Caselet

Despite so many Filipino nurses and medical practitioners working abroad, one of the unmet
healthcare needs is dedicated care for elderly in the Philippines, be it from government, private
hospitals or health insurance organizations. The elderly needs help in mobility, memory, body
control, illness and in other situations.
a. Identify the irritants, disappointments and annoyances of the elderly when it comes to
health care when they needed them.
The elderly Filipinos -- persons 60 years of age and above, estimated to be about 6.8% of the
100 million-Philippine population -- is an integral sector of the society which needs support and
protection to enable them to enjoy and have more productive, quality lives. As we age, A lot of
our elders are coping with at least one of the following conditions, and many are dealing
with two or more of the following: Heart conditions (hypertension, vascular disease,
congestive heart failure, high blood pressure and coronary artery disease). Dementia,
including Alzheimer's disease. Depression, Incontinence (urine and stool), Arthritis,
Osteoporosis, Diabetes, Breathing problems, Frequent falls, which can lead to fractures,
Parkinson's disease, Cancer, Eye problems (cataracts, glaucoma, Macular Degeneration)
As the body changes, other things to be aware of are:
A slowed reaction time, which is especially important when judging if a person can drive.
Thinner skin, which can lead to breakdowns and wounds that don't heal quickly. A
weakened immune system, which can make fighting off viruses, bacteria and diseases
difficult. Diminished sense of taste or smell, especially for smokers, which can lead to
diminished appetite and dehydration

b. Identify the barriers why dedicated elderly care is not being provided.
ABUSE. It can happen in the family. It can happen in nursing homes. It
could be physical or psychological (like verbal abuse) when they are
named called or threatened, or taken advantage because of their memory
problems. One form is NEGLECT! When people who are supposed to care
for them ignore their needs and concerns.Having someone else look after
aging parents is a tough decision to make, and is made even tougher by
fact that one of four nursing homes has been blamed for the death or
serious injury to a resident each year, according to government figures.
LONELINESS. Death of a husband or wife and many friends. Children are
busy with work and may not even come to visit them. Grandchildren are
busy with school. Physically weak elderly may feel that they are burden so
they try to stay away even if people are around. Loneliness leads to
depression they feel alone and unproductive.
POVERTY. They cannot earn anymore and they do not have money. May
receive retirement pension but may not also be enough because of their

increasing medical needs. As such many even try to continue working

even after reaching the retirement age.
HEALTH. Diminished sensory and motor abilities. Tendency to acquire
various illnesses such as heart disease, Alzheimer, cancer, etc.
DISCRIMINATION. Job discrimination employers prefer younger
applicants because.inexperienced workers have cheaper salaries
employers believe that the elders could only stay in work for a short time
because of their declining physical condition.elderly are thought of as
slower and less capable.
Social discrimination maybe excluded from family or community
services because they are seen as in capable.
Medical Discrimination - Some doctors treat them without much care
because they think they dont deserve such because they are already old.

c. Think of how exceptional care and customer service can be provided to the elderly at a
very affordable price when they need it,, that is, in the absence of their families taking
care of them.

d. Your solution must bring reasonable profit to the enterprise in order for the enterprise to
be self sustaining

