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The policy of health and social care is eloquent based on the care and demands of the older people. Older people as well as service providers are affected due to the continuing changes in health provision and pressures for cost containment. Many a time, older people have found themselves means-tested for services that have been provided free of cost. Arrangements from nursing care homes limit the money available all over the world, use of a formula that interprets low, medium and high need. A little contribution to the cost of care is paid. According to an international research, the principles of these kinds of agencies cover assessment, for example, the single assessment process (SAP) and the national service framework. However, the approach of any multi-national agency should expose, in both its structure and process, good and latest nursing practice.
Now it is a well-known fact that nursing assessment for older people is important. An expert nursing care and care homes for older people plays an important role in the care and comfort of older people.
Health and social care needs have been inter-related by the people who need continuing care. Nursing care in care homes has been long argued that distinctions between the two are unworkable. Thus, an interview was conducted which help older could people to communicate and balance their health needs with their chosen lifestyle.
Clinical judgment is used by the Care Home staffs to take care of older people and enable them to , improve, maintain, recover and to cope up with their problems and to achieve a better quality of life.
Older people make up a large and increasing percentage of the current population. As people grow older, with the rate of increasing their ages, they are increasingly at risk of so many health problems many injuries also. Falling down is the first indication of an
undetected illness. Major preventions should be taken for these kinds of problems as they create considerable mortality, morbidity and suffering for older people and their families, and incur social costs due to hospital and nursing home admissions.
Targeted strategies should be made which aim at behavioral change and risk modification for those living in the community appear to be most promising.
Online research data from different web sites, different articles, and theoretical studies from different books. The methodology which had been used was collecting data from both primary and secondary sources. Primary sources were the personal interaction with the experts and secondary was the information collected from websites.
Qualitative interviews were used to explore views on maintaining dignity of 18 residents of nursing homes. A qualitative descriptive approach was used. The analysis was both deductive (arising from the dignity model) and inductive (arising from participants’ views).
LITERATURE REVIEW AND FINDINGS
Today most of the older people living in nursing homes are losing their life there itself. Model based on empirical, is of dignity which has been developed and which forms the basis of a brief psychotherapy to help in promoting dignity and reduce distress at the end of life of older people. The main objective of this study is to explore the generalisability of the dignity model to help older people in nursing homes. As a result of this study, the main categories and features of the dignity model were broadly and intuitively supported on various issues like illness-related problems, social aspects of the illness experience and dignity protecting repertoire. However, some of the sub themes which were related to death were not supported and two new themes came out. Some of the residents found their symptoms and loss of their function were due to old age rather than illness. Although residents did not emerge to experience distress due to thoughts of impending death, rather they were distressed by the multiple losses they had experienced.
These finding helps in adding to our understanding of the concerns of older people in care homes on maintaining dignity and suggest that dignity therapy may boost up their sense of dignity. This is one of the major reasons of choosing this topic related to older people as in today’s scenario, older people are loosing their existence. As per the findings we got to know that the majority of residents who are living in nursing homes die within 2 years from multiple kinds of medical pathologies. Generally they are heavily reliant on staff for their care, which can grind down their sense of dignity. Maintaining dignity are considered as the highest priority in health and social care strategy documents in most European countries and particular concerns have been raised about loss of dignity in care. Although there is a big deal about rhetoric around dignity, there is no agreed and prescribed definition of this. A brief review of the studies based on international researches exploring the concept of dignity from a nursing perspective have showed a wide range of definitions and understanding related to the construct; however, a most common and important theme was to respect a patient as a person. Two of the studies have explored the different views of people on dignity of older people in care homes. One of them found that not being a burden for others was important to residents, and their sense of dignity was threatened by illness and care needs, at the same time the other one described three main themes:
- The body which can not be recognized.
- Feebleness and dependence on others.
- Self inner strength and a sense of coherence.
