BACHELOR OF SCIENCE IN NURSING
NCMB 314 CARE OF THE OLDER ADULT
COURSE MODULE COURSE UNIT WEEK
3 12 14
Trends / Issues and Challenges on the Care of the Older Persons
✔ Read course and unit objectives
✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks
At the end of the course unit (CU), learners will be able to:
Cognitive:
1. Identify current educational trends in gerontological nursing.
2. Distinguish among the certification requirements for Chartered Advisor for Senior Living,
Registered Financial Gerontologist, Certified Senior Advisor, and Certified Life Care
Planner.
3. Describe several settings and positions in which gerontological nurses may be
employed.
Affective:
1. Demonstrate tact and respect when challenging other people’s opinions and ideas
2. Accept comments and reactions of classmates on one’s opinions openly and
graciously.
Psychomotor:
1. Participate actively during class discussions and group activities
2. Express opinion and thoughts in front of the class
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Saunders 2nd Edition. Critical Care & Emergency Nursing
EDUCATIONAL TRENDS IN GERONTOLOGICAL NURSING
Opportunities in gerontological nursing are somewhat correlated with education level.
Many levels of preparation are available for nurses in gerontology such as:
Special education in caring for adults during basic preparation (LPN, RN associate
degree, diploma RN, or RN BSN level.
Post baccalaureate nurses choose a Clinical Nurse Specialist (CNS) or Geriatric Nurse
Practitioner (GNP)
Online programs for graduate or post-master’s study and complete clinical hours in their
own geographic location
Certifications in gerontology currently available from the American Association of
Colleges of Nursing (AACN)
Working in long-term care facilities such as nursing homes, assisted living, independent
living centers, or adult day care, or in an acute care hospital.
Gerontologic Nurse
the nurse must meet all of the following requirements:
o Currently hold an active
o registered nurse license in US or its territories.
o Hold a baccalaureate or higher degree in nursing.
o Have practiced 2000 hours within past 3 years
o Have had 30 contact hours of continuing education applicable to
gerontology/Gerontologic nursing within the past 3 years.
Gerontologic Nurse Practitioner
the nurse must meet the following requirements:
o Currently hold an active RN license in the US or its territories
o Hold a master’s or higher degree in nursing.
o Have been prepared as a nurse practitioner in either of
the following:
o A GNP master’s degree in Program
o A formal postgraduate GNP track or program Within a school of
nursing granting graduate-level academic credit
Clinical Specialist in Gerontologic Nursing
the nurse must meet all the following requirements:
o Currently hold an active RN license in the United States
or its territories
o Hold a master’s or higher degree in gerontologic nursing
o Hold a master’s or higher degree in nursing with a specialization in
gerontologic nursing.
o Have practiced a minimum of 12 months after completion of the
master’s degree
Meet the following requirements in current practice:
o If a clinical specialist must have provided a minimum of 800 hours
( post-master’s) of direct client care or clinical management
in Gerontologic Nursing within the past 24 months
o If a consultant, researcher, educator, or administrator, must
have provided a minimum of 400 hours
Life Care Planning
The concept of life care planning was first developed in the 1980s, to meet a growing
need for an informed document that presented actual estimated costs of care for
persons who had experienced a catastrophic injury or accident. Many settlements for
those persons in devastating accidents were made arbitrarily without actual calculation
and consideration of the multitudes of factors influencing these costs, such as doctors’
visits, equipment, medications, tests, cost of caregiving, and potential complications
over a lifetime.LCP is a comprehensive document designed to help meet the long-term
financial and health needs of a person experienced catastrophic injury. Life care
planners generally develop plans for insurance companies or awyers representing
individual clients, but the ultimate goal is to promote the best outcome for the person for
whom the life care plan was written.
The best life care planners have a nearly equal mix between work for insurance carriers
and work for lawyers who present patients, thus maintaining a neutral and professional
reputation for fairness.
Certification
The Certified Life Care Planner (CLCP) designation may be earned through 128
continuing education hours, successful completion of a sample life care plan, and
passing an examination (MediPro Seminars, 2004). The CNLCP (Certified Nurse Life
Care Planner) designation is offered by the American Association of Nurse Life Care
Planners Certification Board. It is similar to CLCP, but with additional requirements, and
is definitely designed for registered nurses with case management experience.
Future Potential
Life care planner may be a concept that will be carried into the senior population. Not
only are seniors living longer, but they continue participating in higher risk activities today than
in generations past. The principles of life care planning could also easily be extrapolated for
use with those seniors who have long-term chronic health problems. A good financial planner
could provide a more accurate and detailed projection of health care cost over a lifetime of
disability or illness. The demand for professionals in gerontology and rehabilitation is likely to
grow quickly with the aging baby boomer group. Gerontological nurses combine their
knowledge in health care with some financial training to offer distinctive services to the older
age group.
