1. The Civil Rights Era, Part 2
8. Public School Desegregation in the South after 1954
After Brown v. Board, many public schools in the southern
states rolled out an array of measures designed to resist the
ruling.
Some schools created extra layers of administrative delays
designed to stop implementation of the ruling.
Other schools suddenly transferred public property to newly
created, all-white private academies.
A group of southern states--Virginia, Alabama, Mississippi, and
Georgia--resurrected pre-Civil War era laws and passed state
resolutions declaring their right to interpose their authority
between the people and the US government.
The president of the United States, a Republican named Dwight
D. Eisenhower, did not make any public endorsement or
comment about the court’s ruling.
But this soon changed when the governor of Arkansas publicly
declared that he would oppose the Supreme Court’s ruling about
school desegregation.
In September of 1957 in Little Rock, Arkansas, the governor of
the state decided to impede the desegregation order by ordering
the National Guard to block the entrance of 9 African American
high school students to the local high school.
After several weeks of this tense standoff, President Eisenhower
sent 1000 soldiers from the 101st Airborne, an elite unit of
Army paratroopers, to enforce the desegregation ruling in Little

2. Rock.
Although Eisenhower had remained silent on the ruling earlier,
he now defended his actions by delivering a televised address to
the nation saying that federal authority had to be enforced over
state authority.
Many historians have commented that events in Little Rock in
1957 had a Cold War context too.
This was because during the tense standoff Eisenhower also
stated publicly that the “enemies” of America, by which he
meant the Soviet Union, were “gloating” over the situation in
Little Rock because it was an example of inequalities in our
system.
President Eisenhower was the first American president to use
armed troops to support African American Civil Rights since
Reconstruction after the Civil War.
9. Martin Luther King Jr. and Non-Violent Civil Disobedience
In 1956 one year before the standoff at Little Rock, Martin
Luther King Jr. had entered the national spotlight after he
organized a bus boycott in Montgomery, Alabama, that had
lasted 381 days.
King, who was a Baptist pastor, and several other leaders of the
African American community in Montgomery had mobilized
African American residents to boycott the city bus lines after
Rosa Parks (who was a secretary for the local chapter of the
NAACP) was arrested and fined after refusing to surrender her
seat on a city bus to white patrons.
After the 381-day boycott, the bus lines in Montgomery had

3. agreed to desegregate passenger buses.
Martin Luther King Jr. was from Atlanta, Georgia and his dad
had been the leader of a large Baptist congregation in the city
with ties to the middle class.
King attended and graduated from Morehouse College, then
completed a PhD in philosophy and theology at Boston
University.
Early in his university studies he had become interested in the
writings of early twentieth-century Christian social activists in
America, as well as Ghandi in India and South Africa.
Through his studies, King became interested in the idea of
“non-violent civil disobedience.”
King was heavily influenced by the life of Ghandi, who had
used non-violent civil disobedience to force the British Empire
to relax some of its segregation policies in India and South
Africa during the 1940s.
King also looked to his Biblical belief in peaceful, non-violent
resistance to oppressors.
He recognized the applicability of these forms of protests to
change segregation laws in the United States.
He eventually came to believe that if citizens were to
deliberately antagonize the authorities, meaning police, the
government, even the military, in a non-violent manner then the
actions of the authorities would demonstrate the oppressive
nature of the system.
But participants in this type of civil disobedience had to risk
injury, even death, while promising not to return force with

4. force.
These aspects made King’s philosophy extremely popular and at
the same time unpopular with many people.
10. King and the SCLC
On a national level it made his approach to racial issues
extremely attractive because King always advocated replying to
hateful behavior with peaceful, non-violent methods.
This was the center of his approach during the Montgomery bus
boycott…protest thru effective but non-violent means.
After the success of the Montgomery bus boycott, King brought
together over 100 southern churches and community
organizations to establish the Southern Christian Leadership
Conference (SCLC), whose only purpose was to use King’s
philosophy of non-violent civil disobedience to combat
segregation.
After the Montgomery bus boycott, King’s most well-known
Civil Rights victories were in Birmingham, Alabama, and the
march on Washington DC, in 1963.
These two events helped to bring the African American Civil
Rights movement into the homes of the average American
because the events were broadcast on national TV.
TV helped change public opinion in favor of King’s approach to
asserting African American Civil Rights.
In both instances King and the SCLC organized the
demonstrations.

