organizations with designing and building appropriate and receive transition care age-friendly living spaces is Community Living Solutions Are helping someone who is receiving aged care (2008) of Neenah, Wisconsin. This company advertises its services. purpose as “enlightening your life and community with Legal advocacy expert knowledge and sustainable solutions”. With a - a recognized strategy to address social factors that unique team of professionals that includes engineers, influence the health of populations with complex care architects, and other design experts, companies such as needs. Such advocacy can improve housing stability, Community Living Solutions work with organizations such increase access to public benefits that support a host of J.A.K.E 6 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 social needs, assure that medical and financial proxy initiatives are health oriented, and as such they recognize decision makers are in place, and reduce psychosocial the complexity of the socioeconomic, lifestyle, and other distress. nonmedical influences that impact our ability to attain - Older adults are disproportionately likely to have complex and maintain health. medical needs. Legal advocacy has been recognized as - Healthy People 2020 was the fourth iteration of the integral to the health and health care of older adults in the Healthy People initiative. Launched in December 2010, medical literature since 1988, and in current Medicare Healthy People 2020 set an ambitious yet achievable 10- quality metrics. Additionally, since 1965, the Older year agenda for improving the nation’s health. Americans Act has provided legal assistance as an - The vision for Healthy People 2020 was “a society in which “essential service” among other aging supports such as all people live long, healthy lives.” nutrition, transportation, and in-home care. Under the act, - Its mission was to: state area agencies on aging must provide legal services Identify nationwide health improvement priorities free to adults older than age 60 with the “greatest social or Increase public awareness and understanding of the economic need.” determinants of health, disease, and disability and - Yet, while emerging care models for older adults with the opportunities for progress complex needs are highly multidisciplinary, none Provide measurable objectives and goals that are incorporate legal advocacy in their design. This is in some applicable at the national, state, and local levels ways not surprising as clinicians are not trained to Engage multiple sectors to take actions to strengthen recognize or address legal needs of older patients, and policies and improve practices that are driven by the older patients are unable to self-diagnose their legal best available evidence and knowledge problems, thus making it unlikely that they will articulate Identify critical research, evaluation, and data legal needs as such to health care providers, social collection needs workers, or case managers. - Healthy People 2020 set overarching goals to: - In addition, funding mechanisms for health care and Attain high-quality, longer lives free of preventable social services—especially civil legal services—are highly disease, disability, injury, and premature death soloed and deeply asymmetrical. Historical Achieve health equity, eliminate disparities, and underinvestment in civil legal services for the poor has led improve the health of all groups to a shortfall in the legal workforce serving this population. Create social and physical environments that This may provide another explanation for why legal promote good health for all advocacy has not been particularly visible to health Promote quality of life, healthy development, and systems: Legal advocates are focused on emergency legal healthy behaviors across all life stages needs such as loss of housing, neglect and exploitation, - Healthy People 2020 Law and Health Policy and loss of public benefits. Although these needs could The Healthy People 2020 Law and Health Policy be better served through preventive and primary legal project aimed to raise awareness of the impact that advocacy delivered holistically in coordination with other legal or policy interventions can have on public health. social services and health care, funding levels have not The project was a partnership between ODPHP, CDC, enabled such an approach. the CDC Foundation, and the Robert Wood Johnson Foundation. Healthy People Initiatives - The federal government has been establishing goals for These organizations worked with subject matter experts and federal stakeholders to create reports, healthy aging since 1980 when the U.S. Public Health webinars, and products to highlight laws and policies Service published the report Promoting Health/ Preventing Disease with the potential to impact specific Healthy People - Objectives for the Nation. This 1980 report outlined 226 2020 topic areas and objectives. objectives for the nation to achieve over the following 10 - Advancing Public Health Through Law and Policy years. It was referred to by