Category Archives: Caregiving – General

Medicare and Medi-Cal recipients unaware of “advance care planning” benefit

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This article, in Kaiser Health News (a news arm of the Kaiser Family Foundation), the author notes that most Medicare recipients and most Californians with Medi-Cal do not know that they are now eligible for a new health care benefit: “advance care planning” discussions with doctors. Such discussions can include those whom you want to speak for you if you are incapacitated and what your medical wishes are.

Medicare recipients can have an unlimited number of conversations with their doctor.  Medi-Cal recipients can have this conversation twice a year with their doctor.  Other insurance plans may cover these discussions.

The executive director of the California State University Institute for Palliative Care believes that anyone over 18 should have this discussion with their physician and should complete an advance care directive.

Amazingly, I’m helping a local family today with brain donation where the intended brain donor (who has Lewy body dementia and lives in a care facility) has NOT identified a healthcare power-of-attorney nor has she completed an advance care directive. At minimum, I believe we should all have a document identifying our healthcare agent.

The Institute for Palliative Care director recommends the “Five Wishes” form, which I recommend as well. We have completed this form within our family. See fivewishes.org.

There are lots of other California-specific resources online as well for completing an advance care directive or a healthcare power-of-attorney document.

See: khn.org/news/advance-planning-for-your-end-of-life-care/

Ask Emily
Advance Planning For Your End-Of-Life Care
Kaiser Health News
By Emily Bazar
July 7, 2016

Robin

“How to Get the Best Care From the Hospital Nursing Staff” (Wall Street Journal, 7-4-16)

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This recent Wall Street Journal article offers advice to families in interacting with hospital nursing staff:

  • Buy candy, cookies, fresh fruit, or a treat for the nursing staff.
  • “Even more important than candy is to ask questions when you don’t understand something, and ask how you can help with your loved one’s care.”
  • Be an active participant in your loved one’s care. “Family members should never feel too intimidated to question a nurse’s actions if they suspect an error or safety risk.”
  • Don’t challenge medical expertise, such as demanding an increase in pain medication above the prescribed dose. “When families get stressed they sometimes go outside their role. They want to determine care or start trying to dictate things. You have to trust the doctor had reasons, or the nurse knows when to increase the dose.”
  • Offer guidance on your loved one’s preferences that will make caring for them easier, such as taking medication with yogurt.
  • Rather than confronting the nurses, quietly seek out the nurse manager and express your concerns.

See the full article: www.wsj.com/articles/how-to-get-the-best-care-from-the-hospital-nursing-staff-1467649623

Life / Health / The Informed Patient
How to Get the Best Care From the Hospital Nursing Staff
A family’s rapport with the nursing staff can improve the care a patient receives; tips for cultivating the relationship that go beyond baking brownies
Wall Street Journal
By Laura Landro
July 4, 2016

Robin

“What Doctors Know About How Bad It Is, and Won’t Say” (NYT, 7-1-16)

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This article from “The New Old Age” section of the New York Times is about doctors not sharing a negative prognosis with the patient and/or family. A related topic is whether the patient and/or family actually hears the negative prognosis.

Here are some excerpts that address important points:

“Understanding what lies ahead can profoundly affect patients’ quality of life—and death. If they underestimate their life expectancy, they may forgo helpful treatment. If they overestimate it—the more common misperception—they may agree to tests and procedures that turn their final weeks and months into a medical treadmill.”

“Frank discussions don’t disrupt the bond between doctors and patients, Dr. Prigerson has shown. They do increase the likelihood that patients receive the end-of-life care they prefer, and leave survivors better able to cope with grief.”

“Overwhelmingly, patients and families say they want to know prognoses, even if they simultaneously mistrust them.”

“[Families] talked about the importance of ‘good vibrations, the power of positive thinking to actually change the outcome,’ Dr. White said. Believing in recovery, they said, might help bring it about.”

Or families think “Many patients in this situation might die, but their relatives were ‘fighters’ or had other unique strengths, so the usual odds didn’t apply. Alternatively, the family’s religious beliefs sometimes dictated that whatever the doctors thought, only God could determine the patient’s future.”

See: www.nytimes.com/2016/07/05/health/what-doctors-know-about-how-bad-it-is-and-wont-say.html

Health
What Doctors Know About How Bad It Is, and Won’t Say
New York Times
Paula Span
The New Old Age
July 1, 2016

Robin

Nursing homes phasing out bed/chair alarms, fall mats, and low beds

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This is an interesting article in today’s Washington Post about how nursing homes nationally are phasing-out bed and chair alarms, fall mats, and low beds in favor of more attentive care.

The director of nursing at a Wisconsin nursing home said: “We’re putting alarms on residents so we can forget about them.” The article states that there’s a “growing body of evidence indicates alarms and other measures, such as fall mats and lowered beds, do little to prevent falls and can instead contribute to falls by startling residents, creating an uneven floor surface and instilling complacency in staff.”

See: www.washingtonpost.com/national/health-science/nursing-homes-phasing-out-alarms-to-reduce-falls/2016/07/02/c67f129e-406d-11e6-9e16-4cf01a41decb_story.html

Health & Science
Nursing homes phasing out alarms to reduce falls
Washington Post
By Bryna Godar
July 2, 2016 at 12:05 PM

Robin

“And how are you (the caregiver) doing?”

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A member of the BSN support group directed me to an article in the Los Angeles Times explaining one view of the value of caregiver support groups. The article addresses caregiver stress and topics discussed at support group meetings. The reporter interviews Patti Davis, daughter of Ronald Reagan.  Reagan was diagnosed with Alzheimer’s disease. Though this article focuses on Alzheimer’s caregivers, very little of the information is limited to the Alzheimer’s world.

See www.latimes.com/health/la-he-patti-davis-alzheimers-support-20160416-story.html

You’re taking care of someone with Alzheimer’s, but who is taking care of you?
by Rene Lynch
April 16, 2016
Los Angeles Times

Here’s one short excerpt:  “Caregiver stress is a very real thing. … The caregivers are the ones that worry about the future and worry about the past and worry about the present. They’re constantly worrying about finances, what is going to happen next, it never lets up. But they feel like, ‘I don’t have the disease, I’m not entitled to the attention.’ They start to feel less important, less significant. On an airplane, when they give you the lecture about the oxygen mask, you’re told to put on your own mask first before you help a young child or the elderly or the disabled. And I use that analogy a lot. Caregivers have to take care of themselves first. They are entitled to have their feelings understood and nurtured and discussed.”

Robin