o DISABLED: individual unable to hold a pencil or use a

Long Term Care Services conventional toilet

Dr Manalo
2. Elderly
SPECTRUM  Long term care is used primarily by frail elderly who because of
 Long term services includes a broad spectrum of care generally reduced physical vigor (often with some loss of mental acuity)
utilized by individuals with severe medical and social problems can no longer be solely responsible for their own maintenance
that limit normal residential living and functioning
 Armanda of services, both health related and social, that are 5 common chronic problem
needed to help individuals who are fully or partially impaired in 1. Incompetence
their conduct of daily living activities  Alzheimer
 Continuum of care  Multiinfarct dementia
 Family Medicine emphasizes responsibility for total health care  Geriatric Depression
- from the 1st contact and initial assessment through the ongoing  Benign forgetfulness of senescence
care of chronic problems (from prevention to rehabilitation) 2. Immobility (Arthritis)
  3. Incontinence (Urinary)
Target Groups  Urge incontinence
 Bladder inhibition
1. Disabled
 Spinal cord lesion
 Disability may be due to physical or mental health problems
 Neurogenic bladder
 Long term care services extend beyond health care. It includes  S/Sx
social and emotional support services as well  Severe urge to void but can't control
Types  Stress incontinence
o Impairment: a permanent or transitory psychological,  Damage/dysfunction of bladder sphincter
physiological or anatomical loss or abnormality of structure  Leakage of urine when intra-abdominal
or function pressure is raised
o Handicap: a disability that constitutes a disadvantage for a  S/Sx
given individual in that it limits or prevents the fulfillment  Incontinence in coughing or sneezing
of a role that is normal depending on age sex, social and  Overflow incontinence
cultural factors of that individual  Bladder outlet obstruction or detrussor failure
 A physical disability or health impairment is NOT a handicap  Bladder unable to empty normally
unless it limits the individuals participation in routine activities  Overdistention
o NOT DISABLED: a student with an artificial arm who  Leakage
can take part in all activities  S/Sx
 Urgency

Long Term Care Services Page 1

  Feeling of the inability to void
 Small amount of urine
 Reflex incontinence
 Functional incontinence Long term care services
 Immobility/severe cognitive impairment
 S/Sx Acute Care Inpatient units
 Unaware that he/she had voided Psychiatric care
4. Iatrogenic Dse Rehabilitation
 Doctor/nurse induced
Ambulatory care Outpatient clinic
 Due to meds  toxicity
Adult day care
 e.g. NSAIDS/Pan reliever  Ulceration  Renal Failure
Mental helath care
5. Impaired Homeostasis Alcohol and substance abuse
 Heat fatigue
 Hypothermia Extended Skilled nursing facilities
 Dizziness Step down units
 Syncope
 Decreased renin and aldosterone Wellness and Health Promotion Educational program
 e.g. Anemia, Nutritional Deficiency Recreational and social support
Note: Geriatric px require diffferent approach in caring than that Volunteer programs
of adults - PULSE Profile Meal programs
3. Partially impaired/Handicapped Outreach linkage Screening
IMPAIRMENT: permanent/transitory psychological, Information/referral
physiological, anatomucal loss or abnormal of structure/function Telephone contact
DISABILITY: restriction/prevention of performance of an activity, Emergency assistance
resulting from impairment, with in the range considered normal Transporation
for human being
4. Chronically and Terminally Ill Housing Continuing care communities
 Who are these people? Congregate care
o Young people with genetic illnesses Assisted living
o Patients suffering from neurologic dse Home care Hospice care
o Patients requiring parenteral therapy Home health
o Cancer victims Homemaker and personal care
o Terminal patients

Long Term Care Services Page 2

Long Term Care Services Page 3
 1. Home Care o "Linkage" between the physician discharge staff, the
Definition community agencies that provide a variety of services
o Array of services that may be brought into the home singly (from visitors to home health aide) for the homebound
or in combination in order to achieve and sustain optimum Home Care Team
state of health, activity and independence of individuals 1. Physician
requiring such services, because of acute illness or long 2. Registered nurse Commonly Included in the
term acute limitations due to chronic illness and disability 3. Dietitian home care team
o Emphasis is placed on assisting the patient to achieve 4. Physical therapist
independence 5. Medical social worker
o Home care is a team effort 6. Occupational therapist
o Multidisplinary approach: doctors bring back (Px) to at 7. Speech therapist
least normal state 8. Homemaker (Assists in homemaking chores like cleaning,
Services laundry, running errands, etc)
9. Health care aide (assists in self-care activities like bathing,
Available in the local setting Hospital based grooming, dressing, etc)
of home care Respite care Advantages
Hospice care Occupaional therapy o Wounds heal faster
Nursing care Speech therapy o Patients feel and eat better
Physical therapy Home delivered meals
o Patients and families take more responsibilities for their
Oxygen and respiratory Home diagnostic kit
own care
Intravenous therapy Friendly visitors
o Fewer sleeping pills and antidepressants
Medical social service Medical supplies
Self care instructions Medical supplies
o Families are less disrupted by the need to make frequent
Transporation services Durable medical equipmet trips to the hospital
communication devices (wheelchair, beds, etc) o Home care costs less
Diagnostic specimen Home health aide care Home visits
collection Homemaker care Reasons for home visit
Referral to community 1. Assessment and/or management of acute illness
resources a. Too ill: severe attack of influenza or an attack
Bereavement care of CHF
b. In severe pain: exacerbated by movement such
o The primary care physician will inevitably have to carry as sciatica
most of the responsibility in home care c. Too old: such as an elderly patient with stroke
d. In need of some treatment before being
moved to the hospital

