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Recs for Rx
Where to Care?
Now I know my ABCDs
Steel Yourself
Potpourri
100
This term is used to indicate multiple drug use, and usually implies the use of some drugs that are duplicated or unnecessary.
What is "polypharmacy"? (Polypharmacy Objective 1) From textbook, p. 226
100
Mr. Johnson is a 70 year old male who has multiple medical issues that qualify him for nursing home care. He and his wife both receive Medicare and Medicaid benefits. Mr. Johnson's wife is concerned that he is not getting the care he needs at home, and she cannot continue to care for him - even with the help of an occasional home aide and her adult children. Mr. Johnson refuses to live anywhere but his own home. This day program might provide the services Mr. Johnson requires, without requiring him to live somewhere else.
What is the PACE Program? (Program of All-Inclusive Care for the Elderly)
100
This entitlement program, started in 1965, is a major source of health insurance coverage for persons age 65 and older, who are automatically enrolled through the Social Security Administration.
What is Medicare? - Health Policy Objective 1
100
Freedom from suffering, achievement of life closure, and receiving care consistent with one's beliefs, wishes, and values.
What is the definition of a "good death", according to Dr. Nancy Hodgson's lecture. - End of Life Objective 1
100
This part of Medicare combines hospital insurance benefits and medical insurance benefits under an HMO plan managed by a private insurance company.
What is Medicare Part C? Also known as "Medicare Advantage Plans". - Health Policy Objective 4
200
According to Dr. Diane Aschenbrenner, these THREE physiologic aging-related changes in METABOLISM affect the way in which the body breaks down drugs.
What are: (1) Decreased hepatic mass (2) Decreased hepatic blood flow (3) Decreased overall function of the liver? (Polypharmacy Objective 2)
200
This program places special emphasis on adapting a hospital's clinical environment, culture, and staff expertise to improve outcomes for older adults. At its foundation is the role of the Geriatric Resource Nurse (GRN). It may also involve the creation of an ACE Unit, specially designed for acute care of older adults.
What is the NICHE Program? - Models of Care Objective 2
200
These are the three major groups of persons who are eligible for enrollment in Medicare.
Who are: 1. Persons age 65 and older 2. Persons under 65 with certain disabilities 3. Persons of any age with End Stage Renal Disease (ESRD) - Health Policy Objective 2
200
This important aspect of physical well-being, if not well-managed, may prevent achievement of transcendence and closure at the end of life.
What is pain and other unpleasant symptoms? - End of Life Objective 2
200
As opposed to need, this is considered the major driver of health care services for older adults (according to Dr. Ibby Tanner's lecture).
What is reimbursement? Leads to excessive deference to an acute care system where Medicare is biased towards hospital care and Medicaid is biased towards institutional care, leading to an inequitable distribution of services.
300
According to Dr. Diane Aschenbrenner, these three types of PREVENTABLE medication errors can lead to serious adverse effects in older adults, particularly in the hospital setting.
What are errors in prescribing, administering, and monitoring medications? (Polypharmacy Objective 3) Lecture handout & textbook p. 227
300
According to Dr. Ibby Tanner, these are considered three necessary components to facilitate good transitional care.
What are: 1. "health coach"/partner 2. medication management 3. health literacy/education (all of which require excellent COMMUNICATION!) - Models of Care Objective 3
300
The government does not pay into this program, but individuals who have multiple functional limitations and who've paid in for at least 5 years and been employed for at least 3 of those 5 years can purchase this long term care insurance from the government, which will provide a cash benefit up to $50 a day to pay for non-medical services & support.
What is the CLASS Plan? - Health Policy Objective 3
300
This document is different from many other types of advance directives, in that it is transferable across care settings, and unlike a living will, it is a physician order for treatment preferences at the end of life that has been shown to decrease unwanted treatments and enhance symptom management.
What is a Physician's Order for Life-Sustaining Treatment? (POLST - or MOLST in Maryland) - End of Life Objective 3
300
Mr. A, a 78-yo, has a terminal illness and his doctor would not be surprised if he was not alive in 6 months. Mr. A has received aggressive therapy, and is now exhausted and wants to go home to focus on achieving closure and improving his quality of life in his remaining months. This BENEFIT of a government-sponsored entitlement program would cover the cost of care and drugs to manage Mr. A's symptoms and pain during these final months.
What is Medicare- Hospice Benefit.
400
These guidelines assist providers to identify medications that are potentially inappropriate for use in older adults.
What are the Beer's Criteria? (Polypharmacy Objective 4)
400
These campuses are designed to provide "care for life", and may include facilities for independent living, assisted living, nursing home care, sub-acute care, as well as additional services such as dental, podiatry, vision, etc.
What are Continuous Care Retirement Communities? (CCRCs) - Models of Care Objective 4
400
This part of Medicare covers inpatient hospital services and care at skilled nursing facilities up to 100 days per acute episode and home health care when there is a need for skilled nursing care for a limited time.
What is Medicare Part A? - Health Policy Objective 4
400
These are the persons who can make decisions for an elder if that elder is found to lack capacity for a specific decision (list in order - name at least the first 4).
Who are: 1. An appointed guardian 2. Person given Durable Power of Attorney 3. Elder's spouse 4. Adult children of the elder (age 18 or older) 5. Adult brothers and sisters 6. A guardian who may be appointed if no one else is available - End of Life Objective 4
400
These are considered signs and symptoms of imminent death (name at least 4).
What are: 1. decreased urine output (or dark/scant urine) 2. cold and mottled extremities 3. vital sign & breathing changes 4. respiratory congestion 5. "Death Rattle" 6. Delirium/confusion 7. Restlessness
500
According to Dr. Diane Aschenbrenner, these are common problems encountered during med reconciliation for older adults. (Name at least three common problems with older adults' medications)
What are: 1. Patient doesn't know the drug indication or side effects 2. Patient takes drug incorrectly (wrong dose, route, frequency) 3. Drug interactions 4. Inappropriate medications (see Beer's Criteria) 5. Duplicate prescriptions 6. Expired medications 7. Patient is experiencing an adverse effect that has not been addressed 8. Overly complicated drug regimens 9. Patient is taking a drug prescribed long ago for a condition they no longer have
500
These are considered outcomes of excellent transitional care (name at least 3).
What are: 1. lower rates of re-hospitalization 2. lower rates of emergent care 3. better oral medication management 4. improved patient satisfaction & quality of life 5. lower costs of care in the long-term - Models of Care Objective 5
500
This government insurance program is currently a major payer for long term care.
What is Medicaid? - Health Policy Objective 5
500
A philosophy of care and an organized, highly structured system for delivering care that expands on traditional disease-model medical treatments to include the goals of enhancing qualty of life for patient and family, optimizing function, helping with decision-making and providing opportunities for personal growth.
What is the definition of palliative care? - End of Life Objective 5
500
!!!DAILY DOUBLE!!! - This supplemental insurance policy can help low-income older adults who qualify to pay for care and prescription drug costs not covered by Medicare or Medicaid, and can be applied for in a variety of ways.
What is "Extra Help"?