One of the approaches related to dignity-oriented care provision, which focuses directly and specifically on end of life, is Chochinov’s dignity-conserving model. This model was developed from interviews which were conducted with patients with advanced cancer and other old age problems (average age was 75 years), focusing on the factors which supports and undermines their dignity. The particularly most important aspect of Chochinov’s dignity model is that it has provided the framework for psychotherapy which helps in promoting a sense of dignity and reduces psychological and spiritual distress for older people who are reaching the end of their life.This study has shown promising results for people with advanced cancer and other diseases, along with their families. It is quite clear from different international researches that older people living in care homes are completely helpless vulnerable to having a fractured sense of dignity, which suggests that dignity therapy, may be of benefit to them. Since the therapy is brief which usually takes only two sessions and can be delivered at the bedside by a trained health care professional, it may be feasible to offer this in a care home setting. However, the dignity model, and therefore dignity therapy, is based on the views of people who are residing in home care centers, most of whom were cared for in the community. It has been shown that less than 10% of residents of nursing homes die
from diagnosed cancers and other old age distresses also. Whether or not the model is generalsable to people with no these kinds of problems or to those living in other settings such as care homes, is not known. The aim of this study is to explore and understand the generalisability of Chochinov’s dignity model to older people cared for in nursing homes. In recent years there has been a considerable increase in the need for effective health care and them oral boosting for older patients. Our society is ageing day by day, and a large number of people are going into advanced old age.€ ‰dentification of treatable diseases before it stats its affect in older people, promises reduction in premature mortality and morbidity in old age. Most of the elderly and frail people are receiving long term care in the community and there are a number of home care centers for older people.
There is a perception that some early intervention and rehabilitation services, currently which are being provided in hospitals and home care centers, might be provided in community settings. More effective health care centers are available for providing care managing chronic diseases, such as chronic lung disease, cerebrovascular and coronary heart disease, diabetes, depression, and degenerative conditions such as osteoporosis, dementia and Parkinson’s disease. To be implemented for all who might benefit these interventions need to be organized into structured programs.
To be the most effective home care center for older people, and to respond to the needs of individuals, care planning should take integrated account of all of the health care needs of individuals particularly when these include both physical and mental health problems as well as the protection of their dignity. Effective health promotion and proactive health care provided by the health care centers for older people are extending the active life-span of older people, reducing the number of people who suffer disability, vulnerability and dependence.
The National Service Framework for Older People has been published to ensure the delivery of higher quality services to older people all over the world. The NSF requires the identification of service champions for older people within Each home care organization which are running for older people. Older people should have access to a new range of intermediate care services at home or in designated care settings to promote their independence by providing advanced services from the nursing care services and local authorities to prevent unnecessary hospital admission and effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care.
There should be a safe and effective care for older people in enhanced care settings in the community and nursing care centers which require co-ordinated and competent care by a skilled workforce of healthcare professionals, working efficiently together. There should be a proper assessment and rehabilitation in community settings nursing care centers for older people. At the same time there should be a rapid response for acutely ill older people and also a medical support should be provided by Hospital at Home schemes.
Following services should be provided to older people:
Services like podiatry, occupational therapy, hairdressing, personal care, social support, shopping assistance, small group programs, carer support and domestic assistance for self funded retirees and younger people living with a disability and overnight community respite cottage.
Service like Family Support Service for families who have children with disabilities arising from a combination of physical, intellectual and sensory impairment with or without complication health issues (0-16 years). Other Services like Domestic Assistance, Personal Care, Social Support and also Other Food Services, Assessment, Case Management, Home
Maintenance, Goods/Equipment Provision and Transport and a centre-based day care,
social support and other Services like transport should be provided.
Should provide nursing care and other services like personal care, allied health care, respite care, social support, domestic assistance, assessment, case management, and personal care, domestic assistance, in home respite, social support, physiotherapy, occupational therapy, volunteers & chaplaincy. Nursing care; they also provide centre-based day care, in-home respite care, allied health care, other food services, domestic assistance, social support, information and advocacy, counselling/support, language assistance. etc.
Meals on wheels:
This service used to deliver meals to the older people.
Home care services:
Should provide personal care – night time mobile attendant care service for people with physical disabilities who require personal care & assistance throughout the night. Domestic assistance for younger disability;
Should also provide centre-based day care, respite care, podiatrist, hairdresser, transport, home maintenance, minor modification, Home Assist Secure, social support, extended programs, mental health program, younger disability programs, carer support, volunteer coordination.