Caselet
Despite so many Filipino nurses and medical practitioners working abroad, one of the unmet
healthcare needs is dedicated care for elderly in the Philippines, be it from government, private
hospitals or health insurance organizations. The elderly needs help in mobility, memory, body
control, illness and in other situations.
a. Identify the irritants, disappointments and annoyances of the elderly when it comes to
health care when they needed them.
ABUSE. It can happen in the family. It can happen in nursing homes. It
could be physical or psychological (like verbal abuse) when they are
named called or threatened, or taken advantage because of their memory
problems. One form is NEGLECT! When people who are supposed to care
for them ignore their needs and concerns.Having someone else look after
aging parents is a tough decision to make, and is made even tougher by
fact that one of four nursing homes has been blamed for the death or
serious injury to a resident each year, according to government figures.
LONELINESS. Death of a husband or wife and many friends. Children are
busy with work and may not even come to visit them. Grandchildren are
busy with school. Physically weak elderly may feel that they are burden so
they try to stay away even if people are around. Loneliness leads to
depression they feel alone and unproductive.
POVERTY. They cannot earn anymore and they do not have money. May
receive retirement pension but may not also be enough because of their
increasing medical needs. As such many even try to continue working
even after reaching the retirement age.
HEALTH. Diminished sensory and motor abilities. Tendency to acquire
various illnesses such as heart disease, Alzheimer, cancer, etc. A slowed
reaction time, which is especially important when judging if a person can
drive. Thinner skin, which can lead to breakdowns and wounds that don't
heal quickly. A weakened immune system, which can make fighting of
viruses, bacteria and diseases difficult. Diminished sense of taste or smell,
especially for smokers, which can lead to diminished appetite and
dehydration
DISCRIMINATION. Job discrimination employers prefer younger
applicants because.inexperienced workers have cheaper salaries
employers believe that the elders could only stay in work for a short time
because of their declining physical condition.elderly are thought of as
slower and less capable.
Social discrimination maybe excluded from family or community
services because they are seen as in capable.
Medical Discrimination - Some doctors treat them without much care
because they think they dont deserve such because they are already old.

b. Identify the barriers why dedicated elderly care is not being provided.
Disparities in access to health services afect individuals and society. Limited
access to health care impacts people's ability to reach their full potential,
negatively afecting their quality of life. Barriers to services include:

Lack of availability

High cost

Lack of insurance coverage

These barriers to accessing health services lead to:

Unmet health needs

Delays in receiving appropriate care

Inability to get preventive services

Hospitalizations that could have been prevented 3

c. Think of how exceptional care and customer service can be provided to the elderly at a
very affordable price when they need it,, that is, in the absence of their families taking
care of them.
Access to health services encompasses four components: coverage, services, timeliness, and
workforce.
Coverage
Health insurance coverage helps patients get into the health care system. Uninsured people are:

Less likely to receive medical care

More likely to die early

More likely to have poor health status 4, 5, 6

Lack of adequate coverage makes it difficult for people to get the health care they need and, when
they do get care, burdens them with large medical bills. Current policy efforts focus on the provision
of insurance coverage as the principal means of ensuring access to health care among the general
population. Other factors, described below, may be equally important to removing barriers to access
and utilization of services.

Services
Improving health care services depends in part on ensuring that people have a usual and ongoing
source of care. People with a usual source of care have better health outcomes and fewer disparities
and costs.7, 8, 9
Having a primary care provider (PCP) as the usual source of care is especially important. PCPs can
develop meaningful and sustained relationships with patients and provide integrated services while
practicing in the context of family and community.10 Having a usual PCP is associated with:

Greater patient trust in the provider

Good patient-provider communication

Increased likelihood that patients will receive appropriate care 11, 12

Improving health care services includes increasing access to and use of evidence-based preventive
services.13, 14 Clinical preventive services are services that:

Prevent illness by detecting early warning signs or symptoms before they develop into a
disease (primary prevention).

Detect a disease at an earlier, and often more treatable, stage (secondary prevention). 15
In addition to primary care and preventive services, emergency medical services (EMS) are a crucial
link in the chain of care. EMS include basic and advanced life support. 16 Within the last several years,
complex problems facing the emergency care system have emerged.17 Ensuring that all persons
have access to rapidly responding, prehospital EMS is an important goal in improving the health of
the population.
Timeliness
Timeliness is the health care system's ability to provide health care quickly after a need is
recognized. Measures of timeliness include:

Time spent waiting in doctors' offices and emergency departments

Time between identifying a need for specific tests and treatments and actually receiving
those services

Actual and perceived difficulties or delays in getting care when patients are ill or injured likely reflect
significant barriers to care.18 Prolonged Elders wait time:

Decreases patient satisfaction.

Increases the number of patients who leave before being seen.

