death and dying care manager Archives ⋆ Cathy Cress

10 Parts of Care Manager’s Role With Family Death and Dying of COVID-19?

May 13, 2020

GCM Role is Working With Family In COVID-19

Care managers cannot be in the hospital with a patient dying of COVID-19. They can support their bereft children, who cannot see their parents during the hospitalization, in those last moments of goodbye’s or after the death in this deadly pandemic.

In normal times care managers play a big role in end of life issues. They are their navigators through all five stages of dying, many times long before palliative care or hospice are called. Often GCM’s can help the family and client to bring in hospice or palliative care. But is COVID -19 they can offer guidance to the family through the sometimes weeks of hospitalization, intubation, their loved one is on a ventilator and ultimately often- death separated from loved ones.

Navigation Through a COVID-19 Death

The normal final passage through life can emotionally charged. If the family is following a long labyrinth to the end, in coronavirus, the blind alleys may be blocked by a rushed hospitalization, banned from seeing their loved one in the hospital and not understanding the disease that is killing their loved one. Care managers can find an opening through this maze. Family dynamics and fear of dying can all explode a fraught crisis of care in dying of coronavirus. When vital end of life decisions need to be made, the stress of the responsibility and the seriousness of the situation can break in a mammoth wave of distress fear and anxiety over the “ whole family system”. The geriatric care manager specializes in this whole family system even at the end of life.

Facilitate Family talks over hospitalized COVID-19 Elder

Care Managers can facilitate terrified discussions, and clear the way for family members to come together to work as a functional unit around an unknown killer disease that preys on their loved one. Understanding the differing viewpoints is critical. Knowing what a parent wants and does not want during the last days and hours of life help define and simplify the role of the family. It helps the family bear the burden of having the responsibility of making decisions that their parent wants. Turning this around can also help families have some solace that they carried out their parent’s wishes after their parent’s death.

Care managers can help family members handle the stress of an elder’s hospitalization and death by:

Encouraging routines, exercise and social connectedness with friends and family
Advocate for them with the hospital staff to get updates in this chaotic time in hospitals,
Help them maintain contact with hospital personal to get updated medical status
Create opportunities to communicate safely with the hospitalized family member via text, telephone, email, or video chat
Support and mediate if necessary proactive discussions and advanced directive preparation in a rush if not done
Build a circle of care can help to reduce some of the potential conflicts,
Support them in having essential conversations, prior needing intubation, on last wishes if health status deteriorates
Provide opportunities to say goodbye
guide them in setting up rituals that can celebrate the end of life and give solace to a family during a time when there are yet no rituals for a COVID-19 death.
Work with the hospital to set up Zoom with the family to say goodbye to a loved one.
Geriatric care managers do much more with clients and families but especially now with Covid-19 elder’s and their families facing a separated, fractious end of life
See more about Cathy and her book Care Manager’s Working With The Aging Family

Why is CMS Loosening Nursing Homes Infection Control in Pandemic ?

May 9, 2020

When 20% of COVID-19 cases are in Nursing Homes -CMS Rolling Back Infection Control

Insanely CMS and the FEDS are considering rolling back infection control in a nursing home in the middle of a coronavirus pandemic -when more than 20 % of the cases in the US are in Nursing Homes.

The mind-boggling idea was reported in USA Today. A rule proposed last year by the Centers for Medicare and Medicaid Services (CMS) would modify the amount of time infection prevention must devote to a facility from at least part-time to “sufficient time,” an undefined term that lets the facility decide how much time should be spent.

Why do you need infection control in a nursing home- even before COVID -19?

Over 4 million Americans are admitted to or reside in nursing homes and skilled nursing facilities each year and nearly one million persons reside in assisted living facilities. Data about infections that occur in these skilled nursing home include on a normal day before coronavirus

1 to 3 million serious infections occur every year in these facilities.
Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections, and many others.
Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in LTCFs every year.