5. 11. King in Birmingham
Using techniques based on non-violent civil disobedience and
capturing the attention of the media, King was able to capture
the attention of most Americans outside the southern states.
In April of 1963 King and the SCLC arrived in Birmingham
with their list of demands focused on banning segregation in
public spaces; their main strategy was to fill the city’s jails with
peaceful protestors.
They also organized a city-wide boycott to end segregation in
businesses and in public spaces.
King and the SCLC chose Birmingham because it had a
reputation as one of the most segregated cities in America.
King himself was jailed for several days, where he managed to
write his famous “Letter from a Birmingham Jail,” which
outlined the moral and social issues of the movement.
After King was released from jail, the protests in Birmingham
picked up speed and the national media began to pay attention.
Millions of Americans watched on TV as peaceful African
American protestors in Birmingham were attacked by police
with clubs, police dogs, and high-pressure fireman’s hoses.
In the summer of 1963, after President John F. Kennedy spoke
on national TV in favor of King and the protestors, Birmingham
city officials agreed to begin carrying out desegregation; in the
end, more than 15,000 protestors had been arrested.

6. 12. King in Washington DC
At the end of that summer, in August of 1963, the SCLC and
several other Civil Rights organizations helped organize a
march on the nation’s capital.
More than a quarter of a million people including over 50,000
white Americans, gathered at the Lincoln and Washington
memorials in Washington DC, to support Civil Rights
legislation.
After a week of speeches by various prominent activists, Martin
Luther King Jr. provided the closing comments with his stirring
speech about his dream for an America free from racism.
After the march on Washington DC, King had become the voice
and face of the national Civil Rights movement.
13. The Civil Rights Act of 1964
King’s successful campaign in Birmingham and the march on
Washington DC put pressure on the federal government to pass
Civil Rights legislation.
President Kennedy had spoken out in support of Civil Rights
legislation, but it was his vice President, Lyndon Baines
Johnson (LBJ) who proved to be a more forceful supporter of
sweeping Civil Rights legislation.
Johnson had been a senator in Texas during the Great
Depression, and before that he had worked as a schoolteacher
with African American and Mexican school children in South

7. Texas.
During the Depression Johnson became a devout follower of
Franklin Delano Roosevelt and his New Deal programs.
When Kennedy was assassinated in 1963 Johnson became
president.
Johnson embarked on a campaign to exploit all his political
skills to cajole, flatter, and threaten members of Congress to
pass Civil Rights legislation.
The result was that in July of 1964 Johnson signed the Civil
Rights Act of 1964.
It prohibited discrimination in most public spaces in America; it
banned discrimination in employment on the basis of race,
color, religion, sex, or national origin, and it gave broad powers
to the Justice Department to pursue investigations into
allegations of discrimination on the state and federal level.
One of the unintended results of the Civil Rights Act of 1964
was that it gave legal foundation to the assertion of equal rights
for women and other minorities.
By the early 1970s, the Justice Department was receiving over
100,000 complaints of gender and racial discrimination mostly
in the workplace every year.
14. The Voting Rights Act of 1965
One year later, after King organized another non-violent protest
in Selma, Alabama that turned violent, resulting in the deaths of
several protestors, President Johnson signed the Voting Rights
Act of 1965.

8. The Voting Rights Act of 1965 outlawed literacy tests and other
discriminatory tests that had been used to prevent African
Americans from voting in southern states since the 1890s.
It also authorized federal supervision of voter registration in the
South and anywhere that discrimination was suspected.
As a result of the Voting Rights Act of 1965, the number of
African American voters in the south grew from 1 million to 3.1
million by 1968.
Both Civil Rights laws represented a high-water mark of
national interest in Civil Rights, and they rendered
unconstitutional decades of discrimination in the south.
Another unintended consequence was a political re-alignment of
the Democratic and Republican parties in America.
Both Kennedy and Johnson were Democrats.
After 1965 many southern Democrats left the party and either
formed separate political parties or joined the Republican Party.
This political realignment eventually transformed the south
from a solidly Democratic region into a solidly Republican one.

