Overall Health Status

Assignment Expectations
As the environment is of a real-life project team, you will be assessed as to how well you
present your work to your company and peers (writing and presentations).
Feedback and comments from your instructor and peers should be implemented and early
recommendations adjusted accordingly.
General Background

  1. The Mission Viejo Medical Center (in the city of Mission Viejo, California) comprises
    two geographically adjacent institutions:
    a. Mission Hospital Regional Medical Center: Mission Hospital Regional Medical Center,
    and
    b. Children’s Hospital at Mission (CHM): Children’s Hospital at Mission (CHM)
  2. The two hospitals serve — within less than a 10-mile radius — the populations of the
    following nine municipalities: Aliso Viejo, Ladera Ranch, Laguna Hills, Laguna Niguel,
    Laguna Woods, Lake Forest, Mission Viejo, Rancho Santa Margarita, and San Juan
    Capistrano.
  3. Retirement Communities:
    a. The city of Laguna Woods
    b. The city of Mission Viejo is home to “Casta Del Sol,” a retirement community of more
    than 3,000 senior (55 years and above) residents.
  4. Following the example and success of integrating a special CHOC – children’s hospital
    within the Mission Viejo Hospital, it is suggested for the purpose of this paper only, that an
    additional new hospital wing be built, catering to the special needs of the senior population,
    to be named: “Golden Age Hospital (GAH)”.
  5. The “Consulting Team” has been tasked to research and develop a project feasibility
    plan for the future

GAH.Introductions

Reports indicate that seniors aged more than 65 years have high likelihoods of being
hospitalized for longer stay as compared to other age groups (Selker, Kravitz & Gallagher,
2014). Indeed, this type of patients comprises about 54.8% of the overall long stays in hospitals

CASE ANALYSIS 2
(Selker et al., 2014). It is therefore essential to investigate why this group stays longer in
hospitals and how to design ways of dealing with the issue. In some of the strategies of solving
the problem, the Mission Viejo Hospital has proposed to set up an additional hospital, which
would solely cater for the senior population segment. This would be named the “Golden Age
Hospital (GAH).” This case therefore examines the viability of the proposed project.

The Background Information

Common Medical Conditions of seniors
Overall Health Status
According to statistics, 47% of persons hospitalized in USA are older people who are
aged more than 65 years (Yoo, Kim, Geng, Shin & Nakagawa, 2014). Because the number of
older people is on the rise, most of health centers and hospitals are assigned to older people. In
fact care for older persons should be taken seriously just as it happens with children and
adolescents. Intensely sick older persons may encounter regularly prolonged hospital stays more
than any other age groups. In order to improve older people’s safety, a high quality Medicare has
been emphasized in all health centers dealing with older people. The main reason why there has
been massive hospitalization of older people is because of cardiac dysfunction, pneumonia, and
heart failures (Yoo et al., 2014). Indeed, the oldest persons especially aged more than 85 years
are often hospitalized with issues of hip fractures, urinary tract infections, as well as septicemia.
Unique Illnesses among Older People
There are many unique illnesses associated with older persons leading to their
hospitalization. One of them as demonstrated by Yoo et al (2014) is a condition called delirium.
This is a condition of intense confusion, characterized by the impaired fluctuations between
nights and days. The conditions take place in almost 50% of older hospitalized people in the ICU

CASE ANALYSIS 3
and about 25% in the general care medicine wards. The condition might increase the length of
stay in hospitals and also lead to hospital related disabilities. Furthermore, it has been indicated
to increase rates of hospital readmission as well as mortality in older people (Yoo et al., 2014).
Therefore, early discovery is important in the course of caring for older people being
hospitalized.
Another illness associated with older people is falling incidents during hospital stays. In
fact about 10% of those who are hospitalized experience this condition in the course of their
hospital stays (Yoo et al., 2014). The risk components associated with falling incidents are
normally multifactorial. The existing medications may not lower this condition. It has also been
indicated that most hospitals may not get more payments for Medicare or even subject those
enrolled to pay for the services involved in falls and its related injuries. Therefore, prevention
falling incidents are very important because they will lead to the provision of a cost effective and
high quality Medicare (Selker, Kravitz & Gallagher, 2014). This can be done through setting up
a separate hospital wing as it has been proposed.
The occurrence of pressure ulcers is also identified as one of the unique illness associated
with older persons. This condition occurs in about 5% of older persons (Mitton, Dionne &
Donaldson, 2014). The factors that lead to this condition can be prolonged intensive care unit
stay, urinary incontinence using diuretics, delirium, continuous NPO orders, and failure to use
ambulatory services. The condition mainly experienced in the heels, hips and coccyx. Indeed,
Mitton, Dionne and Donaldson (2014) indicate similar finding with falling episodes that
hospitals are unable to get extra payments from those admitted from this illness. Therefore this
becomes costly on the side of the Medicare providers.

CASE ANALYSIS 4
Another unique condition with older persons is malnutrition. The condition results from
continuous NPO orders, delirium, and restrictions of diets (fluid restrictions or low sodium),
delirium, absence of dentures, and inconveniences in being hooked to catheters (Yoo et al.,
2014). Utilizing oral feeding by parental nutrition or tube feeding can control malnutrition cases,
which are hospital related. The treatment of this condition without considerations of oral feeding
may not achieve long-term objectives and survival (Mitton, Dionne & Donaldson, 2014). This
indicates the necessity of setting up “Golden Age Hospital (GAH)” where maximum care shall
be availed to the seniors.

