7. PSYCHOSOCIAL WELL-BEING

1 7. PSYCHOSOCIAL WELL-BEING . Modifiable factors Relationship problems Supporting Documentation (from resident, family, staff interviews and (Basis/reason for checking the item, including the location, clinical record date, and source (if applicable) of that information_. Resident says or indicated he or she feels . lonely . - Recent decline in social involvement and . associated loneliness can be sign of acute .. health complications and depression . Resident indicates he or she feels distressed . because of decline in social activities . Over the past few years, resident has . experienced absence of daily exchanges with . relatives and friends . Resident is uneasy dealing with others .. Resident has conflicts with family, friends, Resident was admitted to nursing home against her wishes due roommate, other residents, or staff to health issues. Both resident and family representative Resident appears preoccupied with the past indicate this is a problematic area.))

2 See Initial Social and unwilling to respond to needs of the History/Social Assessment, dated -/-/-; Initial Activity present Assessment, dated -/-/-; Admitting MDS codes Section Resident seems unable or reluctant to begin to D, E and F, dated -/-/-. establish a social role in the facility; may be grieving lost status or roles . Recent change in family situation or social network, such as death of a close family member or friend Supporting Documentation Customary lifestyle (from resident, family, staff (Basis/reason for checking the item, including the location, interviews and clinical record) (Section F) date, and source (if applicable) of that information_. Was lifestyle more satisfactory to the resident Resident preferred living in her small apartment prior to prior to admission to the nursing home? admission. After falling numerous times, and declining to the Are current PSYCHOSOCIAL /relationship point where she could no longer attend to daily ADLs, her problems consistent with resident's long- family made the decision to place her in a more secure setting.)

3 Standing lifestyle or is this relatively new for She states that she has no say in anything anymore. Prior this resident preferences and routine have been identified and are being Has facility care plan to date been as adhered to as closely as possible. See Initial Social History/. consistent as possible with resident's prior Assessment, dated -/-/-; Initial Activity Assessment, dated -/-/-. lifestyle, preferences, and routines (F0400, F0600, F0800)? Supporting Documentation Diseases and conditions that may impede ability (Basis/reason for checking the item, including the location, to interact with others date, and source (if applicable) of that information). Delirium (C1600 = 1, Delirium CAA) . Mental retardation (A1550). Alzheimer's disease (I4200). Aphasia (I4300). Other dementia (I4800). Depression (I5800). Supporting Documentation Health status factors that may inhibit social (Basis/reason for checking the item, including the location, involvement date, and source (if applicable) of that information).

4 Decline in activities of daily living (G0110) Resident health status had declined significantly prior to Health problem, such as falls (J1700, J1800), admission to nursing home (decline in ADL care, as well as pain (J0300, J0800), fatigue, etc. increased falls). See Initial Social History/Assessment, dated - Mood (D0200A1, D0300, D0500A1, D0600) /-/-; medical history dated -/-/-. Initial MDS codes (dated - or behavior (E0200) problem that impacts /-/-) as indicated by checked items in Sections B, C, D, G and interpersonal relationships or that arises J. See physician-prescribed medications, and monitoring because of social isolation (See Mood State records, dated -/-/-. and Behavioral Symptoms CAAs). Change in communication (B0700, B0800, vision (B1000, hearing (B0200), cognition (C0100). Medications with side effects that interfere with social interactions, such as incontinence, diarrhea, delirium, or sleepiness Supporting Documentation Environmental factors that may inhibit social (Basis/reason for checking the item, including the location, involvement date, and source (if applicable) of that information).))

5 Use of physical restraints (P0100) . Change in residence leading to loss of Resident did not want LTC admission and felt that the decision autonomy and reduced self-esteem was taken out of her hands. See Initial Social Change in a room assignment or dining History/Assessment dated -/-/-. location or table mates Living situation limits informal social interaction, such as isolation precautions (O0100M). Supporting Documentation Strengths to build upon (from resident, family, (Basis/reason for checking the item, including the location, staff interviews and clinical record) date, and source (if applicable) of that information). Activities in which resident appears especially Prefers either self-directed activities and/or social engagement at ease interacting with others in a small, intimate group. See Initial Activity Assessment dated -/-/-. Certain situations appeal to resident more than See above note. others, such as small groups or 1:1 interactions rather than large groups Certain individuals who seem to bring out a more positive, optimistic side of the resident Positive traits that distinguished the resident as Choices and decision-making, being my own boss.

6 See an individual prior to his or her illness Initial Social History/Assessment dated -/-/-. What gave the resident a sense of satisfaction earlier in his or her life? Input from resident and/or family/representative regarding the care area. (Questions/Comments/Concerns/Preferences /Suggestions Family representatives (son and daughter) are anxious about resident's placement, especially since she did not want to leave her apartment, and they made the decision without her agreement. Their major concern is safety, assistance with ADLs, and quality of life. They believe that she will adjust fairly quickly once she develops some friendships and is assured that family and community visits/contact will be more frequent. They indicate that as long as she can watch her soaps and read the newspaper, she should be happy. They have indicated that being in groups make her anxious and nervous. Analysis of Findings Care Plan Considerations Review indicators and supporting documentation, and Care Document reasons(s) care plan will/will not be draw conclusions.)

7 Plan developed. Document: Y/N. Description of the problem Causes and contributing factors; and Risk factors related to the care area Resident's health declined so significantly that she was Yes Care plan will be developed to address the loss of no longer able to care for herself, living alone. Resident self-esteem, autonomy and ability/opportunity to could not complete much of self-care (ADLs) without make choices/decisions. some assistance; and continued to fall on a frequent basis. She has already stated that she feels like giving up, and that the family railroaded her into this place.. Family is extremely supportive and will be visiting on a regular basis. She will come out of her room to small functions/settings, but complains to family that all she does is sit around with nothing to do. Related risk factors are: safety issues (falls), as well as decline in mood state and PSYCHOSOCIAL WELL-BEING . Referral(s) to another discipline(s) is warranted (to whom and why): Information regarding the CAA transferred to the CAA Summary (Section V of the MDS): Yes No