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“Caring for seniors is perhaps the greatest responsibility we have. Those who have walked before us have given so much and made possible the life we all enjoy.”
—Senator John Hoeven
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LEARNING OUTCOMES
By the end of this chapter, readers will be able to:
27-1. Summarize the types of residents typically found in long-term care settings today.
27-2. Appraise the occupational needs of residents in long-term care.
27-3. Evaluate the benefits of restorative care for older adults in a nursing home.
27-4. Create occupation-centered interventions that are appropriate within the long-term care context.
27-5. Analyze the application of strength-based approaches in long-term care.
27-6. Appraise critical legislation that created the modern nursing home.
27-7. Compare and contrast advocacy plans for an older adult in a long-term care setting at the person, group, and population levels.
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Mini-Case Study
Miguel is a 73-year-old former electrician who retired at age 65. He had lived with his wife, Lucinda, of 51 years in a small two-story house. He was independent in all activities of daily living (ADLs) and instrumental activities of daily living (IADLs), handled all home maintenance and yard work, and played soccer once a week with a group of friends. Five weeks ago, Miguel experienced a cerebrovascular accident (CVA) that left him with right hemiplegia and expressive aphasia. He spent a week in an acute care facility and was transferred to a rehabilitation center. He made some progress over his monthlong stay in rehabilitation but was unable to return home safely due to needing a two-person assist for all transfers and increased impulsivity. Unable to afford private care in their home, Lucinda made the difficult decision to move Miguel to a long-term care facility.
Provocative Questions
What client and contextual factors would be most critical to consider in helping Miguel adjust to his new life in a long-term care facility?
In what ways may the occupational therapist need to advocate for Miguel during his stay in the long-term care facility?
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As the number of older adults living in the United States continues to increase, so does the number of older adults experiencing physical or cognitive disabilities. Moreover, approximately 80% of older adults live with a chronic condition, and 68% live with two or more chronic conditions (National Council on Aging, 2023). The increased prevalence of older adults living longer with chronic conditions leads to an increased need for long-term care services (Sengupta et al, 2022). It is expected that as many as 70% of older adults will require a form of long-term care at some point in their lives (U.S. Department of Health and Human Services, 2020). In the United States, long-term care services encompass a large group of services that include assistance for personal care, healthcare, and support services. These services help with tasks such as ADLs, IADLs, health management, and other important daily care. Long-term care services are needed by ...