Long Term Care Services Page 4

 e. Infectious to other people such as adult with Goals of Palliative care
chickenpox 1. Achievement of the "Best Quality of Life"
2. Assessment and management of patients discharged 2. For Patients and their families
from the hospital 3. Interdisciplinary
Due to the trend toward ealy discharge, more 4. Timeline: Admission through "bereavement"
emphasis is given tothe patient's rehabilitation 5. Available at all time
requires adaptation to the home and activities 6. Many aspects of palliative care applies earlier in the course
of daily than to work activities. of illness in conjunction with anticancer treatment
3. Patients are confined to the home due to chronic Services
problem which would require periodic home visits so 1. In patient consultation and referral (charity and pay, can,
that their progress can be assessed ad treatment new cancer)
monitored  Co-manage for: assessment, medical evaluation and
4. Assessment of home conditions and family functions identification of needs pain and symptom control
Home visits can be deleated to allied health  Disclosure issues (Patient and family)
professionals or to paramedical workers  Counseling (Individual and family)
But the physician should remember that  Coordination of care among different disciplines
home visit is one of the means by which  Preparation for discharge including home care giving
bonds between a doctor and a family are (skills)
forged and stengthened  Terminal care
Status and Future of Home Care  Principles in Palliative Care
A National Hospice Coordinating Council has been o Affirms life and regards dying as a normal process
organized to look at the status of hospice care services in o Neither hasten nor postpone death
the country o Offers a support system to help the family cope during
2. Hospice Care the patient's illness and in their own bereavement
o Hospice: comes from the root word hospitality  Supportive, Pallative, Hospice Care
o Latin word "Haspes", meaning stranger
o Hospitalis: friendly, warn welcome to strangers Consult In patient
o Hospitium: Warm feeling between a gust and a host Unit
Home
ation
o WHO Definition: active total care of patients and their
families by the multi-professional team when the patient's
dse is no longer responsive to curative treatment
"To cure sometimes, to relives often, to comfort always" -Hippocrates
o Consist of palliative and supporting services that
provide physical, psychologic, social and spiritual care for
dying persons and families

Long Term Care Services Page 5

 Components of Hospice Palliative Care
1. In patient Units
 Reasons for in patient unit 2. Home care
a. To control pan and other symptoms difficult to  Hospice and palliative care stresses the home as the
manage at home* primary "venue of care" particularly necessary for
a. To provide respite for fatigue family members* patients who are non ambulatory.
b. To provide for training goods  Care includes:
*Require 3-7 days of admission in the hospital.  Management and control of the patinet's
Once problem has been controlled, px may be sent physical symptoms
home  Provision of psychoemotional and social
 Important notes support to the patient and his family
a. Is NOT for any active tx  Provide information and training to the
b. Does NOT have provisions for resuscitation patient's family at home to attend o the other
c. Provides personalized care for the patient needs of the cancer patient
d. Focuses on providing comfort for the patient  Team unit consist of
rather than cure  Doctors
e. Provides emotional and spiritual support for  Nurses
both patients and family  Social workers
f. Provides the interdisciplinary team of nurses,  Pastors
physicians, social workers, clergy and  Family caregivers
volunteers that strives to enhance the quality  Community health workers
of life in the time remaining for that patient  Volunteers
and the family 3. Out Patient Consultation Clinic
g. Specialize in pain and symptom management  Center based, community oriented, geographic
h. Teaches and support the patient and family catchment area with personnel who are trained in
throughout the admission palliative care, patient and family counseling
i. Teaches and support the patient and family 4. Day Care
throughout the admission  Patient can have some form of diversion and activity
j. Provides flexible visiting hours on the 2 hour other than those provided in their homes
basis to accommodate the needs of the 5. Bereavement support
patient and family  After the death of the patient, family members are
k. Allows visitation of children for short period of given help
time  May cover 6-8 months after the patient's death
6. Counseling: psychosocial and spiritual

Long Term Care Services Page 6

 7. Volunteer program and training (caregivers)

Long Term Care Services Page 7

 Criteria for Admission o No strict criteria for when to bring the family of a patient
a. Any patient with limited life expectancy or whose dse is together for a family meeting
not responding to curative treatment (cased on referring o Protocol from Doherty and Baird
doctor's diagnosis and prognosis) a.Routinely convene the family
b. Patient and the family must consent to hospice care 1. Hospitalization (on admission and upon
c. The patient's primary or personal physician must consent discharge)
to hospice care 2. Serious chronic illness
Interdisciplinary Hospice Team 3. Terminal illness and death
o Physician 4. Routine obstetrical and well child care
o Nurse a.Consider convening the family
o Social worker 1. Serious illness
o Counselor 2. Compliance problems
o Spiritual support 3. Poor control of chronic illness
o Patient care coordinator 4. Somatization
o Volunteer coordinator 5. Anxiety or depression
o Volunteer specialist for referral of difficult cases 6. Substance abuse
 e.g. Psychologist, psychiatrist, radiation oncologist,
7. Parent child problems
pain specialist, surgeon, medical oncologist, etc. 8. Marital and sexual difficulties
9. High utilization of medical services
3. Family Meeting  
 Hallmark of family oriented medical practitioner: is his ability  
call for and conduct family meeting when needed  
 Essential for the physician to bring the patient's family
together in cases where their cooperation is very important
particularly in long term care of patients s especially in home
care
WHO?
a. All the members of the patient's IMMEDIATE household
b. Friends involved with the illness
o Discourage inviting new members if they were failed to
attend the 1st session
o Min requirement: presence of persons considered to be
emotionally significant to the patient
WHEN?

Long Term Care Services Page 8