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Unit 10 Assignment 1 Final
Organizational Long-Term Rehabilitation Care Future Design
By: Brittney Gajewski
HS: 5534 Leading across the Care Continuum
Professor: Dr. Washington
December 16th 2014
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I. The situation Long-Term Care facilities are facing
Currently within the state of Wisconsin, over 11,000 older adults are waiting for
long term care services and other forms of support (Wisconsin Department of Health and
Family Services). Although Wisconsin’s long-term-care initiative looks to improve the
access, quality, choice, and cost-effectiveness for long-term care, the need for long-term
care will increase by 45% by 2030. According to Blok, Luijkx, Meijboom, and Schols
(2010) diverse care for adults across different cultures is needed and in a high demand for
different types of care to be met. Additionally, Blok et al. (2010) explained with
increasing age arises the prevalence for multiple types of chronic conditions—or the
prevalence of multi-morbidity.
There is a huge gap that exists because State regulators are only looking to ensure
certain health practices, they do not look to in sure that the quality of life for the residents
of the facility are being met. State regulators are not bringing into question what
practices are inhibiting residence from achieving their daily activities of life involving
leisure activities. By providing physical an occupational therapy services on campus and
in the home, older adults can age in place and have greater access to the elements that
attribute to the quality of an individual’s life.
As a strategy to address shortcomings in the US health care system within long-
term care, the concept of Accountable Care Organizations (ACOs) sought to reform
national health legislation. Stakeholders and consumer groups use measurements that
encompass performance improvement in key national priorities. The US secretary of
health and human services launched pilot accountable care organizations that would stem
from three core principles including reliable measurement to support improved savings
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cost, and reduction of overall costs supplemented through quality based investments. The
design aspects of Accountable Care Organizations (ACOs) should involve substantial
elasticity and a strong primary care base to provide accountability for quality and total
per capita costs within long-term care. Administrators will continue to address models
specific to the long term care design with interdisciplinary relationships strategies with
potential to be put to practice on a national level.
Anheier (2005) overviews the specific fields and dimensions behind nonprofit
organizations. Further organizational structure is extensively covered and it provides a
comparative view between different intersectional relationships. Organizational theory
has centered around similar problems between management, sociology, and economic
divisions. These relationships involve governing directors or stakeholders and the
administrating staff that is held accountable for any difficulties or ethical concerns that
might be faced within long term care. The evolution, rationality of an organization, and
the relationship between the environment and the organization address three key
conceptual difficulties (Anheiner 2005). By utilizing Anheiner (2005), administrators
will have a greater perspective of the resources and types of theoretical approaches that
can be taken into account when facing special topics or issues rehabilitative long term
care. These special topics range from policy issues to global and international relations
that stem from nonprofit organizations. Administrators should utilize this tool to
continue to provide a fair perspective and a greater morale overall.
In 2009, Fry & Kriger discussed the development of a theory that aims to center
five different levels within effective leadership. This developmental theory of leadership
ventures beyond the current theory that emphasizes doing and having, and explores the
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appropriate actions of being depending on the situation an administrator faces. Leading
administrators continue to evolve with theoretical advances within rehabilitative long-
term care. Administrators provide a concise overview of effective leadership that
reviews five levels of being including: the non-dual, level of the spirit, level of the soul,
images and imagination, and the physical world. Utilizing this will advance the long-
term care facility’s epistemological models of care that is effectively carried out in an
ethical situation. Administrators will face ethical decisions on a daily basis and will
involve legal, direct, and indirect cost that are related to the facilities operations.
Leadership development from a being-centered theory supplies another view on ethical
costs and considerations in a long term care facility.
Being-centered care involves the collaboration of mental health care and is key
when providing evidence based approaches as care options for older adults suffering from
mental health conditions (Kaskie, & Buckwalter, 2010). A comparative model that could
be integrated in collaborative models of care is the Iowa Model. Administrators could
use this model to emphasize administrative and financial procedures involved in order to
maintain effective mental health care services in the long term care setting (Kaskie, &
Buckwalter, 2010). The mental health of residents at the facility involves a collaborative
care model. Administrators can provide efficient specialty care and have management
who are responsible for financial challenges that arise with Medicare (Kaskie, &
Buckwalter, 2010).