some as Healthy People 1990. Law and policy are among the most effective tools to - A decade later, in 1990, another10-year national effort, improve health. Many of the greatest public health Healthy People 2000, was initiated by the U.S. Public successes in the United States are the result of legal Health Service in another effort to reduce preventable or policy interventions, such as smoke-free air laws death and disability for Americans. A third effort is and mandatory seatbelt laws.1 Yet many people may currently under way with the Healthy People 2010 not be aware of the precise impact these initiative; however the number objectives has increased to interventions and approaches can have on population 467, and these are distributed over 28 priority areas. health. - There are some notable benefits to the healthy people - Law and Health Policy Resources initiatives. On the positive side, these initiatives give Project partners worked with subject matter experts recognition to health promotion rather than focusing and federal stakeholders to develop a series of exclusively on wars on disease (e.g. tabulating the number Healthy People 2020 topic-specific reports, webinars, of deaths from cancer or heart disease, and then and other evidence-based products such as organizing a campaign against them). The Healthy People infographics and success stories, or Bright Spots. J.A.K.E 7 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 These resources and publications highlight laws and sleep management, use of medications, managing policies with the potential to impact specific Healthy emotions, community resources, communicating with People 2020 topic areas and objectives, including health professionals, problem solving, and decision Leading Health Indicators. making. The program takes place in community settings Review different resources produced by the Law and such as seniors centers, churches, and hospitals. Health Policy project: - The theoretical basis of the program has been to promote o Disability and Health a sense of personal efficacy among participants by using o Healthcare-Associated Infections such techniques as guided mastery of skills, peer o Health Equity modeling, reinterpretation of symptoms, social o Healthy People 2030 persuasion through group support, and individual self- o Leading Health Indicators management guidance. o Maternal, Infant, and Child Health Project Enhance o Mental Health and Mental Disorders - Senior Services of Seattle/King County began the Senior o Nutrition and Weight Status Wellness Project (later renamed Project Enhance) in 1997 o Oral Health at the North Shore Senior Center in Bothell, Washington. It o Policy Levers was a research-based health promotion program that o Substance Abuse included a component of chronic care self-management that was modeled after Kate Lorig’s program Model Health Promotion Programs for Older Adults - The program also included health and functional - One of the more recent efforts in this regard has been assessments; individual and group counseling; exercise organized by the Health Promotion Institute (HPI) of the programs; a personal health action plan with the support National Council in Aging. HPI started by summarizing 16 of a nurse, social worker, and volunteer health mentor; model programs or best practices and compiling them and support groups. into a loose-leaf directory. The summarizes included - A randomized controlled study of chronically ill seniors information on the planning process, implementation of reported a reduction in a number of hospital stays and the program, and program evaluations. average length of stay, a reduction in psychotropic Healthwise medications, and better functioning in activities of daily - The best-known older adult medical self-care program is living. Healthwise. It provides information and prevention tips on Ornish Program for Reversing Heart Disease 190 common health problems, with information - Dr. Dean Ornish, a physician at the University of California periodically updated. The Healthwise Handbook at San Francisco and founder of the Preventive Medicine (Healthwise,2006)is now in its 17th edition. This handbook Research Institute, has developed a program for reversing includes physician-approved guidelines on when to call a heart disease that has been replicated at several sites health professional for each of the health problems its around the country. Dr. Ornish (1992) has recommended cover. a vegetarian diet with fat intake of 10% or less of total - With the assistance of a $2.1 million grant from Robert calories, moderate aerobic exercise at least three times a Wood Johnson Foundation, Healthwise distributed its week, yoga and meditation an hour a day, group support medical self-care guide to 125,000 Idaho households, sessions, and smoking cessation. along with toll free nurse consultation phone service and - Dr. Ornish and his colleagues have reported that as a self-care workshops. Thirty-nine percent of handbook result of their program, blockages in arteries have recipients reported that the handbook helped