Class XVIII Health Care Day - Michael Gloth


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  • Kiely, D. K., Givens, J. L., Shaffer, M. L., Teno, J. M. and Mitchell, S. L. (2010), Hospice Use and Outcomes in Nursing Home Residents with Advanced Dementia. Journal of the American Geriatrics Society, 58: 2284–2291. doi: 10.1111/j.1532-5415.2010.03185.x
  • Class XVIII Health Care Day - Michael Gloth

    1. 1. GREATER NAPLES LEADERSHIP Masters Class XVIII Healthcare Day, February 5, 2014 Dr. Michael Gloth Presentation
    2. 2. Greater Naples Leadership Masters Class VXII HEATHCARE DAY Senior Living and Care: Living and Dying in the State of Comfort and Dignity F. Michael Gloth, III, MD, FACP, AGSF,
    3. 3. Settings for Senior Living • Independent Living – Most living environments after college • Assisted Living – Some Assistance with Some Activities of Daily Living • Bathing, Dressing, Transferring, Toileting, Feeding • IADLs • Skilled Nursing (Medicare) vs. Nursing Home – Rehabilitation
    4. 4. Prescription Management for the Elderly • Medications To Be Avoided – Beers Criteria • Number Of Medications • Individual Assessment – Complications – Interactions – Age – Diet – Cost (Financial and Personal)
    5. 5. ©Hagar the Horrible. Dik Browne.
    6. 6. End-of-Life Concerns • • • • Palliative care Hospice Care Living Wills Health Care Proxy
    7. 7. Palliative Care • Emphasis on Comfort and Dignity • Cure is Not Focus (feasible or possible) • May involve elements of care
    8. 8. Hospice • Palliative Care at the End of Life • Comfort and Dignity • Medical, Social, Spiritual, Volunteer, & Bereavement components • DME, Medications, Respite • Medicare benefit with 6-month prognosis • Entitlement under Medicare Kiely, D. K., et al. JAGS. 2010; 58: 2284–2291. doi: 10.1111/j.1532-
    9. 9. Hospice Criteria • Prognosis less than 6 months • Functional Risk Factors • Nutritional Parameters • Disease Specific Criteria
    10. 10. Living Will/Advance Directive  An advance directive is a written or electronic document or oral directive that: 1. Appoints a health care proxy (agent) to make health care decisions - and/or – 2. States the patient’s wishes about medical treatments when the patient no longer has capacity to make decisions (living will)
    11. 11. Authority of a Health Care Agent • The advance directive determines when the health care agent has authority – “When I can no longer decide for myself”: The individual may decide whether one or two physicians must decide about incapacity – “Right away”: When the document is signed, the agent has authority
    12. 12. Basis of Agent’s Decisions • The health care agent is to make decisions based on the “wishes of the patient” • If the patient’s wishes are “unknown or unclear,” then decisions are to be based on the “patient’s best interest”
    13. 13. Resources (for you or others) • Hospice – AVOW and VITAS
    14. 14. SUMMARY • Living Settings – Independent Living, Assisted Living, Skilled Nursing, and Prescription Management for Older Adults – Prescription Management for Older Adult – Type and Number • End-of-Live – Hospice care, Palliative care, Living Wills, and Health Care Proxy.
    15. 15. ©Shoe. Jeff MacNelly. Tribune Media Services, Inc. 1999.