A fall can result in restricted abilities that affect one’s quality of life and a change
in the individuals care needs. While an individual is recovering from a fall after returning
from the hospital, it is essential to provide care to one’s mental health. It has been shown
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that collaboration between ones primary care and mental health care improves one’s
quality of care (Pamerantz, et al., 2010). During this time the long term care facility
would utilize an integration program to provide a mental health specialist.
Administrators who utilize collaborative care models may be use for managing chronic
diseases and specialty care cases (Pamerantz et al., 2010).
Pressure ulcers are localized injuries that occur due to the compressed tissue
between a surface such as a chair, and a ‘bony prominence’ and often occur after hip
surgery (Baumgarten et al., 2009). Older adults over 70 years of age are more likely to
suffer a hip fracture Baumgarten et al., (2009). Surprisingly Medicare does not provide
hospitals with financial coverage for patients who suffer from pressure ulcers within
hospital settings. With financial coverage it could feasibly be possible to have more
nurses available to keep patients mobile after a surgery. It is imperative that
administrators hold a strong organizational design so that all staff members have a clear
role in their responsibilities when a resident is transferred back home after being
discharged from the hospital. Baumgarten et al., (2009) concluded that pressure ulcers
were most likely to occur within a hospital setting and although patients are encouraged
to become mobile after a hip surgery, they’re often seated and at greater risk for a
pressure ulcer. This is why part of the long term care’s organizational structure will
involve certified occupational therapist who will help with the care transitions between
the hospital, facility and home settings. Baumgarten et al.,(2009) emphasized the degree
to which a hip fracture and surgery can impact the quality of a resident’s life. This is
fundamentally relevant since the long-term rehabilitation services will determine the
severity an impact has on one’s quality of life.
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An administrator can adapt organizational health practices that are a fundamental
notion of public health practice within the long term care setting. Greater attention has
been reflected upon the key components of evidence-based public health (EBPH)
(Brownson, Fielding, and Maylahn, 2009). Administrators will make decisions based on
the current research available, take into account the values and preferences of the
residents cultural needs, include collaboration with the occupational practitioner on site
so that one’s environmental context has been personalized to fit one’s specific care needs
(Brownson, et al., 2009). This new approach to improve the population’s health has been
recommended on a national level. Administrators adapting this approach within the long
term care facility will prove to have indirect and direct benefits that reflect on the ethical
quality of a facility’s programs, policies, public or private resources and superior
workforce efficiency (Brownson et al., 2009). Decision making regarding the care of
residents will continue to be reflected within ethical and financial systems of leading
administrators in the long-term care facility.
An administrator can adapt organizational health practices that are a fundamental
notion of public health practice within the long term care setting. Greater attention has
been reflected upon the key components of evidence-based public health (EBPH)
(Brownson, Fielding, and Maylahn, 2009). Administrators will make decisions based on
the current research available, take into account the values and preferences of the
residents cultural needs, include collaboration with the occupational practitioner on site
so that one’s environmental context has been personalized to fit one’s specific care needs
(Brownson, et al., 2009). This new approach to improve the population’s health has been
recommended on a national level. Administrators adapting this approach within the long
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term care facility will prove to have indirect and direct benefits that reflect on the ethical
quality of a facility’s programs, policies, public or private resources and superior
workforce efficiency (Brownson et al., 2009). Decision making regarding the care of
residents will continue to be reflected within ethical and financial systems of leading
administrators in the long-term care facility.
Leader Member exchange theory (LMX theory) study’s the relationship of the
development process that occurs between employed members and administrative leaders
in long term care (Shunlong, & Weiming 2012). Shunlong & Weiming (2012) explain
objective and subjective employee performance are to outcome variables to
transformational leadership. These performances involve role perception, commitment to
facility, and team innovations. Shunlong & Weiming (2012) provided evidence that
transformational leadership instills charisma, individualized consideration, innovating
behavior, and modeled morale tied with employee’s innovating care practices.
New health care plan strategies and opportunities will continue to develop as the
older adult population’s needs continue to grow. Current aging societies reside on the
forefront of practical implementation of technological instruments used in long-term
multidisciplinary care (Lemke, & Golubnitschaja 2014). A personal approach to one’s
long term care involves research, new products, materials, and education based on one’s
care strategy. As a personalized, predictive, and preventative approach outlines the
whole spectrum it is considered to be one of the emerging practices of the future (Lemke,
& Golubnitschaja 2014). Mandated meetings with one’s multiplidiciplinary team
members allows for greater communication between the resident and care doctors
(Lemke, & Golubnitschaja 2014).
