Physician Orders for Life-Sustaining Treatment (POLST)

Physician Orders for Life-Sustaining Treatment (POLST), a standardized medical order form printed on brightly colored paper, indicates which types of life-sustaining treatment a seriously ill patient wants or doesn't want if his or her condition worsens. Too often, necessary conversations about end-of-life medical interventions and intensity of care don't occur. The POLST form, signed by both the physician and the patient, becomes a tool to capture these discussions and make them part of the patient's medical record. The form moves with the patient and must be honored across all settings of care. POLST is intended to avoid unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored at the end of life.
Since January 2009, California law requires that POLST be honored across all settings of care and provides immunity to providers who honor a POLST document in good faith.
POLST is a vehicle to bring clarity around the difficult decisions for end of life care. When used with an advance directive that names a proxy decisionmaker, it would reduce the initiation of unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients' wishes are honored at the end of life.

Geriatric Assessment and Management: Finding the Right Care Manager

Geriatric Assessment and Management: Finding the Right Care Manager

Trends in Dementia Care

Did you know that exercise, prayer and a nutritious diet can help maintain brain health? Those are cutting edge trends in dementia care according to Dr Lena Smith from the National Association of Geriatric Care Managers Conference in Albuquerque, New Mexico. Not only that but utilizing those positive lifestyle attributes can help a person with dementia cope better with the behavioral affects of the diagnosis.

Slow Medicine: conference topic

The topic of Slow Medicine really captures the essence of my care manangement practice. Dr. Dennis McCullough one of our keynote speakers the significance of the latter part of the lifespan through the mind body and spirit and the benefit of 'slow medicine'. Aggressive medicine dominates our healthcare system but is it really a good thing to 'capture' an older person and put them through the paces of the USA agressive medical system?

National Conference

Here I am in Albuquerque, New Mexico for the National Association of Geriatric Care Managers conference. Weather:warm, dry. Chile: hot. Love both green and red and good news is you can have it for breakfast, lunch and dinner(which I plan to do). I see California leads with the most GCMs in attendance followed by Florida. Tonight will be an opening reception always a nice time to get together and reaquaint with colleagues from accross the country. We will also get together will the planning committee for a toast to our efforts. Kuddos to Marty Brown and Jeff Pine our intrepid leaders.

Renoir:Portrait of an Artist as an Aging Man

Just returned from viewing: "Renoir in the 20th Century" exhibit at the LACMA. In 1913, at the age of 72 Renoir declared, "I am just learning how to paint". Some reviews of the exhibit had pooh pooed the fact that these were later works of the genius, beyond his peak Impressionist period. I found them all to be superb. His use of color and radiance are stunning. Luminescent and glorious are the way I describe them. It certainly doesn't hurt that his models have womanly curves and can even be described as fleshy with colors that radiate life. Part of the exhibit explained that Renoir was crippled by rheumatoid arthritis and in order to continue painting had to have the paint brushes strapped to his hand. Photographs showed him in a wheelchair with gnarly balled up fists, deformed and decrepit. But there he is at his easel with his palette painting each stroke. One picture had someone holding the clay as he molded his sculpture painstakingly. One of his last paintings completed before he died at the age of 78 is The Concert, glorious in hues of pink, orange, yellow and green. "A narrow range of harmonious colors to fuse the pictorial elements into a single effect." Glorious!

Concierge Pharmacist

Concierge Pharmacist
Led Medication Management Services
Age @ Home Home Elder Care Management is pleased to announce a value added service to our clients: Concierge Pharmacist led Medication management

Noelle Randall is originally from St. Louis, MO and went to college at the University of Iowa. At Iowa’s College of Pharmacy, she developed an interest in the special medication needs of seniors. She graduated with a Doctor of Pharmacy in 2008 and went to work as a pharmacist for Target in Chicago. In 2009, she married and with her husband Tim moved to San Diego.
Noelle, says, “As a pharmacist, I really enjoy reviewing patients’ medications, answering their questions, and making sure they are comfortable with their drug therapy plan. I am thrilled to get the opportunity to work for the clients of Age @ Home to assist with their medication management.”