Is associated with clinically significant delays in care.

d. Your solution must bring reasonable profit to the enterprise in order for the enterprise to
be self sustaining

January 30, 1998 98-R-0161

(Revised)
TO:
FROM: Helga Niesz, Principal Analyst
RE: Barriers to Independent Living for Elderly
You asked for a brief description of the barriers to independent living for older adults and state or
other programs that promote independent living and keep seniors out of nursing homes.
It appears that many senior citizens prefer to age in place in their own homes or in some
relatively independent residential setting. They want to avoid going to a nursing home as long as
possible. The state also has a policy and financial interest in seeing that its senior citizens live
independently as long as they can and, when they can no longer live totally independently, that
they have available to them a range of appropriate choices in a continuum of care options.
BARRIERS
Barriers to independence include not so much age itself, but the ill health, frailty, increased need
for medical attention, handicaps, and difficulties with the activities of daily living that are more
likely to arise with advancing age. Another significant barrier can be lack of money. State
programs provide financial aid and medical services, including long-term care, to low-income
elderly. But many people are above the income and asset eligibility limits for these programs yet
still do not have enough money to pay for expensive long-term home health care, housekeeping
services, high-cost prescription medicines, or other medical services they need. Other barriers
include lack of adequate transportation, lack of handicapped-accessible or senior-friendly
housing in the private housing sector, and lack of family or social support that would enable
them to continue to live independently. Sometimes elderly people who have become physically
infirm or handicapped would like to stay in their homes, but the home needs renovations to make
it handicapped accessible. Problems with home security or fear of crime in the community can
also be barriers to seniors who want to remain living independently in their own homes.
FINANCIAL ASSISTANCE
The state provides very low-income elderly with financial assistance through the State
Supplement Program, which augments the parallel federal Supplemental Security Income
program (SSI). Low-income senior citizens can also qualify for food stamps.
Low-to-moderate income elderly can benefit from towns' circuit breaker programs, which give
them a rebate on their property taxes if they are homeowners or their rental and utility payments
if they are renters.

People who are not eligible for state assistance and own a home can consider a private reverse
annuity mortgage (RAM). This is a mortgage for people who are house rich and cash poor,
but do not want to sell their home and move to benefit from the equity they have accumulated.
With a RAM, they can borrow the money in a lump sum or in monthly payments as needed for
any purpose. The interest accumulates, but they do not have to pay the loan back until they sell
the house or die. At that point, the debt is paid from the proceeds of the sale. Only a few lenders
now make such loans. The federal government is starting a program to guarantee them.
The Connecticut Housing Finance Authority also makes very limited RAM loans, for a term of
only five years and only to pay for long-term care for people who are under certain income
limits.
HOUSING AND HEALTH CARE
Options for Seniors Remaining in their Own Homes
People who want to stay in their own homes and need some type of long-term medical care or
assistance with the activities of daily living can of course directly employ someone to provide
these services if they can afford it. For people of more limited means, the state's Connecticut
Home Care Program for Elders pays for home health care and homemaker services provided by a
licensed home health agency. There are two parts to this program. One part, funded by Medicaid,
pays for services to people who meet Medicaid's income limits. The other, state-funded portion
pays for those who are above Medicaid limits but whose assets are under $15,804 for individuals
and $23,706 for couples. There is a graduated scale of co-payments based on what these clients
can afford. But it appears there are limits to what this program pays, which can result in the
individuals having to go to a nursing home.
Another option for people still living at home who have some family or other support is to go to
an adult daycare center during the day and return to their own home at night. The homecare
program pays for an adult daycare center if it is appropriate for those who qualify financially.
But most adult daycare is paid for privately.
The growing availability of long-term health care insurance policies in the private market that
cover home health care as well as nursing home care could, in the long run, contribute to
allowing more seniors to stay in their own homes.
Other Elderly Housing and Health Care Options
Seniors who qualify financially (up to 80% of the area median income) and do not want to, or
cannot, keep up their own home can live in public elderly housing, which provides only
independent housing. For people who qualify financially but need a little more help, there is
state-assisted congregate housing, which provides some housekeeping, limited personal care
services, and at least one meal a day in a common dining room. The state Rental Assistance