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In 2011, Kerr et al., evaluated “The Audit of Physical Activity Resources for
Seniors” (APARS), which is a new tool that can be used to assess the physical activity
environment in residence based facilities. Long-term care facilities will contain the
proper structural design required to provide a safe environment for older adults to feel as
if they’re able to engage socially and independently (Kerr et al., 2011). A person’s
environment can maintain or decrease their mobility and level of functioning. By using
this tool or a similar one that measures ones moderate to vigorous physical activity
(MVPA) the quality of the future long term care designs could provide a supplemental
environment that would help residents maintain levels of activity (Kerr et al., 2011) .
In 2012, highlights of the threats that are faced during the transition process
between care facilities such as the hospital and the long term care facility were reviewed.
It discussed key themes found in the perceptions of older adults who at times feel
‘funneled through’ the care process too quickly (Jeffs, Kitto, Merkley, Lyons, & Bell).
Administrators could use this article to help identify areas of care during this transition
period that need to be strengthened in order to truly engage the patient and their health
expected outcomes.
To further assist with the transition of care after a resident has returned after being
admitted to a hospital, designated team members at the long term care facility would
request the comprehensive geriatric assessment results from the emergency room
discharge nurse (Ellis, Whitehead, Robinson, O’Niell, & Langhorne, 2011). Ellis et al.,
(2011) concluded that there was a significant improvement in one’s chance of being alive
by receiving coordinated care amongst specialists.
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Administrators and leaders within the long term care facility will need to work
together to facilitate the knowledge and skills to produce a better-quality life outcome for
residents and their caregivers. Many residents will need end of life or hospice care
directly at the long-term care facility. To help meet patient and family needs,
interdisciplinary hospice teams contribute various professional skills (Youngwerth, &
Twaddle, 2011). An interdisciplinary-based care team is being seen more through
hospice and palliative care throughout the United States and is expected to grow over the
next few decades. By using interdisciplinary geriatric care teams, clinical outcomes have
proven decreased rates of depression, decreased chance for an adverse drug reactions, and
reduced use of home health care services (Youngwerth, & Twaddle, 2011). The future
design of long-term care being proposed involves active rehabilitative services at a
facility and within one’s home. This design of long-term care specifically aims to help
older adults recover from an injury or surgery, and utilize rehabilitative services such as
occupational and physical therapy to rebuild their strength and skilled coordination that is
needed to maintain a level of independence, autonomy, and education.
II. Description of Long-Term Care
Currently within the state of Wisconsin, over 11,000 older adults are waiting for
long term care services and other forms of support (Wisconsin Department of Health and
Family Services). Although Wisconsin’s long-term-care initiative looks to improve the
access, quality, choice, and cost-effectiveness for long-term care, the need for long-term
care will increase by 45% by 2030. According to Blok, Luijkx, Meijboom, and Schols
(2010) diverse care for adults across different cultures is needed and in a high demand for
different types of care to be met. Additionally, Blok (2010) explained with increasing
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age arises the prevalence for multiple types of chronic conditions—or the prevalence of
multi-morbidity.
State regulators are not bringing into question what practices are inhibiting
residence from achieving their daily activities of life involving leisure activities. That is
why it is important for the future design of this long-term-care organization to facilitate
intergenerational relationships, and a person centered care approach. When older adults
are admitted to the facility after being discharged from the hospital after having surgery,
or after experiencing a fall—the individual will be approached in a personalized manner.
Currently, Wisconsin’s long term care expansion initiative aims to eliminate waiting lists
for long term care facilities or Community Based Residents Facilities (CBRF) by
implementing a Family Care expansion through managed care organizations and the
Wisconsin Partnership Program (Wisconsin Department of Health and Family Services).
Working along side the family care and partnership program expansion, the future
facility would be designed specifically for the functionality of older adults by having
railings in the hallways, good lighting, and accommodating seating around the facility.