9. Responses: Final Exam (due Monday May 11)
In 2-3 sentences briefly explain why WW II was a key factor
shaping the African American Civil Rights Movement?
Who was Emmet Till?
What was the SCLC and why was it important?
2
Chapter 7

10. Economic and Legal Issues
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Social SecurityDesigned as a pay-as-you-go systemAn age
entitlement programAge of eligibility has increased over
timeSupplemental security incomeProvides stipends to low
income people who are aged 65 years or older, blind, or
disabledSocial Security income is not adequatePrivate
investmentsPensions
Late Life Income
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
To be eligible for Medicare, one must be eligible for Social
SecurityOnly covers select services and requires that they are
medically necessaryCosts are covered by a employer and
employee tax of 2.9% and by the beneficiary in the form of
premiums, deductibles, and co-pays
Medicare
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Offers acute care or short-term rehabilitative care Free to those
who receive Social SecurityProvides insurance regardless of
financial status A person is automatically enrolled on the first
of the month of his or her 65th birthday Deductible and co-
payments under Part A vary by setting and can be quite high
Medicare Part A
Copyright © 2018, Elsevier Inc. All rights reserved.
*

11. Copyright © 2018, Elsevier Inc. All rights reserved.
A person eligible for Part A must apply for Part B in the 6
months surrounding his or her 65th birthday or wait until the
next open enrollmentChoose either (the “Original”) Medicare
Part B or an alternative plan available in his or her areaOriginal
is a traditional fee-for-service arrangementPatient is responsible
for a monthly premium (usually deducted directly from the
monthly Social Security check), an annual deductible, and co-
pays
Medicare Part B
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Offers Medicare Advantage Plans similar to an HMO or
PPOReplaces both Medicare Part A and Medicare Part BCo-
pays and deductibles, if any, vary considerably, and extra
premiums may be required for added servicesSeveral new
programs alternatives to Medicare Part C, such as Private Fee-
For-Service Medical Savings Accounts
Medicare Part C
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.

12. Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Person pays a monthly premium and in exchange all of the co-
pays and deductibles not covered by the “primary insurance”
(e.g., Medicare) are paid Some are part of a person’s retirement
benefit or available to members of organizations such as AARP
Supplemental Insurance
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Program funded jointly by federal government and state
governmentState determines eligibility, types, and extent of
services to be covered; sets the payment rates to providers; and
administers its own programsStates pay about 40% of the costs
with the federal government paying the restProvides care for
those with low incomesCovers more services than Medicare
Medicaid
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Veterans Administration (VA) system is a model for the
continuity of care in various care provider systems Active duty
and retired military members and their dependents are
eligibleVA hospitals have restrictions; the problem has to be
service relatedFinancial support, “Aid and Attendance Pension,”
is provided
Care for Veterans
Copyright © 2018, Elsevier Inc. All rights reserved.
*

13. Copyright © 2018, Elsevier Inc. All rights reserved.
TRICARE health care programHealth care insurance program
provided by the Department of Defense for eligible
beneficiariesRequires the person to enroll in both Medicare Part
A and Part B and pay the premiums for Part BAs a Medigap
policy, Tricare for Life covers expenses not covered by
MedicareLong-term care insurance
Other Veterans
Administration Services
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*
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Which part of Medicare helps cover some skilled nursing
facility care, hospice care, and home health care under certain
conditions?
Part A
Part B
Part C
Part D
Question
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*
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A—Medicare Part A covers acute hospital care, short-term acute
rehabilitative care, and costs associated with hospice and home
health care under certain circumstances.
Answer

14. Copyright © 2018, Elsevier Inc. All rights reserved.
*
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Financial issuesHealth care decisionsConsent to
treatmentsCapacity
Legal Issues in Gerontological Nursing
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*
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Ability to understand a problem, the risks and benefits of a
decision, the alternative options, and the consequences of the
decisionRange of tasks, from handling finances and daily
business, to taking care of self and making medical
decisionsOnly the courts can declare the person “incapacitated
Capacity
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*
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Powers of attorneyConservatorshipGuardianship
Advanced Care Planning
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*
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Legal document that gives a designated person the power to act
on the behalf of a personTwo types of power of attorney (POA)