them avoid decreased in size, and blood flow has improved in as a visit to the doctor. Blue Cross of Idaho reported 18% many as 82% of their heart patients( Gould et al.,1995). A fewer visits to the emergency room by owners of the guide. five year follow-up of this program reported an 8% Chronic Disease Management reduction in atherosclerotic plaques, while the control - Kate Lorig, a nurse-researcher at the Standford University group had a 28% increase. School of Medicine, and her medical colleagues have Benson’s Mind / Body Medical Institute been evaluating community-based, peer-led, chronic - Dr. Herbert Benson is a physician affiliated with Harvard disease self-management programs for more than two Medical School, and best known for his best-selling books decades, beginning with the Arthritis Self-Management on the relaxation response and for popularizing the term Program (Lorig et ai.,1986) This program has since evolved mind/body medicine. into a curriculum that is applicable to a wide array of - For individuals feeling the negative effects of stress, chronic diseases and conditions. Benson’s program teaches them to elicit the relaxation - Typically, each program involves about a dozen response, a western version of meditation. participants, led by per leaders who have received 20 - The Benson-Henry Institute for Mind/Body Medicine’s hours of training. The peer leaders, like the students, are clinical programs treat patients with a combination typically older and have chronic diseases that they response techniques, proper nutrition and exercise, and contend with. The program consists of six weekly sessions the reframing of negative thinking patterns. about 2 ½ hours long each, with a content focus on Strong for Life exercise, symptom management, nutrition, fatigue and J.A.K.E 8 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - The Strong for Life Program is a home-based exercise cognitive changes that occur with aging should program for disabled and nondisabled older adults. not prevent use of telehealth by older adults.  - It focuses on strength and balance, and provides an Even adults who experience conditions such as exercise video, a trainer’s manual, and a user’s guide. mild cognitive impairment (MCI) can successfully - The program was designed by physical therapists for learn new skills, especially if they use home use by older adults, and relies on elastic resistive compensatory strategies like making notes or bands for strengthening muscles. using reminders. This could include making - The exercise program led to high rate of exercise reminders about telehealth appointment times in adherence among older participants, as well as increased their calendar and using a series of written notes lower extremity strength, improvements in tandem gait, about how to start their computer or tablet and and a reduction in physical disability (Jette et al., 1999) launch a telehealth application. There are some older adults whose cognitive TELEHEALTH AND THE OLDER PERSONS impairments may be too advanced to use telehealth Telehealth successfully (for instance, in severe dementia). - Allows patients across the lifespan to receive care However, some older adults with mild forms of remotely in a manner that is often more accessible and dementia can use telehealth effectively with some convenient than in-person care. modifications or adjustments. For instance, they may - A common misconception is that older adults have either need a family member’s assistance to set up the no interest in the use of technology or cannot use telehealth account or to get the telehealth session technology platforms. started. - Current data indicate otherwise; in fact, most older adults 3) Strategies for providing technology support (7 in 10) have and utilize a computer, smart phone, or Don’t assume older adults are uninterested in tablet with internet access at home. However, when it telehealth. comes to the use of telehealth, there is limited reach Just as you do with all patients, meet older adults among older adults (e.g., only 11% feel comfortable using where they are and talk about the pros and cons of telehealth). telehealth. Provide a clear explanation of what to - Beyond reimbursement limitations with health insurance, expect and let them know that most people barriers to telehealth among older adults include provider experience a few “bumps” adjusting to new misperceptions of interest, lack of telehealth technology but you’ve been able to successfully work training/orientation in older adults, and telehealth with people with this modality. platforms that do not account for the needs of older Providing technology support requires additional adults. resources early in treatment but avoids delays on the - Here are some factors to consider and strategies to day of the appointment, so plan to provide additional implement when providing telehealth to older adults. instruction and individual tech support. Though 1) Sensory and motor changes telehealth platforms may not be intuitive to older Most older adults experience age-related changes