Program (RAP) provides a partial subsidy to low-income residents of elderly housing and
congregate housing.
For people who need additional help, including more hands on nursing services, but do not yet
need a nursing home, there is assisted living. These services are generally offered in a
managed residential care community, which can be a rental complex or other usually high-end
retirement community. For instance, a number of continuing care retirement communities
(CCRCs) provide assisted living services to their residents. CCRCs receive no state assistance
and usually require an entry fee of $100,000 or more and a monthly fee of from $1,000 to
$3,000. But they guarantee long-term care, usually in an attached or affiliated nursing home if it
is needed. These high entry and monthly fees usually prevent lower-income seniors from
choosing this option.
Medicaid, which pays for homecare for some low-income people, does not pay for assisted living
services. The 1997 legislature authorized funding for a pilot program to bring assisted living
services to lower-income people living in one state-assisted congregate housing complex.
Providing a whole range of these different living options for people at all income levels is one
way of delaying or preventing more entries into nursing homes.
TRANSPORTATION
Transportation is a problem for many elderly. Some older people are unable to drive because of
illness, frailty, or finances. Some of them, particularly older women, never learned to drive. And
public transportation is not always available, convenient, or adequate. Finances may prevent
frequent use of taxis and there may not be relatives or friends available to take them to doctor
appointments or shopping. Dial-a-ride programs attempt to fill in these gaps, but their funding is
limited.
OTHER PROGRAMS
Other programs that support independent living for seniors, such as ConnPACE, elderly nutrition
programs, meals-on-wheels, home heating assistance, adult family living, and the homeshare
program are described in OLR Report No. 98-R-0160, which is enclosed.
HN:lc/pa
1. 1. Caring for the Elderly
2. 2. ..generally begins at the age of 60People in this age group are called
..Senior Citizens
3. 3. According to the World Health Organization. .there are almost 700 million
people over the age 60 living in the world today. among those 13% are over 80
years old. it is expected that by 2050 this number will be almost 2 billion and
the number of elderly will be higher than the number of children

4. 4. In the Philippines. According to the National Statistics Office, the total

number of Senior Citizens (60 years old and above) is 4,565,560 as of 2009
.this number comprises 5.97% of the total Philippine population.
5. 5. More Statistics At this time elderly population is growing by 800,0000 a
monthDid you know thatChina has the most number of elderly in the world
..about 88 million
6. 6. What are the Elderly Like?Physicalvisual and hearing problemssmell and
taste lossessusceptibility to illnesses Leading Cause of Death heart diseases
pneumonia cancer
7. 7. What are the Elderly Like?Cognitivedecline in mental processes may
experience memory lapses or disorientation. Spotlight on: ALZHEIMERs
Diseaseis a progressive irreversible brain disorder that ischaracterized by
gradual deterioration of memory,reasoning, language and physical
functioning...WHO reports as of 2009 that almost 35 million elderlysufers from
this kind of disease.
8. 8. What are the Elderly Like? Spotlight on: ALZHEIMERs Disease this disease
has no cure and the cause is unknown, as such people do not know how to
prevent it although some doctors reported that it could be alleviated with some
form of diet and memory training games. Alzheimers is a sad disease the
elderly cannot remember the people and place in their lives. They need
consistent care because they could walk away or get lost
9. 9. What are the Elderly Like?Socialbecause of their declining health and
limitedmobility, most elderly have the tendency towithdraw from the society
spending most oftheir time looking back reflecting on what theyhave made out
of their lives. Social Theories of Aging Disengagement Theory Activity Theory
Social breakdown Reconstruction Theory
10. 10. What are the Elderly Like? Social Theories of Aging Disengagement Theory
as older adults slow down, they gradually withdraw from the society.
Disengagement is a mutual activity in which the elderly not only disengaged in
the society, but the society disengages from the older adult. The elderly develops
greater self-preoccupation and decrease emotional ties with people and reduced
interest in social activities. Such social withdrawal and increased self-absorption
was thought to increase life satisfaction among them.
11. 11. What are the Elderly Like? Social Theories of Aging Activity Theory as
opposed to the disengagement theory, this theory argues that the more active
and involved the elderly are, the more likely that they are satisfied with their
lives. It is therefore important to find substitute activities for them after their
retirement.
12. 12. What are the Elderly Like? Social Theories of Aging Social Breakdown
-Reconstruction Theory This theory states that aging is promoted through
negative psychological functioning brought about by the negative views of the
society about elderly and inadequate provision of services for them. Social
reconstruction can occur by changing the societys view of the elderly and by
providing adequate social services for them.
13. 13. What are the Elderly Like? Society views elderly as Society develops label for
the incompetent; obsolete elderly: useless; inefective; helpless Society provides
inadequate support services, and funds for the elderly. Elderlys skills deteriorate
Elderly labels self as incompetent
14. 14. What are the Elderly Like? Society develops positive label for Society views
elderly as the elderly: helpers; self-controlled; competent; important wise;
competent Society provides support systems for the elderly: family support;