Nursing Homes deaths May Be 50% of All Deaths in Pandemic

These infection control rationals were before COVID-19. Now, in the midst of this black plague of the 21st Century, it is thought, according to the Washington Post that nursing homes may account for 50% of death BEFORE infection control is further diluted by CMS.

Cities& States Reduce COVID-19 Risk in Nursing Homes -Feds Increase Them

In contrast to the blighted policy idea of the Federal government, Detroit, as a city, has tested every nursing home and in addition, is testing all staff and providing them with PPE.San Francisco is also now testing every resident of a nursing home. States like Maryland and Wisconsin and testing all nursing homes.

The Kaiser Family Foundation reports that at the end of the pandemic we may find out half of the deaths in the pandemic were from residents of nursing homes. In light of all of this carnage and potential destruction of the elder population in the US- why then are CMS and Trump loosening infection control? Is this throwing salt into the would of frail elders, madness, an attempt to delete people on social security, incompetence at CMS or CMS following the bedeviled destructive policy of the Trump administration? We need answers but will we as a country get them in time?

Advanced Directives AND COVID-19- Do You Know When To Initiate in the Pandemic

May 5, 2020

Covid-19 Makes Signing Advanced Directives Critical

Advanced directives are even more critical with COVID-19 patients, who are often elders. The New York Times had a story about an older woman who was suffering from Covid-19 When she entered the hospital no one asked about advanced directives. After several weeks on a ventilator, the hospital asked about advanced directives, she had none. All her elderly sisters could recall was what she had said about dying when she was young.

WHEN DO YOU DISCUSS ADVANCE DIRECTIVES?

Advanced Directives should be part of your initial psychosocial assessment. Once the COVID-19 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

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 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 durable power for an attorney for healthcare

• A living will

• 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. But if hospitalization is imminent, getting the patient to consider signing with legal consultation maybe your own option, with the family’s permission.

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The 2 Deadliest US Sites of COVID-19 Nursing Homes & Prisons

May 2, 2020

PRISON INMATES AND NURSING HOME PATIENTS NOT 6FT APART – 6 FEET UNDER

70% of inmates in federal prisons have COVID-19. In Kansas, the Lansing Correctional Facility had a riot of inmates over COVID-19 lack of care or protection It took the rebellion to get the coronavirus testing PPE and care. The Bureau of Prisons in Kansas confirmed finally that 79 staff have coronavirus and 88 prisons and prisoners dead.

Older residents in nursing homes cannot rebel like prisoners. Many can’t even walk. The Atlantic Magazine just published an article, We are Killing Elders Now. The writer states “In at least six states, these fatalities account for half of all COVID-19 deaths, and according to the World Health Organization, half of all coronavirus fatalities in Europe have been traced to nursing homes too. Some of this mortality is linked to long-term-care facilities that are shoddily run or that violate health standards. But most of them are doing the best they can with what they have. And they don’t have much”.

KAISER FOUNDATION NURSING HOME STAFFING AND USE OF PPE NOT REQUIRED IN MOST STATES

Kaiser reports -Staff Screening. It is more common for states to recommend rather than require daily screening of staff for illness in NFs (24 states recommend, 16 states + DC require)

Use of PPE. More states recommend (23 states) than require (7 states + DC) staff to use PPE

Two States that require testing for coronavirus of ALL residents of nursing homes are Maryland where 556 have died as of the Washington Post article. and Tennessee

THE FEDS HAVE NO CMS FEDERAL GUIDELINES OR REPORTING

We have no federal guidelines for safety testing according to an article by the Kaiser Foundation

It is now estimated that 16,000 deaths have occurred in nursing homes and that is without the federal government revealing any numbers and not making available any testing. But the numbers are probably huge- if we could just do testing.

CMS announced it would have a meeting of a “panel” of experts “ sometime at the end of May”. After probably 20,000 older people died and the feds did nothing this shows their sense of urgency about this pandemic’s national “elder cleansing”.

