Cathy Cress

Expert in Aging Life and Geriatric Care Management

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What Does a Care Manager Do When a Client Asks For Help with Assisted Suicide?

August 9, 2017

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The terminal phase of any life-threatening illness is the time between diagnosis and the final decline when no cure or extension of life is in the offing. The individual confronts progressive decline and deterioration. Death is imminent. The care manager has a role.

The focus of doctors and patients now changes from attempting to cure the illness or prolong life to trying to provide relief from pain and to comfort the sufferer. Religious concerns such as what happens after someone passes away or how to handle the suffering at the end of life or how to give comfort to family members are the focus during this time as well as trying to tie up any loose ends.

But what happens, when in the terminal phase the client asks you, the geriatric care manager, about the right to die in your state. In California where In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness, they do have a right to discuss this with their physician. Four other states have passed this law including Oregon, 20 years ago.

In an article in yesterday’s New York Times a physician in Oakland, Ca discussed the ethical dilemma that physicians face. She called for more, guidance and training for physicians in solving this dilemma themselves but also said the law was working well.

For geriatric care managers.

This speaks to more directions for care managers who face this request and it’s ensuing dilemma. We cannot make any of these decisions but this adds another step for us if the clients ask us to help them with physician assisted suicide. So we need protocols and training as well.

 I am adding new  protocols ,about requests for physician assisted suicide, to  the product Care managers Working With Death and Dying  in My Geriatric Care Management Operations Manual, for those who want to add a death and dying service  or End of Life to their  Menu of Services

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Filed Under: Aging, Aging Life Care, aging life care manager, Blog, care manager, Care Plan, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Families, GCM Start -Up, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager Tagged With: aging family, aging life care manager, aging life or geriatric care manager, aging parent care, aging parent crisis, Assisted Suicide, care manager, case manager, Certified Senior Advisors, Hospice, nurse advocate, nurse care manager, palliative care manager

Can a Geriatric Care Manager or Social Worker Be a Midwife for a Good Death ?

June 24, 2017

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Atul Gawande’s breakthrough book, Being Mortal tells us the ultimate goal, after all, is not a good death but a good life to the very end. Elizabeth Kubla- Ross tells us the death is really in parts called five stages.

A Care Manager or Geriatric Social worker can be a midwife through these five stages to a good death, reaching towards joining the ultimate midwife team, hospice.

The Acceptance phase of death occurs when people finally are able to cope with the mental, social, physical, religious and financial effects of their disease, a heavy load  In the disease process and acceptance process, this is the period of time after a medical procedure such as chemotherapy, radiation or surgery. The client’s response to treatment is being monitored. Recovery does not always mean remission, but instead, it is the ability to accept and deal with the struggles of their illness. 

A Story About the acceptance phase Mr. Murphy

William accepted his coming death while in the hospital. He had 4 physicians’ who were treating him aggressively for renal failure with dialysis. He was 93 and refused to sign a DNR. The doctors discovered what they thought might be a tumor. However, they were afraid the biopsy procedure would be too radical for his age. So they kept up the dialysis.

The care manager appealed to the nurses for help when the physicians would not intervene. A nun appeared – it was a Catholic hospital- and said, ” the nurses called me to go around this problem.  Talk to the head Dr. about ordering palliative care.” The Care Manager did.

Sure enough, after the care manager talked to him that physician ordered palliative care. Then one by one one the 4 physicians came to Bill’s bedside and talked softly, asking him to accept that he may have cancer and the biopsy could not be done. The last, a gentle urologist, held his hand and talked of letting go and accepting he would die. He agreed to stop the dialysis.

Bill accepted his death reluctantly wanted to live to watch his 3 great grandchildren grow. The urologist ordered palliative care and Bill changed the DNR with the help of his son. Hospice met with the family and all agreed to move William to the son’s home with 24-hour care and hospice to die. 

Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family  

Filed Under: Aging, Aging Life Care, aging life care manager, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager Tagged With: Acceptance Phase of Death, aing life care manager, Atul Gawande, care manager, case manager, geriatric care manager, Hospice, nurse care manager, palliative care manager, recovery phase of death

How Can a Care Manager Bring Joy to a Dying Client ?

June 22, 2017

 

 

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A care manager can bring joy in the terminal phase of dying and give a good life to the very end.Here is a wonderful example 

 Bill died at the home of his son after he had accepted that he was to die of liver failure. After coming to terms with his death, he and his family, sons, and grandchildren were able to say the goodbyes and offer the unconditional love that they had been fearful to express before his acceptance. A feeling of light joy permeated his room, a family room overlooking the garden, where his hospital bed was set up. Great grandchildren brought pictures, marveled at “grandpa grandpa “ high up in a hospital bed.

His son put a  headphone with a mike on and William could hear and speak, as he had not in years.  It was like the wonderful film and concept  Alive Inside.  Hearing was a gift that gave him such joy. in his last weeks of life.

His 24-hour caregivers were  gifted loving care providers from a GCM agency Livhome .The 24-hour shifts included a nurse of 18 years from Central America and a man finishing his Ph.D. from the Congo. They cared for him with great warmth, so his family could just be his family, relaxing in their love and surrounding him, as if in a circle, that swirled with 4 generations, going every which way while he watched, really loved and melted into his last stage. They ate meals, chitchatted and welcomed new family coming in to see William, as he remained in the center in his hospital bed, the fulcrum of the gathering.

The geriatric care manager, GCM Mary Brennan, from Livhome , a seasoned ,powerful and so kind LCSW, adjusted here and there, with care providers, family needs, Bill’s needs and followed the guidance of Hospice, who were slowly increasing the pain meds, and supporting his heath and medical care needs in death. The geriatric care management agency worked as a partner supplying 24 care and support for the family.