Administrators would review the comprehensive geriatric assessment results from the
emergency room (Ellis et al., 2011) to help personalize a rehabilitation plan that serves
the individual and would provide the greatest functional quality outcome. Administrators
would then determine the date to which the individual will reside at the facility until
coordinating team members help one adjust to living back in one’s own home. When an
individual returns home, this organization will continue to provide rehabilitive services in
the home. While rehabilitation services at the facility would focus on rebuilding core
strengths and movements, the rehabilitation services that are continue within one’s home
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are more specific to their home environment. This allows occupational and physical
therapist to personalize the rehabilitative plan for an individual when they’re able to
assess the activities that that individual is a part of or does in their daily life.
Further, consulting services will be available to help direct older adults to the
resources they need depending on the level of care they require or medical condition that
they currently have would be available. Consulting services offered would include areas
pertaining to the improvement of quality of life, nutritional, financial, medical, and end of
life care arrangements. Aging in place would be strongly encouraged to allow for
personalized rehabilitative care.
III. Organizational policies and practices of future design.
The future design of the long-term rehabilitation a care facility will utilize a
partnership with the universities in the surrounding area in order to provide
intergenerational relationship opportunities. This facility will also use the mentoring
program for students who are going into similar careers that relate to healthcare and long-
term aging. Students would mentor with occupational and physical therapists at the
facility and within the resident’s home. These students are able to utilize this time to
obtain experience and meet their clinical hours required to finish their occupational or
physical therapy programs. Further, this would implement appropriate multicultural
relationships and a grave understanding of different ethnic values and beliefs, life styles
and activities of daily living.
While examining client’s social relationship domains and their current activity
participation, researchers were able to measure the impact of student-administered
occupational therapy on the quality of a client’s life (Moore, 2012). Utilizing the
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Activity Card Sort (ACS) and the World Health Organization Quality Of Life-BREF
(WHOQOL-BREF) as instrumental scales, Moore (2012) reported significant
improvement in those specific areas in clients lives. Further, explaining that the
occupational therapist felt they could better serve them as clients.
Clark et al., (2011) found cost-effective interventions for older adults who were at
risk for the loss of their independence and at a risk for declining health through
community based occupational therapy interventions. Significant improvements in the
quality of life of ethnically diverse older adults from various types of communities (Clark
et al., 2011) holds potential for the Wisconsin Partnership Program and the
implementation of this organization to create cost effective interventions that would
benefit Wisconsin on a community level. Activity and quality of life scales pertaining to
the lives of older adults would examine and help measure the impact students have on the
lives of older adults. The organizational design of this rehabilitative facility involves the
administrating director and administrative assistance works with the local university to
assist students meet their clinical based hours for their programs. The future facility will
have several wellness directors that help coordinate interdisciplinary care that is
cultivated to the needs of an individual. Further, the organizational staff design will
involve volunteers, administrative nurse team members, and Certified Nursing Assistants.
Other administrating staff members include administrating transfer coordinators
who help one move individuals from the hospital to the facility, and finally back into
one’s own home. These administrators would work collaboratively as a team with
administrating consultation services at the facility in order to provide overall supportive
and feasible transitions for every person. In 2012, Jeffs et al., revealed three key themes
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found in the perceptions of residents and their families going through interfacility care
transitions including: the feeling of being channeled through at a quick pace, the lack of
education and recognition in the difficulty faced when adjusting from total care to self-
care practices. Together at the future facility, administrators and their staff will work
with residents and their families to ensure families are provided with accurate
information that they can understand and educational resources for individuals and their
families to remain in control when adjusting to different levels of care at all times during
the rehabilitation process. Jeffs et al., (2012) concluded patients need to play a more
effective role in their recovery transitions and that family members play a valuable role in
the development of the patients’ personal care rehabilitation plan.
IV Long-Term Care management strategies and methods
In the future cultural or ethical concerns may arise if there is conflict between
staff and or the residents. Future administrators would discuss with both parties and
depict what occurred, is misunderstood, or disrespected between the resident and their
caregiver if they’re ever to resolve the situation on hand. According to Hoban, (2005)
many complaints arise from situations with miscommunication resulting in cultural
misunderstandings. Administrators would urge the resident and the caregiver to devote
time to mediate their relationship and overcome any cultural barriers that are affecting the
quality of care and facilitation of care. This resolution should also be applied to conflict
experienced between caregivers and other partnership staff members working at the
facility.