15. documentsGeneral POA
Usually has the right to make financial decisions, pay bills, and
so on in defined circumstances but not necessarily to make
decisions related to health careDurable POA
Can make health-related decisions for persons when they are
unable to do so themselves
Power of Attorney
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*
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Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Individuals, agencies, or corporations that have been appointed
by the court to have care, custody, and control of a disabled
person to manage his or her financial responsibilitiesGuardian
is a person appointed to be responsible for another
personConservator is a person specifically appointed to control
the finances of the person
Guardians and Conservators
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Nursing roles includeHelping older patients deal with financial
issuesUsing their expert advocacy and negotiation skillsThe
nurse may be the first to notice the subtle changes indicating a
potential change in capacity Obligation to work with the
applicable statutes of his or her state, province, or country
Implications for Gerontological Nursing and Healthy

16. Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Who can be the POA for an older adult?
Anyone
Attorney
Blood relative
Anyone except a blood relative
Question
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*
Copyright © 2018, Elsevier Inc. All rights reserved.
A—Although it usually is a friend or family member, a person
can designate any another person to act on his or her behalf.
Answer
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*
Copyright © 2018, Elsevier Inc. All rights reserved.
Chapter 7
Economic and Legal Issues
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.

17. Social SecurityDesigned as a pay-as-you-go systemAn age
entitlement programAge of eligibility has increased over
timeSupplemental security incomeProvides stipends to low
income people who are aged 65 years or older, blind, or
disabledSocial Security income is not adequatePrivate
investmentsPensions
Late Life Income
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
To be eligible for Medicare, one must be eligible for Social
SecurityOnly covers select services and requires that they are
medically necessaryCosts are covered by a employer and
employee tax of 2.9% and by the beneficiary in the form of
premiums, deductibles, and co-pays
Medicare
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Offers acute care or short-term rehabilitative care Free to those
who receive Social SecurityProvides insurance regardless of
financial status A person is automatically enrolled on the first
of the month of his or her 65th birthday Deductible and co-
payments under Part A vary by setting and can be quite high
Medicare Part A
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
A person eligible for Part A must apply for Part B in the 6

18. months surrounding his or her 65th birthday or wait until the
next open enrollmentChoose either (the “Original”) Medicare
Part B or an alternative plan available in his or her areaOriginal
is a traditional fee-for-service arrangementPatient is responsible
for a monthly premium (usually deducted directly from the
monthly Social Security check), an annual deductible, and co-
pays
Medicare Part B
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Offers Medicare Advantage Plans similar to an HMO or
PPOReplaces both Medicare Part A and Medicare Part BCo-
pays and deductibles, if any, vary considerably, and extra
premiums may be required for added servicesSeveral new
programs alternatives to Medicare Part C, such as Private Fee-
For-Service Medical Savings Accounts
Medicare Part C
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.

19. Person pays a monthly premium and in exchange all of the co-
pays and deductibles not covered by the “primary insurance”
(e.g., Medicare) are paid Some are part of a person’s retirement
benefit or available to members of organizations such as AARP
Supplemental Insurance
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Program funded jointly by federal government and state
governmentState determines eligibility, types, and extent of
services to be covered; sets the payment rates to providers; and
administers its own programsStates pay about 40% of the costs
with the federal government paying the restProvides care for
those with low incomesCovers more services than Medicare
Medicaid
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Veterans Administration (VA) system is a model for the
continuity of care in various care provider systems Active duty
and retired military members and their dependents are
eligibleVA hospitals have restrictions; the problem has to be
service relatedFinancial support, “Aid and Attendance Pension,”
is provided
Care for Veterans
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
TRICARE health care programHealth care insurance program

20. provided by the Department of Defense for eligible
beneficiariesRequires the person to enroll in both Medicare Part
A and Part B and pay the premiums for Part BAs a Medigap
policy, Tricare for Life covers expenses not covered by
MedicareLong-term care insurance
Other Veterans
Administration Services
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Which part of Medicare helps cover some skilled nursing
facility care, hospice care, and home health care under certain
conditions?
Part A
Part B
Part C
Part D
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
A—Medicare Part A covers acute hospital care, short-term acute
rehabilitative care, and costs associated with hospice and home
health care under certain circumstances.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.

