Palliative care manager Archives ⋆ Cathy Cress

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.

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

April 9, 2020

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.

https://www.forbes.com/sites/johnkoetsier/2020/04/02/elder-tech-how-to-keep-seniors-connected-safe-happy-in-the-coronavirus-era/#3443c2dc66cf

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

What is the Care Manager’s Role with Hospice?

February 15, 2020

What is a Geriatric Care Manager’s Role in Hospice?

The geriatric care manager serves older adults before they find they are dying. GCM’s work with chronic care clients, some times for years, who eventually succumb to their illness. They also work with clients who come to them facing the end of life issues.

The process of acceptance and adjustment to terminal illness has five phases:

· before the diagnosis,

· the acute phase

· the chronic phase

· the recovery phase

· the terminal phase

A care manager is a GPS for both the client and family through the

5 stages, bringing in critical services like palliative care and hospice

caregiver respite and quality of life the whole continuum of care for supporting the end of life- at the right phase at the right time –

Benefits You (as a GCM) will Bring to Hospice

You (as a geriatric care manager) will bring the client to Hospice much earlier in the 5 stages of death and dying than one month before death

You will do a Quality of Death assessment to find out the patient’s wishes for a good death

You will make sure all the critical paperwork is needed is gathered and organized, including:
Insurance
Legal
Financial
Healthcare
End of life

Interventions vary according to the phase. The GCM may already have served the client and they are now facing a terminal diagnosis. But a geriatric care manager may be brought in when the family is negotiating through any one of these phases, their work begins with making a determination of what phase the client is in and what services are appropriate for that client at that stage. They are also the best professionals to bring in the quality of life to every phase so that the client can have not only a good death but a good life to the very end.

Benefits You Bring To the Family Friends and Hospice

You will monitor the client/care receiver’s and family caregiver’s health and psychosocial status and the paid caregiver’s care plan, to improve the quality of care and life for the client and caregiver So That Hospice can direct all it’s attention to the client and assured family
caregivers needs are being met

Shot of a wife consoling her husband during a counseling session with a therapist

You will accompany the client to all medical appointments and make sure that the 10 minutes cover all questions, that the physician’s orders are recorded and followed, and that all meds are picked up and set up properly So What –Hospice does not provide this and ensures the client gets to all appointment relieves the family of another task and everyone is getting all the correct information from the physician

You will make sure that the family has an online personal health record or a notebook if they wish So What -The family has a way to keep track of information from many professional involved and passes on the correct information to everyone in the family and they can feel more in control in an emotionally chaotic time

You will do a caregiver assessment and suggest interventions from the local continuum of care, including support groups, counseling, respite care, and private duty home care So What –You are insuring a whole family approach and the family caregivers are getting the support and respite they need in this frightening time for their loved one

You will coordinate family meetings to facilitate issues like shock, grief, and shutting down So What- You are a container, allowing the family caregiver to deposit their tremulous at timesdesperate feelings in a safe place so they can get help from you and be calmer for the dying loved one
You will coordinate health literacy information and training of disease skills for family So What- You will create a forum for the family caregivers to express their grief, fear and even hopes and demystifying all the unknown medical terminology to make the family feel more literate and self-assured in approaching the medical staff to get the information they need

You will monitor anticipatory grief in family and friends and bring in resources

So What- You will create a forum for the family caregivers to express their grief fear even hope and find the help they need to so on with the journey to death

You will review all new medication with family caregivers and care staff- So What-you will unravel the confusing litany of pharmaceutical terminology and make sure the family and friends both understand what med does what, how to set up meds and remind the meds when hospice is not present

Join me in my new FREE Webinar
Learn to Sell Benefits not Features to Third Parties to Grow Your Care Management Bottom Line

When: February,20th 2020
2PM-3:30 PM PST
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What is a benefit vs features and how to find benefits for each 3rd party you market to?

What specific problems you solve for hospice, wealth managers, elder law attorneys, and concierge physicians

What specific problems to solve for upscale Assisted Living, accountants, financial planners, MD’s

Step by Step how to set up meetings with 3rd parties to make the sale

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Find out more by watching my youtube playlist on Death and Dying on my channel Geriatric Care 1

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Afraid of Your Competition ??-You Can Learn How to Position Your Business From Them

January 14, 2019

Your competitors can show you how to position your business so you stand out from the competition. Positioning is how you make clients in your area choose you over others in the area you serve. Your ALCA or Care management competition survey, ( which should so yearly by getting a mystery shopper). The Trump administration says there are lots of people out there be a mystery shopper since he shut the government down. These mystery shopper calls ( the coast guard or your staff) let you identify and survey other direct GCM competitors like the area agency on aging which may have a GCM arm or for-profits like accountants or elder law attorneys who include geriatric care management in their service mix.

Identify substitute providers like hospitals, often through their home health services. These can also be part of your competition to take market share from you. Private duty home care agencies offer geriatric care management to their web site. But you have to discover whether they have a certified aging life geriatric care manager as part of their staff. Tracking this down takes having a secret shopper calling all of these agencies and talking to the actual geriatric care manager and asking for their credentials, prices, services, and many more variables.

Professional Patient advocates in your area should also be tracked as possible competitors.

Non-profits often spin off for profit geriatric care management arms to help with the more needy clients they serve. Many religious denominations have geriatric care as a choice so you can learn how they are leveraging their brand. Area Agencies on Aging offer private geriatric care management and can do a good job of leveraging their respect and brand in the community.

Trust departments or wealth management services can have care management to assist with their elderly clients or the adult children in wealth management, who care for their parents.

All these competition surveys will show you marketing/positioning alternatives in your this competitive landscape. They will show how to better brand and shape your branding message- so you are the top choice of customers.

Find out how you can position your own GCM/ALCA agency, over your competition and be chosen by clients seeking care for loved ones.

Join me in my new FREE Webinar
Learn to Market Like Your Business Depended on it!
When: January 23, 2019
2PM-3PM PST
Learn

How to position your agency so it stands out from your competitors
How to develop or rewrite a strategic marketing plan in 2019 that brings more customers
How to use branding to build positive gut feelings about your agency
How to develop lead generation and tactics through third parties
How to set up leads generation with both a speakers bureau to do co-presentations & join the rubber chicken circuit to reach adult children and targeted audiences:
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What Does a Care Manager Do When a Client Asks For Help with Assisted Suicide?

August 9, 2017

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.

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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