Elderly in Emergency Room: Not good!

Age @ Home Elder Care Managers Advocate
in the Emergency Room

Older adults are going to the emergency room at alarming rates. Frankly the ER is the last place you'd want your older loved one to be. It is not uncommon to spend 5-6 hours in an emergency room setting. Good consistent medical care and taking medications as prescribed should cut down on unnecessary trips to the ER. Your elder care manager (ECM)is the go to person to help navigate the need for an emergency room trip. Prevention of and reducing the number of trips to the ER is a top careplan goal for the Age @ Home ECM.

No question that 911 is called for in “real” emergencies such as stroke, heart attack or stopping breathing. Other situations may include falls, change of consciousness, acute pain. When there is room for doubt, the ECM will make a quick call to the primary care physician to see if an office visit or urgent care trip is a better response. Once the need to go to the ER is established, 911 is called and paramedics respond to the scene. Do Not Resuscitate forms as well as a Vial of Life are helpful to the paramedics.

Families are the number one ER advocate for their loved ones. However when their work, family or long distance prevents them from being there the GCM becomes the profession advocate with master's level training and medical advocacy experience in dealing with many, many emergency room situations.

The purpose of the ECM advocate is to:
Facilitate communication between the ER staff and the patient
Improve the quality of care received.
Decrease the level stress of our client

Communicating to ER Staff
The ECM has written permission to advocate and speak to the doctors and nurses in the ER.
The ECM knows the medical history and who the clients primary care provider is, as well as other specialists involved with care.
The ECM knows who holds the durable power of attorney for health care (DPOA) and can communicate with that person in real time.
Age @ Home ECMs all use Blackberrys for real time communication with family including phone, e mail and texting.
Age @ Home provides all our clients with a mini medical file
The Age @ Home ECM can provide a baseline of functioning and describe the acute exasperation of symptoms to the triage nurse and ER physician.
The ECM has the current medication list an knows the clients allergies.
The ECM will check her client in and handle the Medicare/insurance questions.

Facilitating communication from ER staff to Age @ Home client
Help our client understand what is happening.
Help our client to make informed decisions


Decrease the level of stress of our client
The ECM is a friendly face and calming influence.
The ECM will advocate for speedy results
The ECM will advocate for pain management

Advocating in the ER with dementia clients
Minimize distress and confusion
Communicate the clients baseline cognitive functioning to the ER staff.
Interpret information to the dementia clients such as any testing, labs, x rays, blood draws, CT scans and finally the need for admission.

After the ER
The Age @ Home ECM stays until the client is admitted or sent home.
When admitted to the hospital, the ECM accompanies the client to the floor and completes the hospital admission process.
If discharged the ECM takes the client home, making sure the discharge instructions are followed and any prescriptions are picked up.
The ECM coordinates any follow up caregiver needs
The ECM coordinates the follow up medical care such as doctor appointments.

For more information about this topic contact your Age @ Home Elder Care Manager or Krandall@ageathome.net.

Happy New Year

2010 has started out slow. After a busy holiday season and nice getaway vacation in December I am raring to go. Have sent out lots of e mails, scheduled many meetings and am eager to start solving all those age related problems that affect so many older adults out there. FOr instance:trips to the emergency room. Older adults constitute up to 60% of the ER visits overall. Yet sometimes this population is so vulnerable that the ER experience itself can be debilitating. We always reccommend going with an advocate, hopefully a family member who knows your situation, is aware of the event that precipitated the ER trip, knows your medications, can ask for pain control or even something as simple as a drink of water. If a family member isn't availabe a paid caregiver should accompany and the best case scenario is a geriatric care manager who by definition is a professional advocate. Never let your aging loved one langer in an ER alone.