Financial Gerontology
Financial gerontology is a growing subfield of financial planning. FG is defined as “ the
intellectual intersection of two fields, gerontology and finance, each of which has practitioner
and academic components” which combines the knowledge and skills associated with financial
planning and asset management with expertise in meeting the unique needs of older adults.
Certification for FG
Chartered Advisor for Senior Living (CASL)
- A person with CASL certification assists older persons with retirement savings,
pension and social security planning, health and long-term issues, estate
planning and managing life course transitions, family relationship and living
arrangement. A person must complete five courses that take approximately 60-
80 hours of study each. After the course the individual must pass a computerized
exam. Maintenance of the certification with continuing education credits. A code
of ethics must also be agreed to in writing prior to being granted the designation.
Registered Financial Gerontologist (RFG)
- The RFG certifications a similar designation to the CASL, but is offered through
the American Institute of financial Gerontology and supported by the American
Society on Aging. The Individual must complete six courses, a learning
requirement, and a comprehensive examination. Course content is related to
wealth span planning, ethics, and serving the older adult. Compared to CASL
courses, the curriculum appears more suited to gerontologist than financial
planners.
Certified Senior Advisor (CSA)
- The CSA is a designation offered by the society of Senior Advisors. The
curriculum includes a large number of topics in aging, chronic illness, end of life,
and long-term care as well as Medicaid and financial planning. It is self-study
program that takes 2-6 months to complete. To obtain the CSA, the person must
also pass a secured, computerized, final comprehensive examination online that
consists of 150 multiple choice questions within 3 hours.
Recent trends in health promotion & disease prevention activities, such as:
Improved nutrition,
Decreased smoking,
Increased exercise, and
Early detection & treatment of risk factors such as hypertension & elevated serum
cholesterol levels.
TRENDS IN LONG-TERM CARE
Long-term care is the “broad range of medical, custodial, social, and other care services
that assist people who have an impaired ability to live independently for an extended period”.
The National Council on aging estimates that 6.4 million people all over the age of 65 and 50%
of those over age 85 will need long-term care. Thirteen million persons in United States
currently report having long-term health needs. This number is expected to grow to 22 million
in the next decades. The nation spent $ 183 billion on long-term care services in 2003
(American Health Care Association & National Center for Assisted Living, 2005). In 2005,
Medicaid spent nearly $95 billion on long-term care. Persons must pay for many long-term
care expenses from their savings and assets before being eligible for Medicaid. This has
prompted new sources of funding for future long-term health care needs.
LONG-TERM CARE INSURANCE
Long –term care insurance is designed to cover individuals needing health care outside
of the hospital, including diagnostics testing, rehabilitation, and custodial care. Reasons for
purchasing long-term care insurance include worrying about being a burden to their family,
staying financially independent, having more choices for care if needed( such as remaining in
the home), preserving their assets, and providing peace of mind.
The cost of long-term insurance premiums (at age 65) ranges from $1,000-$2,650 per
year, depending upon a number of factors including health status and history. The average
stay in a nursing home is 2 years. The average cost for a private room in a nursing home in
2003 was $181.24/day (National Council in aging, 2005). This average cost increase to
$194/day by 2006 (over $70,000/year), though costs vary widely by geographic area. Assisted
living facilities average $2,691/month for a one-bedroom unit. Financial analysts predict that if
nursing home care costs rise a bit faster than inflation, by 2026 a room in a nursing home
could cost $ 177,000 per year; another cost projected the cost to increase to $ 200,000 per
year by 2030.
Long-term care insurance can be purchased at anytime, but premiums increase with
age. In, 2005, the annual premiums for a low-option policy for a person who was age 65 was
about $1,800, and increased to about $5,500 at age 79. Long-term care insurance may cover
any one or all of the following types of care.
Nursing Home care
Assisted living
Hospice
Home health
Adult day care
Respite
Caregiver training
Home health care coordinators
EMERGING MODELS OF CARE
A Shift to Different Living Facilities
One of most significant changes in care for older adults is the shift away from nursing
homes. As they have known traditionally. Some predict that the only nursing homes that will
survive will be excellent ones. The institutional look of the older nursing home that was
modeled after the hospital, with long hallways and a sterile-looking environment, is becoming
unacceptable to many older adults as a place to live out their final days. Newer lonf-term care
facilities promote private rooms, residents’ choices and control, and a more home-like
environment that mirrors assisted living facilities of today.
CONTINUING CARE RETIREMENT COMMUNITIES (CCRCs)
Growing trend for older adults, services by promoting aging in place through offering
various levels of care on a continuum that might include independent living, assisted
living, skilled care, and home health services all on one campus. The trend will be to
bring services to the CCRCs versus transferring persons to the next level of care on the
continuum (for example, sending them to the “nursing home” when their care demands
increased).
Green Houses- a movement to replace nursing homes with more home-like environments,
started through the vision of a physician named Bill Thomas, consist of 10-12 residents in a
home setting who enjoy private rooms and share a common living space. This designed
provide a full range of care services, but in a friendly atmosphere that reminds one of
home.