WHAT CONNECTS PRISONS AND NURSING HOMES – CONCENTRATION CAMPS

So, what is the connection between the viral spread of COVID-19 in nursing homes and prisons- 6 feet ? Prisoners and residents, in nursing homes, and prisons cannot social distance. Jails and prisons have human beings crammed together with no choice. Nursing homes have 2 beds or if you are on Medicaid three to a room. Neither group has a choice to social distance. They are ” concentrated” as in concentration camps or death camps.

Do SOMETHING – HELP NURSING HOMES PREVENT MORE CARNAGE

So, as someone who has spent her career in aging, I am calling out to everyone, especially professional in aging – do something. Since the feds appear to be doing little- call your congressman, write a letter to the editor.

BE KIND LIKE RACHEL MADDOW REPORTS LA JEWISH HOME LA WAS

Rachel Maddow suggests calling your local nursing homes and see what they need. Be kind like the LA Jewish Home was to a smaller nursing home LA Brier Oaks. They wanted to test their residents and had no tests and the larger LA Jewish Home had tests and shared them with the smaller as a good neighbor. What they found was ravaging but it also showed caring and generosity. Care and be generous and show the helpless elders in nursing homes in your town you are opposed to -nursing home being prisons or concentration camps.

Care Manager’s Must Help Elders at Risk of Covid -19 Prepare End Of Life Docs Fast

April 29, 2020

Aretha Frankin died without will 18 months ago -before COVID-19. Now older people both famous and out of the spotlight are dying in a pandemic not seen since 1917. According to Aretha’s ‘lawyer, Ms. Frankin was aware she needed to take care of this but ” never got around to it”. This left her estate liable for potentially millions of dollars of taxes and attorney fees and a drawn-out timeline for her 4 sons to inherit the proceeds from her estate.

Franklin was, as many have said, ” a force of nature” and a woman who would be hard to sway. But care managers specialize in working with VIP clients and the rich and famous. These clients are often uber difficult to work with- entitled, narcissistic equally hard to sway. Aretha Franklin’s attorney might have convinced her that she needed to work with him to protect her family and her estate before she died.

You as a care manager may have to take a more urgent approach by yourself or with the client’s attorney because the stakes are so much higher as

now elders are likely to die with this virus rampaging throughout the world, striking the people with comorbidity, like people over 65, the hardest

Most geriatric care managers work with the wealthy top 10% if they want to survive as a business as Medicare does not cover long term care. Only the top 10%, like Aretha Frankin, can afford it. But what comes from being a good care manager is knowledge of death. End of Life care is one of their jobs. Making sure their client has all their legal documents ahead of time is critical at this minute. With COVID-19 that clock runs on speed.

Right now with 80% of all the people in the US dying of COVID-19 elders, these documents- one a living will- are ana important job of the geriatric manager, as death

may be shrouded and waiting around the corner for many of your clients

Once the COVID-19 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. The problem with COVID-19 is that the onset of the disease can be rapid. 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.

Your job as a care manager is the make sure your older client has these documents before they have COVID-19:

A durable power for an attorney for healthcare
A living will
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.

But During Covid-19 could rush an elderly client towards death like a mammoth mudslide sweeping them into a hospital where no one can enter, even the family.

Care Managers play a big role in the end of life issues. They are their navigators through all five stages of dying, which is the time before COVID-19 could be long before palliative care or hospice are called. But in this plauge’s reign, there is little time to plan so the five stages of death are on steroids. So, talk to your clients now before they get into a screaming ambulance to the hospital where no one can follow the including you and may never return.

Proactive discussions and legal planning now can help to reduce the risk of dying like Frankin leaving the legacy of her music, a soundtrack to her life but a family both shattered and at war with each other. The COVID-19 clients you see now could be in this position and their families will be left with no rituals no funeral no advanced directives and only hopefully a zoom family meeting to say their last words. Good legal guidance can also help clients make better decisions, avoids all this other legal horror on top of the torturous death of coronavirus. Making a will or a trust now will save the family from adding to the burden of a lonely painful death.

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