Cathy Cress

Expert in Aging Life and Geriatric Care Management

Care Plan Interventions- How to Make Doable

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Make Interventions Doable

Interventions in a care plan need to be doable. Let’s take for example with Mr. Jefferson the client we have used in my You Tube on Dual Assessment . In creating  care plan interventions for him, as an aging professional or geriatric care manager, you want Mr. Jefferson to accept your intervention of having a replacement for careprovider Sally, his live in 80 year old companion, to do ADL’s and IADL’s 4 days a week. After all he is mentally competent and very attached to Sally and could reject your intervention.

How do you make this doable? What you as an aging professional or geriatric care manager may use to convince him to ” do this” is what I said in the You Tube about him – he would rather die than burden Sally. If you can convince Mr. Jefferson that by relieving some of the care for him four days a week, this will relive Sally’s burden. This will also mean conferring with Sally and having her agree to this intervention and get her buy in.

Then this must mean having a small meeting with Sally and Mr. Jefferson where consensus can be reached that they both agree to this intervention and that Mr. Jefferson is willing to pay for this private duty care provider. A geriatric care manager or aging professional  would also reach out to the adult child who hired you, Alice, and explain your strategy and reasoning to her. As she is worried about Sally’s health, this would be a way to show you that you are working professionally to answer both her and her Dad’s needs along with Sally’s.

It may be that the family, Sally and Mr. Jefferson, may want you to interview the care providers and recommend which one they should hire. So, remember to create a solution based on facts derived from your assessments plus the art of convincing the client to accept your intervention. This makes the solution doable.

 

How do You Craft a Care plan for a Dual Assessment

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SPLAT- Documenting Falls and Reporting to Drs.

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SPLAT blog Friday

The job of the aging professional or geriatric care manager is often to be the messenger. When you assess a client and find problems like falls you report the falls to the primary physician. This is being the messenger.

How do you code the message about a fall?

I mention SPLAT in my You Tube Video on Mobility and Falls SPLAT is an acronym to document falls. This can be used by a geriatric care manager or other aging professional

SPLAT-

Symptoms -When you visit the client and they report a fall- what were the symptoms, before the falls such as lightheadedness-

Previous- Ask if they had previous falls

Location of the fall.

Activity- ask what they doing previous to the fall

T- Time of the fall.

After you document a fall, the next step is to report the fall to the older person’s primary physician. Dr. Dr. Alicia Arbaje from Johns Hopkins Medicine discussed the effects of elderly falls as well as how they can be prevented. Watch her You Tube on Falls and learn more

 

The Daily Shower Can Be a Killer – Falls in the bath

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The Daily Shower Can be a Killer was the headline of the NY times article on January 29, 2013. As we have covered activities of Daily living as a part of a Functional assessment, the deadly nature of bathing for the elderly comes up as a giant red flag Falls are the most common cause of death in the elderly, as I discussed in the You Tube on Mobility and falls yesterday. According to the CDC , if you are over 65 falls are the leading cause of injury and death.

What can a geriatric care manager or aging professional do to prevent these falls?

Most elders fight with bad vision, thereby making them an easy prey to falls is the bathroom. GCM can take steps to increase the bathroom safety for elders living in at home and have vision examinations updated normally

Most senior eyes may require extra light to see things clearly. GCM or aging professional can increase the light in the bathroom by fixing bulbs with high voltages and dimming light.

Besides this, slippery surface can serve as a perfect recipe for bathroom falls.

The GCM or aging professional needs to take preventive measures before things get worse? Fixing an overflowing tap, purchasing some non-slippery carpet on the ground and suggesting any other any tool that you think can help you get rid of the slippery bathroom surface.

Clutter in the bathroom can be addressed. A cluttered place will increase the chances of injury. All clothing and other required materials should be kept in a safe place from where they do not fall very often.

Grabs bars should be a necessary fitting in your bathroom. It’s important that you have stainless steel and solid grab bars that can offer firm support. Grab bars can come very handy when a person loses his/her balance. Also, a GCM or aging professional can have the elder invest in a good shower chair. More than often, elders slip while performing some basic movements in a standing position.

By introducing a shower chair can enable elders to sit comfortably while having a shower, thereby reducing the chances of getting injured. . The GCM or senior professional can make sure there is a non- slip bathmat in the tub.

Besides this, make sure that you make life easier for elders in your family by keeping things within their reach. Your best bet over here would be to store all bathroom related amenities in a place where they can easily reach without bending or stretching their body. This will prevent the instances of bathroom falls. Elderly people suffering from arthritis and other bone diseases will thank you a lot.

 

Assessing for a care providers or family member to do standby with bathing is another safety assessment to prevent bathroom falls. Remember , the bathroom is the most dangerous room in the house.

 

Functional assessment does dovetail. You can see now how doing the ADL evaluation of bathing is integrally related to mobility in functional assessment. All the parts of a functional assessment and the whole geriatric assessment can help older people not only functional better in their home and avoid falls that can obviously be a killer.

Falls and Mobility- Assessments to Evaluate

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In a Functional Assessment you test mobility. Direct observation can identify problems in gait and balance. Early detection of deficits in mobility can identify those clients at risk of injury. Whenever possible, rehabilitation can then assist in restoring functional losses and reduce the risk of falls. For those deficits that cannot be rehabilitated, assistive equipment such as a cane or walker can be provided.

The Tinetti Balance and Gait Evaluation is a 28-point assessment tool that is performed by a trained evaluator. This can be done by a GCM, an OT or an RN but all should be trained in the test.

A condensed version of the Tinetti is also available. This test, the Get Up and Go Test, is simple to administer, requires no special equipment, and can be conducted in a brief amount of time. The test begins with the client sitting up straight in a high-seat chair, which allows the person to sit with hips at a 90-degree angle to knees. The client is then instructed to (1) get up (without using armrests if possible), (2) stand still, (3) walk forward 10 feet, (4) turn around and walk back to the chair, and (5) turn and be seated. The evaluator notes sitting balance; transfers from sitting to standing; pace and stability of walking; and ability to turn without staggering. Statistical verification of the test by the developers showed good correlation between test scores and other measures of gait, which in some cases involved more sophisticated laboratory-based measures of balance and gait.

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