Once the terminal diagnosis is known with an elderly client, the care manager who has added end of life services to their agency ,is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.
Hopefully this has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.
Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents which must be signed, dated and witnessed naming another person to make decisions for you.
Your job as a care manager is the make sure the dying client has these documents:
• A do not resuscitate order DNR (efforts to restart the heart after it has stopped
If the client does not have these legal documents and wishes to create them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney.
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