Problems of culture clash that can emerge in the Long-term care environment can
involve ethnicity, culture, and personal “diversity” and are not limited to personal
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habits. Hoban (2005) explains many service caregivers are interacting with one another
and facilitating activities that encompass the elders’ daily life. By holding educational
diversity workshops with the direct caregivers, a better relationship can be
fostered. Annual picnics with families of residents and the associates have shown to
create better functioning amongst residents, and respect for other workers and situations
like the one scene in this weeks media piece (Hoban, 2005).
Hoban (2005) expanded on how breakout discussions amongst associates’
interpretations and senses about diverse topics strive for the understanding that
everybody faces aging and everybody deserves to age with dignity. Through this the
facilities administrator would advocate for both parties to resolve any culture clashes or
perceived tensions. Depending on the type of facility, public and private organizations
and individuals within Wisconsin have the option of joining Wisconsin Long-term care
workforce alliance. According towww.wiworkforcealliance.com, their purpose is aimed
at the long-term care workforce and strategies to improve the status of being a caregiver.
Advocating for both parties displays a balance amongst the caregivers and the
residents and is often encouraged to create a harmony within long term care (Hoban,
2005). It is important that residents feel safe and that they are given equal dignity if
concerns are raised. The administrator manages all grievances in an ethical, and
justifiable manor in order to bridge tensions between different ethnicities.
Youngwerth & Twaddle, (2011) explained that interdisciplinary team care models
have a greater chance of producing a superior outcome because patient care utilizes
combined knowledge and skills. While multidisciplinary team members can each be
identified as “wedges of a pie” (Youngwerth &Twaddle 2011), their contributions remain
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separate from the rest of the pie. Transdiciplinary model allows for more communication
and collaboration between team members but the definition of each team member’s role
remains disorganized. By using synergistic interactions with team members who are
experts within their own specialty—team members will bring their skills together to
provide collaborative rehabilitee care plans for older adults. Teams that taken
interdisciplinary care approach are more likely to show care with the patient and their
family, consideration with their values and culture, and heighten the commitment and
productivity from older adults themselves (Youngwerth &Twaddle 2011). For
interdisciplinary care to be applied in the future it will need to be a part of the education
in the healthcare field, this way there is a standardization in the delivery of quality health
care. Team members practicing this approach within the geriatric field have seen clinical
outcomes related to: a decrease in the admission to nursing homes, a decrease in drug
reactions, and lower rates of depression and symptoms of delirium. Finally, clinical
outcomes with interdisciplinary care models have shown that older adults are able to
maintain their functional health status, and decrease the loss in activities with their daily
life (Youngwerth &Twaddle 2011).
V. Long-Term Care financial and budgetary principles
Residents will be admitted to the facility after having been admitted to the
hospital. These individuals will be referred to the rehabilitation facility through the
university hospital. During this time, administrators will work with stakeholders and
other administrating coordinators to further align care-funding resources. This future
rehabilitation facility will apply a person-centered Green House conceptual approach to
care.
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By utilizing a more client centered care approach, administrators and staff
members will be able to design a more personal rehabilitation plan according to one’s
lifestyle and activities of daily living. This will be especially important during one’s
transition back into their home where their occupational therapy services will be
personalized to their home environment. According to Bilsky, & Aber (2007)
administrators approaching care services from a business perspective are able to place a
cost on quality measures; this approach will be reviewed by administrating staff members
and applied at the rehab facility and then within a resident’s home. Financial
administrators and stakeholders will work together with the state’s health department
resources to improve quality system surveys. In the future, the state’s health department
will be more involved and recognize other cultural barriers and techniques.
For successful implementation, policy makers and labor departments will need to
work together with the state governing board to help redesign job roles, responsibilities,
and more extensive entry-level training to gain the proper administrating care credentials.
Utilizing data sets gathered from the results of future research, future policies can be
devised to promote a greater sense of well being in person centered care (Koren, 2010).
The redesigned role of the caregiver, referred to as Shahbazim, within Green
Houses allow for greater self-managed interdisciplinary team approaches to rehabilitative
care. It was found that Shahbaz were able to take on more defined responsibilities
without affecting the amount of time spent with each resident (Sharkey, et al., 2010).
