• results from internal & external factors that causea person to be susceptible to poor health
• often there is a cycle to vulnerability
• sometimes when one problem is solved, another emerges, leading to feelings of hopelessness
• example: AIDS pts

• greater than average risk of developing health problems due to marginalized socio-cultural status, limited economic resources, age, gender, etc.
• more likely to develop health problems after exposure or have worse outcome
• more sensitive to risk factors; often have cumulative risk factors 

• poverty rate is increasing
• primary cause of vulnerability
• child poverty rates are twice as high as those for adults
• lack "human capital": all strengths, knowledge, skills that enable person to live a happy life
• age: people at both ends less able to adapt to stressors
• changes in normal physiology
• disadvantaged lack access to economic resources

• feeling of separation from mainstream society
• no emotion connection with a group
• weak social support systems
• lack linkages to formal community groups like churches
• lack resources 

• 1965 Medicare, Medicaid: provided for health care needs of elderly, poor, disabled
•  1997 Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to uninsured children

• not all private agencies/insurance want to provide services
• more expensive to treat because of multiple, cumulative risks; require special service delivery
• lack of insurance a major factor to limited access to health care 

• comprehensive family-centered "one-stop" services
• wrap-around services: comprehensive health services usually, but also social & economic services provided directly or through referrals
• social & economic services "wrapped around" health services to ensure effectiveness 
• advocacy
• social justice
• culturally & linguistically appropriate health care
• comprehensive services where people live and work

• emphasize improving health by modifying the individual, social & environmental determinants of health
• having a primary care provider who coordinates health services & provides preventive services

Should assess:

• socioeconomic resources
• preventive health needs
• congenital & genetic predisposition to illness
• amount of stress
• living environment/neighborhood surroundings 

Nurses identify client strengths & needs and develop intervention strategies designed to break the cycle of vulnerability

• Focus on prevention
• know when to walk beside the client and when to encourage the client to walk ahead
• know what resources are available
• develop your own support network

• the usual ones
• persons with communicable disease & those at risk
• HIV positiv, HEP B or STD

• Jan 1, 2006
• Part D
• can be purchased through private companies, each of which has its own formulary (what drugs they will cover)
• best source of info: AARP

• everyone on Medicare can get drug coverage, regardless of income
• you choose & enroll in a private drug plan that Medicare has approved
• you can enroll or switch plans during the annual open enrollment period, Nov 15-Dec 31
• special enrollment period for those new to Medicare: the 3 months before you turn 65
• extra help available to those with low income 

• expected to help those in poverty, but value to the rest questionable

• Deductible: $265
• Initial coverage: plan pays 75%; you pay 25%; amount paid by plan & insured together up to $2400
• Coverage gap/donut hole: costs between $2400 and $3850 are paid for 100% by the client
• Catastrophic: Once drug costs reach $5451, up to 95% of the rest of the drug costs are covered that year