adults, many can successfully use them. Contact the in vision, hearing, touch, perception, mobility, and older adult over the telephone prior to the balance. Many of these declines begin at age 40. appointment to provide verbal instructions, test the For older adults, there may be difficulties with telehealth platform, and ensure the older adult light perception, sensitivity to glare, reduced understands and is comfortable with the technology. acuity, and impaired focus on nearby objects. Support staff may be able to do this step. Additional Discriminating between background noises benefits include increasing older adults’ access to becomes more difficult as we age, and low-level care and promoting treatment continuity by sounds are muffled. And for some, there is overcoming barriers to in-person sessions. increased risk of developing Tinnitus, which can Prior to the appointment, provide older adults with make certain sounds difficult to discern. written instructions for using telehealth (you may find There are also changes to muscle strength and this beneficial for all your patients). Instructions that tone that make muscles stiffer and less use concise language, a larger font size, and include 2) Cognitive changes screen shots of each step of the process may be Most older adults experience some cognitive particularly helpful. changes as a part of the normal aging process, Older adults using telehealth technology will benefit such as slowed speed of processing, difficulty in from visual presentation modifications (e.g., raise multitasking, and small declines in episodic display/screen illumination, use matte surfaces memory, which generally do not interfere with instead of glossy surfaces). everyday functioning. However, many cognitive Auditory enhancements may also help the user abilities, including semantic memory, reasoning, experience (e.g., adjust volume settings, offer closed problem solving, and executive functioning are captioning options with enhanced text size, consider preserved well into late life. The relatively minor the use of headphone sets). J.A.K.E 9 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 You can provide these suggestions in the initial geriatric patients and their families can benefit from written information or discuss during the setting up telehealth. session. When using a video platform, a neutral, not “busy” The Need for Affordable Elderly Care visual background for you will ensure the older adult - Elderly patients tend to have complex healthcare needs as with visual challenges is better able to focus on you they manage a range of conditions and diseases. But and not other stimuli in the background. Similarly, getting access to healthcare can be a challenge for many reducing noise on the provider’s end reduces auditory elderly patients, especially for those that live in rural areas. interference for the patient. Be aware of noises such Around 7 million older adults are considered homebound as HVAC, white noise generators, and other sounds or have trouble leaving their home without help. and seek to minimize these with the position of your - Without a loved one to help them or a dedicated driver, equipment and the use of headphones.  To curb pain these individuals may be unable to visit their healthcare from muscle stiffness, ask your patient if they need provider in person, leaving them with few alternatives movement accommodations for their sessions (e.g., unless they have access to telehealth services. allow time for stretching, invite older adults to use - The price of putting an older patient in a nursing home is items that may be of comfort like heating pads, simply unaffordable for many families. Additionally, older comfortable chairs, etc.). patients tend to prefer at-home care to staying in a Providing an end-of-session summary of the goals, nursing home. In many cases, a loved one will move in reading, and exercises to be completed between with the older patient to provide at-home care, but, sessions can be advantageous for all clients but without proper training, many of these family caregivers especially valuable for older adults. will still need the advice and support of the healthcare 4) Strategies for establishing rapport community. Directly acknowledge that telehealth sessions can feel awkward. Reassure older adults that most people How Telehealth Can Improve Access to Elderly Care feel increasingly comfortable over time. - Telehealth gives patients the option to consult with their Attempt to look directly at the camera as much as healthcare provider remotely using live video, audio and possible to mimic eye contact. instant messaging on a telemedicine app. This reduces Use clarifying and reflective techniques to avoid the need for in-person visits and consultations, making it miscommunication and misinterpretation of the older easier for at-home caregivers to meet the needs of their adult’s emotions. Clarify ambiguous body language loved ones. verbally with the acknowledgement that telehealth - Many of these at-home caregivers will have can make communication