Geriatric Care management – Another emerging trend in gerontological nursing is the role
of the geriatric care manager. The professional geriatric care manager (PGCM) is a
specialist who helps families care for older adults while encouraging as much
independence as possible. PGCMs may come from a variety of backgrounds such as
social work, psychology. Sociology, geriatrics, and nursing, nurses have emerged as
natural leaders in this growing field. The educational background knowledge of the aging
process make this role an excellent fit for nurses who seek a position that affords
independence and autonomy while using their skills.
PGCM perform the following:
Conduct assessments
Develop care plans that address pertinent problems
Arrange, interview for, and monitor in-home caregivers or other services
Act as a consultant for caregivers who live near or far
Review financial, health-related, or legal issues
Provide referrals to other geriatrics specialists
Intervene in times of crisis
Act as an advocate and/ or liaison between families and service providers
Coordinate or oversee care
Assist with transitions in living arrangements, including recommending the most
appropriate settings and helping facilitate the move
Provide education and links to resources
Offer counseling and support
Some PGCMs also offer guardianship, caregiving, and /or financial services.
COMMUNITY LIVING DESIGNS – another fascinating trend related to gerontological
Nursing is the emergence of companies completely devoted to the strategic planning,
engineering, architecture, building, and marketing of community living designs that are tailored
to today’s older adults. Older adults who choose to live in senior communities expect to have
access to transportation and needed services such as health care, appropriate housing, and
opportunities for socialization. Baby boomers are predicted to live in suburban communities
versus urban or rural areas (Frey 2007), so the need for age-appropriate and friendly
retirement communities is projected to increase. Lehning,Chun, and Scharlach (2007) stated
that:
An aging –friendly community has three primary characteristics: 1) age is not a
significant barrier to the maintenance of life-long interests and activities; 2) supports and
accommodations exist to enable individuals with age-related disabilities to meet basic health
and social needs; and 3) opportunities exist for older adults to develop new sources of
fulfillment and engagement.
In spite of the need for such communities, shortfalls in public policy and lack of creativity
in architecture have led to structural barriers related to best use of land, housing policies,
transportation, and opportunities for involvement in the larger community. There remains a
general lack of concern and investment of suburban communities in providing housing for the
aging portion of their citizens. This has created a gap in service that potentially can be filled by
forward thinking companies who recognize the plight of long-term care in this area and stand
ready to assist.
One such example of a company developed to assist organizations with designing and
building appropriate and age-friendly living spaces is Community Living Solutions (2008) of
Neenah, Wisconsin. This company advertises its purpose as “enlightening your life and
community with expert knowledge and sustainable solutions” . With a unique team of
professionals that includes engineers, architects, and other design experts, companies such as
Community Living Solutions work with organizations such as continuing care retirement
communities (CCRCs), independent living facilities, and assisted living design and build
attractive, contemporary living areas within a fiscally responsible budget. The ideal team takes
into consideration the mission and needs of the community and understands the unique
limitations and desires of their older clientele. A great deal of thought and effort goes into
designing an environment that will be attractive and functional for older adults, and marketable
for the institution. Attention to details such as positioning of garden areas and windows to best
use the space and sunlight is essential, and the savvy builder carefully plans all aspects of the
environment with consideration to older residents.
Gerontological Nursing - is the specialty of nursing pertaining to older adults.
Gerontological nurses work in collaboration with older adults, their families, and
communities to support healthy aging, maximum functioning, and quality of life.
Journal reading (Access to social services) Read and summarize all the benefits
access in social services, then reflect on its implication(s) in today’s nursing practice.
Textbooks:
Eliopoulos (2018). Gerontological Nursing 9th Edition.Wolters Kluwer
Meiner (2019). Gerontologic Nursing 6th Edition. ELS
Miller (2019).Nursing for Wellness in Older Adults 8 th Edition . Wolters Kluwer
Touhy ( 2018). Ebersole and Hess Gerontological Nursing and Health Aging
Filit (2017). Brocklehurts Testbook of Geriatric Medicine and Gerontology
Patińo, Mary Jane. (2016). Caregiving volume 1. Manila: Rex Book Store. F 649.1 P27 2016,v.1, c1
Doenges, Marylinn E. (2002). Nursing care plans: guidelines for individualizing patient care, 6 th ed.
Philadelphia: F. A. Davis Company. R 610.73 D67 2002, c5
Meiner, S. E. (2007). Gerontological Nursing 3rd Edition. Quezon City. pp. 310-311, 371.
Wold, Gloria Hoffman. (2012). Basic geriatric nursing, 5th ed. MO: Elsevier.618.970231 W83 2012,
c1
Mauk, Kristen. (2010). Gerontological nursing: competencies for care.MA: Jones & Bartlett
Publishers.610.7365 G31 2010
Cuison (2017).The Philippine College of Geriatric Medicine’s
Websites:
www.ebscohost.com
www.doh.gov.ph
http://www.pna-pjn.com