Should provide other services like, Centre based and in-home respite, podiatry, occupational therapy, hairdressing, personal care, social support, shopping assistance,
small group programs, carer support and domestic assistance for self funded retirees and younger people living with a disability, overnight community respite cottage and Veterans Home Care.
Community health centers:
Should provide domestic assistance, social support, allied health care, nursing care, personal care, assessment, health promotion, indigenous health.
Allied health care services:
Services should be Centre based and in-home respite, hairdressing, social support, shopping assistance, small group programs and domestic assistance for self funded retirees and younger people living with a disability, personal care etc.
Following measures should be taken by Nursing care homes for older people:
In order to help the older people from poverty, isolation and neglect, following actions should be taken:
- Make older people enjoy a better life by providing life-enhancing services and vital support.
- Keep developing products that are specifically designed for older people and which are helpful in their day to day life.
- Provide advice and information through their help lines, publications and online at all times.
- Fund pioneering research into all aspects of getting older.
- Join forces that will ensure more of their funds go where they’re needed.
In order to improve the current situation of the place, the agency needs a huge amount of money. So it should work on the following areas to raise funds for the development:
The agency should always look for donations and gifts which are always proved as the greatest source of income.
The average value of new legacies has been increased over the years.
British Journal of Social Work 2009 39(4); doi:10.1093/bjsw/bcp024
Events and sponsorship are the most valuable sources of income. Money is raised through an exciting variety of events including dances, local walks and runs, overseas treks and cycle challenges.
All members of the agency should come together and help in raising over a million pounds to support their work with disadvantaged older people.
The members of agency should use their voice to raise money for the welfare of the older people. They can either sing door-to-door, out in their community or plan a special carol service.
Membership and sponsorship schemes:
Many voluntary organisations operate membership schemes. These often offer something to us in return – access to historic buildings, nature reserves, galleries, or magazines and the chance to attend events.
More and more organisations now offer the opportunity for supporters to sponsor a beneficiary or a project. These schemes bring us closer to the work we are supporting so we can get a real picture of what sort of difference our money is making.
Schemes that seem identical on the surface can be very different in detail – they are all valuable as far as the charity is concerned but may offer different experiences to us as a donor and we need to know what to expect.
In oder to motivate the memebers of the nursing care homes, the managers should use the following ways:
By rewarding the team members
Always implimenting new ideas
By giving responsibilities and recognitions as well
In order to get more and more amenities for the older people, the nursing homes and communities for older people along with the other members of the agencies should work on the following principles:
- Their vision should see a world in which older people flourish.
- Their mission should to improve the lives of older people.
- They should make a real difference to the lives of older people. They can do it by combining the unique strengths, skills and experience of the great charity organizations and sponsors.
- They should create one united organization that will be stronger and more influential than ever before.
- They should develop excellent and sustainable services that enhance older people’s lives.
- They should deliver transformational and sustainable change through their research, policy and influencing.
- They should always provide definitive products and services tailored specifically for older people but available to all.
- They should maximize their reach through their retail estate and quality training services.
- They should create a single, powerful compelling brand by 2010.
- They should try to become a world renowned organization, reaching out to enhance the lives of older people globally.
- They should create an effective partnership with their national and regional networks.
Agencies for older people should implement the following strategies:
There should be a strategy which the agencies should implement, strategy and action plan following consultation on a broad range of seniors’ issues including health, transport, workforce participation and housing.
The main aim this strategy should be to ensure seniors feel safe, supported and have access to appropriate services. To achieve this, the agencies should be keen to explore
ideas for working in partnership across government as well as with business and the community. The Government is developing a whole-of-government loom for the way they support seniors into the future. The strategy will definitely identify priority areas for action with an emphasis on making positive changes for seniors who are vulnerable, disadvantaged or socially isolated.
Journal of Aging & Social Policy, Volume 21, Issue 1 January 2009
The socially isolated older people should be provided the following amenities:
Basically, the meaning of social isolation is a low level of interaction with others combined with the experience of loneliness. It is a serious issue for seniors because of the unfavorable impact it can have on health and wellbeing of the older people.
Although the majority of older people are not socially isolated, the number of people at risk of social isolation is expected to increase with the ageing of the population. The older people living in nursing care homes are also socially isolated.
The older people who are residing in these kinds of agencies are either retired, physically disabled and ill health or loss of a partner and loss of transport.