more difficult (e.g., “I want responsibilities of their own, from raising children to to make sure I understand how you are feeling. holding down a job. If they can consult with their loved Meeting over video can make that more difficult since one’s doctor from the comfort of their own home, they I can’t see you completely. You seem to be won’t have to spend as much time shuttling their loved frustrated—is that how you are feeling?”). one to and from the doctor’s office. At-home healthcare Implementing these strategies could increase the providers can quickly gain valuable insight and knowledge likelihood of older adults successfully engaging in and from these remote consultations, improving their loved benefiting from telehealth. one’s quality of care. - Telehealth can help families and elderly patients in the Using Telehealth to Care for the Elderly following ways: - When we think of digital technology, we tend to think of Reduce the burden and cost of certain travel younger individuals using their smartphones and other expenses digital devices. But this line of thinking doesn’t necessarily Reduce the number of unnecessary hospital visits apply to telehealth. Older generations can use telehealth Reduce the stress put on at-home caregivers technology to improve their access to care and reduce the Improve overall patient satisfaction cost of healthcare services. - The number of Americans age 65 and older is rising Using Telehealth to Care for the Elderly dramatically. Estimates show this demographic will rise - At-home caregivers can use telehealth to help better from 46 million today to 98 million by the year 2060. With manage and treat a range of conditions and diseases that more elderly patients seeking care, families will have to tend to affect older patients. While in many of these cases, make difficult decisions when figuring out how to best in-person visits will still be required, telehealth makes it care for their loved one. easier for family caregivers to care for their loved one by - The cost of a nursing home can be out of reach for many giving them direct access to healthcare professionals. If Americans, which means many families will need to stay they have a question about caring for their loved one, they at home to care for their loved one. Telehealth can reduce can always consult with a licensed physician or specialist the burden on these families by lowering the cost of using telemedicine video conferencing software. essential healthcare services. Learn more about how J.A.K.E 10 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - Telehealth can be used to care for and manage the - The Commonwealth Fund concurs in its To the Point blog following conditions and diseases: post, stating “numerous studies have demonstrated Palliative Care: At-home caregivers can use telehealth [telehealth’s] effectiveness across a range of modalities to report on the condition of their loved one as their (e.g., telephone, videoconference) and mental health health continues to deteriorate while receiving concerns (e.g., depression, substance use disorders). valuable feedback and advice from healthcare Virtual services are safe, effective and comparable in professionals. outcomes to in-person services.” Transitional Care for Heart Failure: At-home caregivers can use telehealth to stay on top of their Mental Healthcare Providers, Older Adults, and Telehealth loved one’s treatment regimen following an episode of Usage heart failure, including dispensing medications, diet, - The American Academy of Family Physicians (AAFP) physical activity, and managing stress levels. defines telehealth as “electronic and telecommunications Chronic Disease Management: Telehealth helps at- technologies and services used to provide care and home caregivers report on the condition of their loved services at-a-distance.” Telepsychiatry is a specific form one, giving healthcare providers insight into how their of telehealth that, according to the American Psychiatric disease is progressing over time. Caregivers can use Association (APA), “can involve direct interaction between telehealth to stay on top of medications, dietary a psychiatrist and the patient” and include “psychiatrists information, and mental and physical changes. supporting primary care providers with mental health care Primary Care for Frail Individuals: Patients that have consultation and expertise.” trouble moving or leaving the house can use - “Video-based telepsychiatry helps meet patients’ needs telehealth to consult with healthcare professionals on for convenient, affordable, and readily accessible mental a variety of primary healthcare issues and concerns, health services,” according to the APA. including joint pain, muscle stiffness, medications, - According to the 2020 Survey of America’s Physicians, and accident management and prevention. conducted by Merritt Hawkins in collaboration with The - There are so many ways elderly patients and family Physicians Foundation, 48 percent of U.S. physicians caregivers can use telehealth to their advantage. Digital currently are treating