By taking on roles including cleaning, laundry, and cooking, other hiring staff expenses
for these areas can be virtually eliminated. Shahbazim is quickly taking upon the role as
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the “midwife of elderhood”, rising in elevated job characteristics and an elevated
important job status (Loe and Moore, 2011).
The Green House model allows greater reciprocal relationships to emerge from its
unique perspective of care. Further these Green House “culture change” principles will
guide the promotion of maximum functionality, offer greater areas for meaningful
activities, for residents and result in positively fostered spiritual and emotional well-being
(Loe and Moore, 2011). The structurual and cultural aspects of Green Houses empowers
caregivers and their residents. Reports support that Shahbasim feel greater sense of
personal fulfillment and professional fulfillment, greater sense of accomplishment, and
higher job satisfaction rates (Loe and Moore, 2011).
Empowerment of Shahbasim is the core aspect of culture change initiatives that
stem from the development of the Green House model. In 2011, Bowers detailed upon
the quality of the resident’s life is dependent upon the contingency of the caregivers
assignments and their relationship with the staff. For enhanced efficiency and
effectiveness, staff will be encouraged to make collaborative decisions to manage
resident’s care plans and work to provide a homelike atmosphere (Koren, 2011). This
established systematic care process is measurable to continued quality improvements, and
has shown to surpass other resident clinical outcomes. Organized cultural care
management has shown to have positive effects on staff’s performance and on staff turn
over (Koren, 2011).
The state of Wisconsin can use Medicaid dollars, grants, Civil Monetary Penalty
funds, legislative funds, or a permutation to help forefront cultural change activities. To
manage capital costs, policy makers will reconstruct codes for person-centered care
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design innovations, creating interests, targeting grants and other tax credible barriers to
replace what is typically thought of as a ‘nursing home or rehabilitation facility’. The
future rehabilitation facility can also use the states’ payment incentives to adopt person
centered care (Koren, 2011). In 2013, Miller et al. studied the prevalence of culture
change practices within nursing homes and how its prevalence is associated with state
Medicaid reimbursement policies. As culture change practices are implemented through
policy changes, it can be used as a promising strategy for enlarged Medicaid
reimbursement funds (Miller et al., 2013). With the states pay-for-performance Medicaid
reimbursement rate, the inclusion of culture change will increase performance measures
on the future rehabilitation environment.
VI. Conclusion
Perhaps one of the most important steps coming to long-term care over the next
two decades involves advances in medical and behavioral health for elder adults. Long-
term rehabilitation care organizations are at the forefront to encourage older adults to
learn how to remain active and age healthily. As long-term rehabilitation, care devolves
over the next few decades’ doctors and other team members would be able to further
track the progress and status of baby boomer generation after experiencing a fall. It is
imperative that baby boomer generation be trained on any technology that they may need
to use in order to manage their chronic condition.
The care for future generations of elders shows a pressing need for a better
education on the technology that is being used today to track medical progress. The
future rehabilitation center will host educational classes for elders we need to use any
technical devices to communicate with any occupational therapist, physical therapist,
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doctors, pharmacists, or other team members who are involved in ones interdisciplinary
care plan. In the future, older adults can communicate with team members about any
questions they have regarding their rehabilitation plans and further allow for a smoother
transition between the greenhouse environment and one’s own home. For instance if one
has a question on how to perform a specific exercise, their physical therapist would be
able to response by sending a video that shows how to perform exercises and further
discuss which muscles the elder should be concentrating on all doing there rehabilitation
exercises. Leading administrators within the system would respond by implementing
changes in legislation to provide sufficient funding for older adults to gain greater access
to technology within long-term rehabilitative care. Further leaders would ensure older
adults utilizing these technological resources are educated on their function and purpose.
In conclusion, it is recommended legislation preserve funding to develop Green
House rehabilitation homes within Madison and surrounding area. The funding to
develop these Green House rehabilitation homes serves to improve the quality of life of
caregivers and residence themselves. The implementation of this long-term rehabilitation
care organization will allow Madison’s older adults to recover from injuries or surgeries
in a homelike atmosphere that provides occupational and physical therapy and overall
support for the individual’s personalized care needs. Utilizing interdisciplinary care
teams will foster effective communication amongst care team members and the resident
and lead to a positive collaborative outcome towards a successful recovery.
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