It should always be given importance that older people have the opportunity to be socially connected and, if they wish, to participate in community life.
There is a project called The Cross-Government Project which is working to reduce Social Isolation of Older People and was established in 2003 to identify and develop innovative responses to reduce the social isolation of seniors. The project has identified many key findings that can inform program design, service delivery and policy development. A number of reports from various stages of the project have been published. The project also developed best practice guidelines to assist service providers, government agencies and community groups in designing and implementing projects to reduce social isolation of seniors.
The British journal of social work
Following improvements should be made in nursing care homes for older people:
In order to improve the condition of Nursing care homes and communities for older people, the following services should be provided:
- Rents of the agencies should be decreased.
- The place should always be kept clean and hygienic. To keep the place clean and hygienic there should be a well managed housekeeping department.
As we know that the success any organization is totally dependent upon the employees of the organization. If the employees are getting their job satisfaction then only they give their 100% to the organization. So, If the emplyees of the agency are not satisfied with their salary, then they should be paid competitively. So the salaries should be competitive (In comparison to other organizations). Hence, agency should always do Salary survey, to settle this grievance of the Employees.
Employees’ nature of the job should be challenging at each and every stage but not so difficult that it appears impossible. It should not be boring, hence, set challenging goals for the employees of the agency.
- Upward/Downward flow of communication should always be ensured.
- Management of the agency should be highly effective.
- All the employees of the agency should feel the sense of belongingness with the kind of work they do.
- Managers of the agency should always play the role of counselors and mentors in the Organization.
- At all times, the agency should identify the need of the Employees as well of the older people and should decide the motivation strategy.
- The way of reaching these agencies should always be kept convenient.
If the social work agencies are facing difficulties in reaching the park, then the government should also provide transportation to them. The government can not afford to loose these social work agencies at the cost of bad transportation as these agencies play a vital role in uplifting the welfare of the older people.
The first and the most key principle of good practice is to be aware of the presence of older people in an emergency and take active steps to locate and identify them.
It is an essential step that relief interventions are developing to make consultation with the target community. To perform this activity, first it is necessary to locate, meet and assess the needs of older people through direct observation and discussion and can also be done by directly working with them to identify and address both their immediate needs and their vision for recovery. There should be some steps to achieve these goals. First that includes locating older people, checking their records in service facilities to find out if the expected numbers of older people have attended and, if not, investigate why they are not attending. There should be an ‘outreach’ approach into assessments, which can include staff, volunteers and other older people to locate vulnerable older people in particular. Mutual support networks of older people can also be used to gather information on the whole community of older people and also the civic, religious and other community leaders can be enquired because getting on track of older people is the foremost important task in order to make developments for them. Group meetings should be organized by using participatory rapid appraisal (PRA) techniques to allow older people to identify, prioritize and begin to address their problems and explore their capacities.
It should be ensured that older people are represented on relevant decision-making and advisory bodies such as disaster preparedness committees, emergency co-ordination committees, nursing care homes and special issue groups. Older people all over the world have begun to control their own lives and influence decisions in their own communities. Basic training should be provided to older people’s representatives and other home care centers to help them to identify the most vulnerable members in a community.
Several basic needs have been identified for older people.
If there homes have been destroyed, they need building materials and labor to help
rebuild shelters. To cook food, they need help for collecting fuel and other ways to share
cooking arrangements with neighbors or other individuals.
Clothing, fooding and shelter are among the basic items required for older people.
Nursing care homes should also provide some work to older people; agencies should address the basic needs and should therefore take account of the some needful factors.
Many older people are not automatically given shelter by their adult children and they need and find shelter for themselves. Nursing care homes are aiming at grouping older people together with people, whom they do not know (for example, to make up the numbers required to qualify for shelter or for allocation of supplies such as utensils, plastic sheeting and blankets) can lead to problems of exclusion and abuse
as the larger group rejects or resents the presence of the older person. There are situations where basic shelter facilities provided by agencies working for older people leave older people sleeping on cold, hard, or damp surfaces may mean that chronic but manageable joint problems become acute and severely debilitating. But there are solutions to overcome theses problems. Nursing care homes are working on that. They are providing better services to older people. Nursing centers are providing proper fooding system to them. They have simple age-related clinics to deal with issues such as joint pain and other ailments associated with ageing are especially relevant where displaced people are sleeping in the open or on hard, cold or damp surfaces. These clinics are helping in reducing pressure on limited resources by treating groups of older people together, and also they are limit ‘revolving door’ patterns of repeated patient visits to regular clinics.