21. Financial issuesHealth care decisionsConsent to
treatmentsCapacity
Legal Issues in Gerontological Nursing
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Ability to understand a problem, the risks and benefits of a
decision, the alternative options, and the consequences of the
decisionRange of tasks, from handling finances and daily
business, to taking care of self and making medical
decisionsOnly the courts can declare the person “incapacitated
Capacity
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Powers of attorneyConservatorshipGuardianship
Advanced Care Planning
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Legal document that gives a designated person the power to act
on the behalf of a personTwo types of power of attorney (POA)
documentsGeneral POA
Usually has the right to make financial decisions, pay bills, and
so on in defined circumstances but not necessarily to make
decisions related to health careDurable POA

22. Can make health-related decisions for persons when they are
unable to do so themselves
Power of Attorney
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Individuals, agencies, or corporations that have been appointed
by the court to have care, custody, and control of a disabled
person to manage his or her financial responsibilitiesGuardian
is a person appointed to be responsible for another
personConservator is a person specifically appointed to control
the finances of the person
Guardians and Conservators
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Nursing roles includeHelping older patients deal with financial
issuesUsing their expert advocacy and negotiation skillsThe
nurse may be the first to notice the subtle changes indicating a
potential change in capacity Obligation to work with the
applicable statutes of his or her state, province, or country
Implications for Gerontological Nursing and Healthy
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.

23. Who can be the POA for an older adult?
Anyone
Attorney
Blood relative
Anyone except a blood relative
Question
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
A—Although it usually is a friend or family member, a person
can designate any another person to act on his or her behalf.
Answer
Copyright © 2018, Elsevier Inc. All rights reserved.
*
Copyright © 2018, Elsevier Inc. All rights reserved.
Chapter 8
Assessment and Documentation for Optimal Care
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Is more complexIs more detailedTakes longer to
performRequires special abilitiesDone in every setting
Assessment of Older Adults

24. Copyright © 2018, Elsevier Inc. All rights reserved.
*
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Collection of dataBiological, psychosocial, and functional
informationCultural and spiritual assessmentsCognitive
abilitiesPsychological well-beingCaregiver stress or
burdenPatterns of health and health careReview of preferences
for advanced care Presence of any geriatric syndromes
Assessment Components
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Sexual functionDepressionAlcoholismHearing lossOral
healthEnvironmental safety
Problems to Address in an Assessment
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Listen patientlyAllow for pausesAsk questions that are not often
askedObtain data from all available sourcesKnow that not all
positive findings need interventionsKnow normal changesPace
the assessment according to the patient’s stamina
Special Assessment Abilities
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Establish rapportData collection approaches includeSelf-
reportReport by proxyObservationIdeally should be done to

25. gather baseline data before the older adult has a health crisis
Collecting Assessment Data
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Conduct the assessment at a time when the patient is at his or
her bestAvoid biasing the responseExplore for more information
only if neededApproach sensitive information in a matter-of-
fact mannerRecord the patient’s words for accuracy
Guidelines for an Assessment of the Older Adult
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*
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What is the best approach to take when obtaining a health
history from an older adult?
Choose a private, quiet area in a comfortable room
Ask a family member to respond to some of the questions
Raise your voice if the patient does not appear to hear you
Take thorough notes during the interview, asking detailed
questions as needed
Question
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A—When collecting a verbal health history, the nurse should
use techniques that optimize communication. This includes
choosing a private, quiet area in a comfortable room.