Medical Institutions for the seniors

Types of institutions and clinics serving seniors
According to Yoo et al (2014), by 2012, the United States had adult day centers whose
capacity was approximately 4800 adults, home health agencies were 12,200, hospices were
15,700, and residential care communities were 22,200. Of this statistics, about 58, 500 were
controlled and long-term operators. About two thirds of these numbers offered care services in
the residential settings (with 26.8% being nursing homes, 37.9% being residential care
communities). Approximately one third offered services within homes and in community settings
(adult day centers being 8.2%, home health agencies; 20.9%, and hospices; 6.3%). Because of
these trends in treatments of the seniors, it could be impeccable if the seniors could just have
their own hospital wing so that maximum care can be dedicated to them. This can help reduce
old age mortality.
Depending on the maximum number of persons allowed, the available 4,800-day services
could accommodate about 276,500 persons on daily basis. The daily capacity allowable of the

CASE ANALYSIS 5
daily service centers accommodated between 1 to 780 persons, with averagely 58
accommodations. The available 15,700 nursing homes offered a sum of about 1,669,100 beds.
There was a range in capacity of the nursing homes from 2 to 1,389 capacity beds, with
averagely 106 beds. On the other hand, there were 852, 400 beds in the 22,200 residential
community cares. The capacity of the community care centers ranged in capacity from 4 to 582
beds, with averagely 38 beds (Yoo et al., 2014).
Types of Special Services Provided for seniors and Catering to their Needs
The seniors’ care services may incorporate a wide range of supportive services, personal
care and healthcare services which meet the expectation of the older people. Most of these
seniors have no ability to take care of themselves as a result of mental disability, cognitive,
physical injury, chronic illness as well as other conditions related to the health of the older
persons. There are many arguments concerning the quality care services that should be offered to
the seniors. Many arguments revolve around mechanisms that can lead to the improved quality
and communications. This lowers the rates of error occurrences, operation costs and variations.
In fact, to achieve better services for the seniors, there should be initiatives on improvements
which should be put in place using strategies such as continuous quality improvements, critical
pathways, and clinical practice guidelines (Gershengorn, Kocher & Factor, 2014). Therefore
setting up a separate wing for the seniors is an improvement strategy that can cater fully for the
needs of the older persons.
Length-of-Stay of seniors at Various Hospitals
Studies suggest that seniors tend to stay longer in hospitals as compared to other age
groups. This condition increases the likelihood of contracting other hospital related illnesses,
interfering with patients access and flow as a result of shortage of beds. Therefore, the shortage

CASE ANALYSIS 6
of bed in hospitals raises issues concerning the safety of patients and the efficiency of
infrastructure in healthcare centers (MacLeod, 2014). It is important to evaluate the elements that
are related with increased length of stay of seniors in hospitals in order to get the guidelines of
how to design the interventions geared towards solving them. Long hospital stays of seniors are
associated with delays in discharge, which are associated with different reasons. These may
include; challenges in accessing social care, career and patient needs, hospital related factors
(results of examinations and delay in diagnosis), as well as medical issues. The establishment of
the Golden Age Hospital will help to ease congestions in the Mission Viejo Hospital hence
improved efficiency.
Local (Mission Viejo area) City demographics
Aliso
Viejo
Ladera
Ranch

Laguna
Hills
Laguna
Niguel

Laguna
Woods
Lake
Fores
t
Mission
Viejo

Rancho
Santa
Margarita

San Juana
Capistrano

Population 50,231 22,980 30,972 65,328 16,415 83,23
6
96,386 49,359 36,282

Gender Male 23,586
 
11,209 14,983 31,542 5,722 41,67
5
48,808 24,412 17,596

Femal
e
26,645 11,771 15,989 33,786 10,693 41,56
1
47,578 24,943 18,686

Age (median
resident age)
36.9
years
33.4
years

43.9
years
45.3
years

76.3
years
38.9
years
43.7
years
37.2
years

42.7 years

Household
income

$108,1
40
$81,837 $97,06
9
$107,101 $41,05
3
$100,
557
$111,5
03

$109,496 $83,144

CASE ANALYSIS 7

(median)
Race (whites
only)

59.3% 69.4% 57.2% 72.5% 84.0% 54.5
%
65.7% 67.0% 56.1%

Est. per capita $48,98
6
$38,247 $48,03
8
$802,100 $41,86
5
$43,1
15
$47,83
8

$47,749 $42,977

Median gross
rent

$1,864 $2,070 $1,997 $1,973 $1,645 $1,95
4
$2,268 $1,864 $1,872

Conclusions
In conclusion therefore, it is recommended to set up Golden Age Hospital, which will not
only be useful in controlling congestions in Mission Viejo Hospital, but also promote the quality
of Medicare dedicated to the seniors. Doing this will for a greater extent reduce old age mortality
and promote the quality of life.

References

Gershengorn, H. B., Kocher, R., & Factor, P. (2014). Management strategies to effect change in
intensive care units: lessons from the world of business. Part III. Effectively effecting and
sustaining change. Annals of the American Thoracic Society, 11(3), 454-457.

CASE ANALYSIS 8
MacLeod, L. (2014). Addressing the problems of outpatient observations vs. short-stay inpatient
admissions. Physician leadership journal, 1(1), 32-38.
Mitton, C., Dionne, F., & Donaldson, C. (2014). Managing healthcare budgets in times of
austerity: the role of program budgeting and marginal analysis. Applied health economics
and health policy, 12(2), 95-102.
Selker, H. P., Kravitz, R. L., & Gallagher, T. H. (2014). The national physician payment
commission recommendation to eliminate fee-for-service payment: Balancing risk,
benefit, and efficiency in bundling payment for care. Journal of general internal
medicine, 29(5), 698-699.
Yoo, J. W., Kim, S. J., Geng, Y., Shin, H. P., & Nakagawa, S. (2014). Quality and innovations
for caring hospitalized older persons in the Unites States. Aging and disease, 5(1), 41.

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