They make ensured that drugs are available to treat any kind of diseases suffering by older people. Several psychosocial programs are developing that involve and support older people in all conditions. In situations of displacement this may mean dealing with issues such as the fear of death and burial in a ‘foreign’ place, as well misery for losses already sustained. These nursing care homes are also providing proper food that is digestible by older people for example: maize flour rather than whole grain maize etc.), and that takes account of digestive disorders and a common lack of teeth. They provide food which is familiar and culturally acceptable. They also provide Lobby for supplementary feeding systems to include severely malnourished
older people. They also ensure that food for work programs do not exclude older people from food provision and older people have the resources (such as fuel, water and utensils) to cook their food rations if they are not taking from the nursing care home. If the older people are living alone or in pairs, it is important that the utensils available
to them are manageable and enough for them. Older people should be linked with their families, only if the family as well the older people are ready to keep the relationship. These agencies are understanding and taking care of the particular risk factors and issues affecting the nutritional status older people. Generally, older people try to hide their sorrow and bad experiences, they stay calm and patient, they try to gather together in groups to support each other and try to share their problems. Older people always want to build, not to destroy.”
Journal of Aging & Social Policy, Volume 21, Issue 1 January 2009
Nursing care homes for older peole and agencies working for older people teke care of the their interestd and also some of them rely on fundraising income to achieve their aims. The fundraisers make sure the these kinds of organizations achieve maximum impact in their fundraising activities, drawing on the strength of organization’s ‘brand’ to encourage supporters to make whatever contribution they can to their work.The agency is working for the welfare of socially isolated and disadvantaged older people and making efforts to overcome all the obstacles coming in their way to provide the best facility to the older people.For the disadvantaged older people, Christmas was never the same without their family……but the places like Caravan Park of Queensland gave them somewhere to stay and arranged counseling for them â€¦..things are better now…they are looking forward to Christmas.
Most of the elderly people are living alone. From the findings we came to know that there are 1.5 million people over 70 in the Netherlands, of whom a third are living alone. Usually older people in nursing care home have lost their partner. The largest majority of the older population still surviving and staying on their own. Half of the people over 70 still live with a partner. We can say that one in three lives alone. Only less than 10% live in an old age or nursing home. Many older people are only admitted to a home when they are very old other wise they go for nursing care homes and agencies which are working for older people. Only 3% of people in their seventies live in an old age or nursing home. Among people in their eighties the showed percentage is still higher, but the people living in homes are a minority (17%). It is only when people reach their nineties that half of them live in a home. More older people still have their partner
It has been forecasted that in the next twenty years, these nursing homes are going to get older people as they are providing the best amenities to them in terms of food, shelter and cloth. The number of older people who are living on their own is expected to decrease.
Some 47% of the people over seventy still have their partner and both of them residing in nursing care centers only. It is expected to become 53% in 2020. The average life expectancy will increase, especially among men. One of the causes for the increase in the number of elderly single people living on their own is that a smaller percentage will be admitted to old age and nursing homes. Between 1995 and 2000 the population over 70 increased by nearly 7%. Government policy of Dutch advocates that older people should go for such kinds of nursing home care centers and agencies working for them. The main aim of the policy is that people only get institutionalized when they can no longer live in their own environment and not with the help of organized home care.
Statistics of Netherlands expects a increase in the percentage of older people admitted into care facilities. While the population over 70 will increase by 50% in the next 20 years, the number of people admitted to a home is expected to increase by 20%. Care in the home environment will be increasingly replaced institutionalized care. Moreover, there will be a big development in forms in between living totally on ones own and living in a home: for instance living semi-independently in an apartment complex geared to providing care on demand.
REFERENCE AND BIBLIOGRAPHY
News paper articles:
Publications available from websites
British Journal of Social Work 2009 39(4); doi:10.1093/bjsw/bcp024
The British journal of social work
Journal of Aging & Social Policy, Volume 21, Issue
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