housing; health services; economics; nutrition and social services. Elderlys skills
improve Elderly labels self as competent
15. 15. Issues Facing the Elderly ABUSEIt can happen in the familyIt can happen in
nursing homesIt could be physical or psychological (like verbalabuse) when
they are named called or threatened,or taken advantage because of their
memoryproblems.One form is NEGLECT! When people who aresuppose to care
for them ignore their needs andconcerns
16. 16. Issues Facing the Elderly ABUSE Having someone else look after aging
parents is a tough decision to make, and is made even tougher by fact that one
of four nursing homes has been blamed for the death or serious injury to a
resident each year, according to government figures.
17. 17. Issues Facing the Elderly LONELINESSDeath of a husband or wife and many
friends.Children are busy with work and may not even come to visit them.
Grandchildren are busy with school.Physically weak elderly may feel that they
areburden so they try to stay away even if people arearound.Loneliness leads to
depression they feel alone andunproductive.
18. 18. Issues Facing the Elderly POVERTYThey cannot earn anymore and they do
not havemoney.May receive retirement pension but may not also beenough
because of their increasing medical needs.As such many even try to continue
working evenafter reaching the retirement age.
19. 19. Issues Facing the Elderly HEALTHdiminished sensory and motor
abilitiestendency to acquire various illnesses such as heartdisease, Alzheimers,
cancer, etc.
20. 20. Issues Facing the Elderly DISCRIMINATIONJob discrimination employers
prefer younger applicants because.inexperienced workers have cheaper
salariesemployers believe that the elders could only stay inwork for a short
time because of their decliningphysical condition.elderly are thought of as
slower and less capable.
21. 21. Issues Facing the Elderly DISCRIMINATIONSocial discrimination maybe
excluded from familyor community services because they are seen
asincapable.Medical Discrimination - Some doctors treat themwithout much care
because they think they dontdeserve such because they are already old.

hanks to new medications and surgical techniques, people are living longer. However, the
body we had at 55 will be a very different body than the one we have at 75. Many issues,
both genetic and environmental, affect how we age.
The most widespread condition affecting those 65 and older is coronary heart disease,
followed by stroke, cancer, pneumonia and the flu. Accidents, especially falls that result in
hip fractures, are also unfortunately common in the elderly.
A lot of our elders are coping with at least one of the following conditions, and many are
dealing with two or more of the following:

Heart conditions (hypertension, vascular disease, congestive heart failure, high

blood pressure and coronary artery disease)

Dementia, including Alzheimer's disease

Depression

Incontinence (urine and stool)

Arthritis

Osteoporosis

Diabetes

Breathing problems

Frequent falls, which can lead to fractures

Parkinson's disease

Cancer

Eye problems (cataracts, glaucoma, Macular Degeneration)

As the body changes, other things to be aware of are:

A slowed reaction time, which is especially important when judging if a person can
drive.