26. Answer
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Increase the likelihood of obtaining reliable, useful dataCan be
used to monitor changes over timeExisting instruments can
categorize physical health, mood, motor capacity, manual
ability, self-care ability, instrumental abilities, and cognitive
and social function
Assessment Instruments
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*
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Is collected in a face-to-face approach with the patient or a
review of the patient’s written historyIncludes medical history,
review of systems, medication history, nutritional history, and
factors that influence the person’s quality of life,
includingLiving arrangementsFinancial resourcesSupport
Health History
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Begins the moment the nurse sees the personPerform a problem
assessment first because of the length of time it takes to
conduct an assessmentWhen the focus is a well-check
assessment, the emphasis is placed on health problems in later
life
Physical Assessment
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*

27. Copyright © 2018, Elsevier Inc. All rights reserved.
FANCAPESFluids: State of hydrationAeration: Respiratory
functionNutrition: Type and amount of food
consumedCommunication: Adequate ability to communicate his
or her needsActivity: Ability to meet basic needs of toileting,
grooming, and meal preparationPain: Physical, psychological,
or spiritual painElimination: Difficulty with bladder or bowel
eliminationSocialization: Ability to give and receive love and
friendship
Assessing Frail and Medically Complex Patients
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Need to conduct an assessment of mental status, especially
cognitive abilities and mood whenever there is a change in an
elder’s condition or safety Assess whether an increase in
chronological age has resulted in an increased rate of dementing
illnessAssess cognition and mood
Mental Status Assessment
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*
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Tools for cognition assessmentMini-Mental State
ExaminationClock Drawing TestThe Mini-CogGlobal
Deterioration ScaleTools for mood assessment Geriatric
Depression Scale
Cognition and Mood Assessment
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*
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28. Copyright © 2018, Elsevier Inc. All rights reserved.
*
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*
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Thorough functional status of the patient includesIdentifying
areas where help is neededDetermining whether a change in
abilities from one period to another has occurredAssisting in the
determination of a needDetermining the safety of the patient’s
living situationIf the patient is healthy and active, record a
simple statement such as, “The patient is active and independent
and denies functional difficulties.”
Functional Assessment
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IncludeEatingToiletingAmbulationBathingDressing Grooming
Tools to assess ADLsKatz IndexBarthel IndexFunctional Index
Measure

29. Activities of Daily Living (ADLs)
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*
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Considered to be more complex activities necessitating higher
physical and cognitive functioning than ADLsIncludeHouse
cleaningShoppingManaging moneyTools to assess IADLs
Instrumental Activities of Daily Living (IADLs)
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OARS Multidimensional Functional Assessment Questionnaire
(OMFAQ)Fulmer SPICES (sleep disturbance, problems with
eating and feeding, incontinence, confusion, evidence of falls,
and skin breakdown)Minimum Data Set used in skilled nursing
facilitiesOASIS used in certified home care agencies
Comprehensive Assessments
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30. A nurse who needs to assess a patient’s ability to perform ADLs
will choose which tool for this assessment?
OASIS
Katz Index
Fulmer SPICES
Global Deterioration Scale
Question
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B—The Katz Index measures the ability to perform ADLs and
has served as a basic framework for most of the subsequent
measures.
Answer
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Chronicles, supports, and communicates the patient’s
conditionProvides the data needed for the development of the
individualized plan of care Helps the nurse identify, monitor,
and evaluate treatment or interventionsProvides the
communication needed to ensure continuity of careDetermines
reimbursementDemonstrates the quality of care provided
Documentation
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Level of documentation required varies by setting and

31. determined by state and local lawsDocuments and communicates
day to day careWhen care is not considered “skilled” and
covered by Medicare, narrative notes are reduced to “problem-
oriented only” or “as needed” depending on the facility and
licensing body
Skilled Nursing Facility Documentation
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When care is covered by Medicare, Medicaid, or another
insurer, reimbursement in all settings is based on the assessment
and the documentationDocumentation used varies by
settingSkilled nursing facilities—MDS and RUGSkilled home
care—OASISInitial reimbursement in acute care settings—
DRGs
Documentation and Reimbursement
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Nursing responsibilitiesMake sure that communication and
documentation are of the highest qualityCommunicate important
information regarding safe patient careCollect accurate data in
the most efficient yet caring manner possibleUse tools as a way
to organize assessment data and compare the data from time to
time
Implications for Gerontological Nursing and Healthy Aging
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