patients through telemedicine healthcare services reduce the need for in-person compared to only 18 percent in 2018. appointments, lower the cost of care, reduce costly visits - Meanwhile, 26 percent of people 50 to 80 years old to the emergency room, and improve patient satisfaction. reported having had a virtual medical visit since the As more patients reach the age of retirement, more outbreak of COVID-19, according to the University of families will need to depend on these services to care for Michigan (U of M) 2020 National Poll on Healthy Aging their elderly loved one. (NPHA). This is compared to only four percent in the 2019 NPHA. Benefits and Limitations - As the COVID-19 pandemic continues, depression and Why is Mental Telehealth Important for Older Patients? anxiety are on the rise. As a result, mental healthcare - There are multiple, potential benefits for older adults who providers are being pushed to provide care to more use telehealth to communicate with their mental health patients, while keeping themselves, their staff, and practitioners. patients safe. - At the top of the list is access, according to the APA. - Many are turning to telehealth as a way to provide During the pandemic, access is vital, especially since treatment to patients when they can’t be seen in person. some seniors may be immunocompromised. Additionally, The integration of telehealth into traditional medicine bringing care to the patient’s home or location via could reach far beyond the pandemic and into the future. telehealth may open possibilities for those who live in - Telehealth does have its positives and negatives, though. remote or rural areas to connect more easily with mental When implementing a plan for seniors and telehealth, healthcare specialists. healthcare providers should consider both the barriers - The APA suggests several other benefits of telehealth and opportunities to conduct the most effective telehealth including: visits for their patients and themselves. “Help integrate behavioral health care and primary - Are Mental Telehealth Visits as Effective as In-Office are, leading to better outcomes Mental Health Visits? Reduce the need for trips to the emergency room Yes, they can be. According to an article published in Reduce delays in care Annual Review of Clinical Psychiatry, evidence from Improve continuity of care and follow-up more than 100 controlled trials suggests that guided Reduce the need for time off work, childcare services, Internet treatments for a wide range of psychiatric and etc. to access appointments far away somatic conditions “can be as effective as face-to- Reduce potential transportation barriers, such as lack face treatments, lead to sustained improvements, of transportation or the need for long drives work in clinically representative conditions, and Reduce the barrier of stigma” probably are cost-effective.” J.A.K.E 11 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 - Telehealth becomes especially important as more older significantly from learning important business skills such adults are suffering from mental disorders at a time when as marketing, accounting and managerial techniques. their ability to meet with healthcare providers in person Then an aspiring nurse entrepreneur often begins work as has decreased significantly. a professional nurse in order to learn the industry and - Statistics from the American Association for Geriatric discover business opportunities within it. Psychiatry show that 20 percent of adults age 55 and older - While an advanced degree is not required for nurse have a mental health disorder such as anxiety, cognitive entrepreneurs to start their own business, many nurses impairment, or mood disorder. More recent data from the may consider a dual master's degree program in nursing Centers for Disease Control and Prevention (CDC), and business administration, in which students complete gathered between April and August 2020, show that week their Master's of Science in Nursing and Master of by week, the number of adults aged 50 to 59 who reported Business Administration degrees simultaneously. suffering from either depression or anxiety has risen to - Nurse entrepreneurs work for themselves and therefore levels as high as 40 percent. Additionally, those in the 60 the skills required for this position vary depending on the to 69 age range showed highs of 32%, while those in the nature of the individual business venture, but in general 70 to 79 or the 80 years and above age ranges showed the following skills and qualifications are beneficial for highs near 25%. nurse entrepreneurs: - Geriatrician Laurence M. Solberg, MD, who has been using ADN (Associate Degree in Nursing) or BSN degree and telemedicine through the U.S. Department of Veterans valid RN license Affairs (VA) for more than a decade, writes in the Institute Prior professional nursing experience within the for the Healthcare Improvement blog that “televisits are relevant area of specialty especially good for frail, older people because they don’t Basic business skills and knowledge (e.g., accounting, get worn out from the traveling to your office.” marketing, ability to manage staff) - Solberg recognizes that in spite of the benefits, there are Good communication skills for interacting with communication challenges that practitioners may need to customers, patients and employees manage when using telehealth with older patients. Ability to work independently and willingness to take Particularly, some providers may find it hard to make sure on personal financial risk that communication with older adults over an audio line or - In general, nurse entrepreneurs have completed a video screen does not seem impersonal or give the minimum of the ADN or BSN degree and have attained an impression that the provider is “just going through the RN license in the state in which they live. A background in motions.” business is also highly valuable for nurses who wish to - To overcome these obstacles, he recommends that start their own businesses. This may include informal providers consider using the 4Ms Framework: training or mentoring in business skills, taking a few Address what MATTERS to the patient in terms of their courses in business, or attaining a business degree. Many goals, preferences and priorities nursing schools across the country offer dual programs What MEDICATIONS they currently take which deliver MSN and MBA degrees simultaneously. Their level of cognitive impairment or MENTATION Their level of MOBILITY Certifications or Credentials Needed? “Using the 4Ms Framework is a simple way to - There are no specific certifications or credentials required personalize telemedicine and make it more for becoming a nurse entrepreneur. However, a nurse supportive of older patients,” Solberg writes. entrepreneur may find certain certifications valuable How to Make Telehealth Easier for Older Patients based on the nature of their business. For instance, a nurse who runs a home health company and provides NURSE ENTREPRENEURIAL patient care may wish to hold the Basic Life Support - Nurse entrepreneurs use their professional nursing Certification (BLS) from the American Heart Association or experience and education to start their own business in American Red Cross. the healthcare industry. Businesses established by nurse - Nurse entrepreneurs may work in a variety of settings, entrepreneurs may include developing and selling a home including in offices running their own business, as an health product or medical device, or offering independent independent nurse contractor in hospitals or clinics, in nursing services, such as patient care, nursing education, home healthcare visiting patients, or as a nurse educator. home health and/or consulting services. A nursing career Nurse entrepreneurs have the freedom to set their own path that offers independence and autonomy, becoming a hours and the flexibility to determine their own work nurse entrepreneur requires creativity, hard work and environments based on the company they establish. strong business skills. - Nurse Entrepreneur Do – A nurse entrepreneur uses his - As in other nursing careers, aspiring nurse entrepreneurs or her background in professional nursing to start their begin their careers by completing their Associate's Degree own business within the healthcare industry. Business in Nursing or Bachelor of Science in Nursing degree and ventures established by registered nurses run the gamut pass the NCLEX-RN exam. In addition to the standard from medical devices and home health products to nursing education, nurse entrepreneurs benefit independent nursing services such as patient care, J.A.K.E 12 of 13  CARE OF OLDER ADULTS – LEC: BSN 3RD YEAR 1ST SEMESTER FINAL 2022 nursing education, home health services and consulting work. The day-to-day responsibilities of a nurse entrepreneur depends upon the specific venture, but usually includes activities related to running a business including accounting, marketing or sales, and developing a customer base. Roles and Duties of a Nurse Entrepreneur Use nursing education and experience to establish their own business venture within the healthcare field Promote the business, including advertising and sales efforts to attract and retain customers Hire and manage employees to assist in running the business as needed Tend to the financial side of running a business, including accounting, payroll and tax issues Provide healthcare products or nursing services which may include direct patient care, education or consulting services depending on the nature of the business Nurse Entrepreneurial - An increasing number of nurses are enjoying the benefits of self-employment. While salary can vary widely based on the specifics of their business ventures, many nurse entrepreneurs are also independent nurse contractors who set the terms of their own services and negotiate their salary with a healthcare facility, such as a hospital or nursing home. While not as certain as traditional employment, a career as a nurse entrepreneur can be more profitable than a standard RN position. GOOD LUCKKK WITH UR FINAL EXAM, FUTURE NURSES!! J.A.K.E 13 of 13