Thinner skin, which can lead to breakdowns and wounds that don't heal quickly

A weakened immune system, which can make fighting off viruses, bacteria and
diseases difficult

Diminished sense of taste or smell, especially for smokers, which can lead to
diminished appetite and dehydration
The list can seem daunting. However, with proper care, elders have a life filled with joy
HOME
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LIFESTYLE
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Home News Opinions and Editorials Elderly care

Elderly care
by Dr. Jose S. Pujalte Jr.
November 8, 2014
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Do not go gentle into that good night, Old age should burn and rave at close of day;

 Dylan Thomas (1914-1953), Welsh poet,

Do Not Go Gentle in That Good Night (1.1-2), (1953)
The poem continues with and this seems to be the line most recognized Rage, rage against the
dying of the light. My Humanities professor in college explains this as the upshot of the Western ideal
of the island individual till the very end (as opposed to the Eastern metaphor of seeing ones death as
a raindrop returning to the ocean). And I suppose people dont very much care if they live only up to
65. That is, until theyre 64. Nevertheless, Filipinos are getting older and older. There comes a point
that theyre no longer as independent. We look around us and we see our aging loved ones struggling
to keep alive. There are always better ways of taking care of them.
That starts with knowing the common problems of the elderly.
5 Common Problems. According to the The Caregivers Essential Handbook, these are priority issues for
the aging: depression, memory loss and dementia, vision loss, hearing loss, and incontinence. Its
somewhat unreasonable to blame aging per se as the reason that the elderly have problems. Its like
saying teenagers are troublesome because theyre teenagers.
Spot Depression. According to the manual, the symptoms of depression are:
Lack of interest in activities that were enjoyable before.
Withdrawal from social contact.
Lack of energy.
Strong feelings of guilt or self-criticism.
Feelings of hopelessness.
Eating too much or eating too little.
Sleeping too much or too little with disruption of usual sleep pattern.
Difficulty concentrating.
In older people, its probably more difficult to diferentiate sadness from depression. Sadness is normal,
depression is not even with the elderly. Sadness is fleeting (from a few days to even two weeks) and
some cause is identifiable a skirmish with the spouse, disappointment with children, loss of property,
and so on. Depression develops insidiously over several weeks into what a good friend calls staring
into the Abyss. Depression symptoms can also be physicalized by Lolo or Lola into headaches, aches
and pains, and digestive complaints.

What can be done. What cantbe done is talking the person out of depression. Currently, researchers
believe that in depression there is an imbalance of neurotransmitters norepinephrine and serotonin.
These are natural chemicals needed in the communication of brain cells with each other. Genetics has
been implicated. Scientists have shown that depression like diabetes and hypertension filter through
generations. Antidepressants may be prescribed by the doctor but of course it will help if the family
cares.
Take out the depressed person for short walks, to visit the mall or another relative he or she cherishes.
Attend to chronic physical illness like diabetes, hypertension, arthritis, heart disease; being sick for
long periods initiate depression.
Dont underestimate the positive efect of small grandchildren who are always ready to play and, like
their grandparents have all the time in the world to talk, eat, and to just do things together.
Another problem of the elderly is dementia, the most common being Alzheimers disease. The
caregivers manual lists the following signs to watch out for: memory loss forgetting names,
personally important dates like birthdays and anniversaries, confusion forgetting a favorite story
midway, disorientation forgetting where one is, the day, or time, problems with self-care such as
grooming and hygiene, mood swings, language problems difficulty finding even common words, math
difficulty simple addition or subtraction capability is lost; poor judgment like avoiding another person
walking directly into her path.
Even as there is no cure for Alzheimers, many drugs are now available to control disabling symptoms.
Some of these are: tacrine, donezepil, rivastigmine, and galantamine. All of them prevent symptoms
from becoming worse. Treatment is also not just about medications. Its about adjusting to the
condition by reinforcing routine in the persons life. This may amount to a specific time for breakfast,
for bathing, and for other everyday tasks. On the average, someone diagnosed with AD lives for
another 8 to 10 years and with much care, up to 20 more years.
Lets talk about vision loss, hearing loss and incontinence next week.

Read more at http://www.mb.com.ph/elderly-care-2/#eyWDla6x9SdiPWYJ.99