Bill was able to have again, a magical care provider from Livhome, who had been with him for almost two years and was so at the end.

You are only as strong as your weakest link- those are the care providers. These people were the raft that floated Bill up while the family, offered love and hospice provided medical and end of life support. Together they buoyed Bill into his last stage of dying, knowing that his family was the fabric of every step he took toward forward towards death. They gave him that good life till the very end.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filed Under: Aging, Aging Life Care, aging life care manager, Blog, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Families, Geriatric Care Manager, geriatric care manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager, Quality of Life for elders Tagged With: aging life care manager, Alive Inside, care manager, case manager, geriatric care manager, Hospice, Livhome, nurse advocate, nurse care manager, Palliative Care

Can You Give a Good Death without” Rage, Rage Against the Dying of the Light”?

June 20, 2017

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Dylan’s Thomas warns us in his poem

 

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

 

But today a care manager or geriatric social worker can help an older client go gentle into that good night, they do not have to burn and rage at the close of their day because you will be giving them as Atul Gawande suggest – a good death – not a cold terrifying dying of the light.

 

The terminal phase of any life-threatening illness is the time between diagnosis and the final decline when no cure or extension of life is in the offing. The individual confronts progressive decline and deterioration. Death is imminent. The care manager has a role.

The focus of doctors and patients now changes from attempting to cure the illness or prolong life to trying to provide relief from pain and to comfort the sufferer. Religious concerns such as what happens after someone passes away or how to handle the suffering at the end of life or how to give comfort to family members are the focus during this time as well as trying to tie up any loose ends.

 

Care Manager tasks:

Make referral to hospice if family has not  already reached out

Partner with hospice and work under them

 

Monitor anticipatory grief needs

 

Communicate that this is the end (and time to say goodbye)

 

Assess spiritual needs and contact the appropriate religious spiritual counselors to provide comfort and healing.

 

Encourage family members to say The Four Things That Matter Most   “Please forgive me”, “I forgive you”, “Thank you”, and “I love you”.

 

Assess the need for paid caregivers to help the family or help family members share round the clock care among family and friends

 

Support the family members in their need to

grieve and have respite by continuing to assess for overload and burn out with a caregiver assessment tool  

Prepare family for active phase of dying which can be loud and disturbing to someone who is not aware of what will occur

 

 

Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family  

 

 

Filed Under: Aging, Aging Life Care, aging life care manager, Blog, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Families, Geriatric Care Manager, geriatric care manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager Tagged With: aging life care manager, Atul Gawande nurse care manager eldercare manager, care manager, case manager, death and dying, eldercare manager, end of life care, geriatric care manager, hopsice, Palliative Care, terminal phase of dying

What are the 9 Care Manager’s Jobs in the Chronic Phase of the Good Death

June 17, 2017

 

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Create an end of life care management service that gives a GOOD DEATH. Every stage of dying can be part of a good death, including the difficult point called the chronic phase.

This is the time between the diagnosis and the result from the treatments. During the phase, the dying person tries to cope with the demands of daily life while also going through necessary medical treatment, “often having to struggle with the unpleasant side effects of their treatment”.Chronic illness may also involve repeated episodes of deterioration in which the patient confronts and adjusts to these losses. Examples of these losses include cognitive function, sexuality, toileting, the ability to ambulate, eat and dress. The focus of life for both the family and the patient needs to be redefined, shifting from hope for a cure to coping with the illness

Geriatric care manager tasks:

  1. Assist family to determine type of long-term care which may  be safest and healthiest for the loved one: institutional: hospital chronic care or nursing home care, in-home nursing care or family care and make arrangements
  2. Co-ordinate help from community organizations through the continuum of care
  3. Assist client and family connect with support groups in death and dying
  4. Assist learning management of disease skills such from health care staff, videos, manuals or brochures.
  5. Monitor anticipatory grief needs
  6. Learn about disease in order to help the patient make good decisions about his/her care and to help family members monitor their expectations
  7. Monitor caregiver burden: encourage family caregiver’stake time for selves, take breaks, get rest get to medical appointments, for grief needs
  8. Assess client’s non-medical needs: transportation, physician’s appointments, household tasks, personal care  if hospice  involved- medical if not involved
  9. Assess family caregiver for overload, burnout, educational supports, home care supplement or family replacement care

 Add an End of Life service and other care management services, plus all the forms necessary, by going my website Cathy Cress.com and check out MY GCM Operations Manual 1284078981.jpg

 

 

 

 

Gwendolyn LAZO Harris MA, CT, Seniors at Home, San Francisco and Diane LeVan MA both highly expert care managers, created a seminal chapter “Palliative Care and End of Life Care Manager ” in my book Care Manager’s Working With the Aging Family  

 

 

 

 
 

Filed Under: Aging, Aging Life Care, Blog, care manager, case manager, Death and Dying Care Management, death and dying care manager, elder care manager, End of Life Care manager, Families, GCM Start -Up, Geriatric Care Management Business, Geriatric Care Manager, geriatric care manager, geriatric social worker, nurse advocate, nurse care manager, Palliative care manager Tagged With: adding end of life services, aging family crisis, aging life care manager, anticipatory grief, chronic phase of death, death and dying, eldercare manager, end of life care manager, geriatic care manager, geriatric care manager, hospice care manager hospice, nurse advocate, nurse care manager

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Cathy Cress is the leading national expert in Aging Life and Geriatric Care Management. She is author of Handbook of Geriatric Care Management 4th edition, Jones and Bartlett, published 2015 and known as the bible of geriatric care management. Continue Reading >

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