High Tech Health Care for Boomers

images-1As I stated in my book “Passing the Torch, Critical Conversations with Your Adult Children” care for seniors will change dramatically as more and more baby boomers join the retiree ranks. Most boomers never want to go near a nursing home and are very adverse to ultimately living in a traditional assisted living residence.

Research has shown the boomers who will need long term care want to stay in their own homes. They don’t want to be shipped off to some institution. But the problem will be finding the people to provide the care for them at home. The pool of available family caregivers is decreasing as more families require two full time incomes to meet expenses. The daughter or daughter in law that you traditionally relied on to take care of mom or dad just can’t do it anymore. She is working full time as as well as taking care of her own family.

The alternative is to seek home care aides who work independently or through a home care agency. But these people are generally underpaid, not respected and aren’t rewarded for outstanding performance.

But now the high tech industry is stepping in to provide a better solution. Seth Sternberg, with the help of Marc Andreessen, Apple stores creator Ron Johnson, former Sen. Bob Kerrey, Yelp CEO Jeremy Stoppleman, Facebook CTO Mike Schroepfer, PayPal co-founder Max Levchin and a long, long list of notable Silicon Valley entrepreneurs and investors has created a firm called “Honor”.

Honor will create an online marketplace. Caregivers will be able to list their qualifications, skills, hours they’re able to work and distances they’re willing travel. Seniors will specify the type of help they need, the hours they want and important personal details — that they only speak Mandarin, or that they have cats, or that they live in a multi-story unit. Honor will match caregivers and seniors accordingly, with final approval of the match in the hands of the seniors and their families.

Honor will also give seniors a custom-built, easy-to-use touchscreen appliance where they will be able to update caregivers on any changes in their needs or condition, so the caregivers will be better prepared when they walk in the door. The devices will also be used to record what services seniors received and for how long, and to allow them to rate the quality of care. Authorized relatives will have access to the information, so they’ll be able to monitor the situation.

The difficulty for Honor will be to recruit the right people to provide home care services and pay them a reasonable wage. Let’s face it, taking care of elderly, incapacitated people is not an easy job. Honor has brought in Phaedra Ellis-Lamkins, a respected former labor organizer from the South Bay and CEO of an anti-poverty organization to begin recruiting workers in the San Francisco area. We will keep an eye on this program to see how it develops.

Will Hospice Shorten Your Life?

images-1Many of us might believe that when we choose to accept hospice care at the end of our lives, our lives will be shortened as a result. After all, hospice patients often stop painful chemotherapy or other interventions that are expected to prolong their lives.

But a number of studies have proven this not to be true. A landmark study from the Massachusetts General Hospital in 2010 made some startling findings. Researchers randomly assigned 151 patients with Stage IV lung cancer to two possible approaches to treatment. Half received the usual oncological care. The other half received the same oncological care with additional visits from a palliative care specialist. These specialists focus on preventing and relieving the suffering of patients.

Those who saw a palliative care specialist chose to stop chemotherapy sooner, entered hospice far earlier and experienced much less suffering at the end of their lives. And they lived 25% longer that those who did not receive palliative care!

Atul Gawande, M.D. ,in his groundbreaking book, “Being Mortal”, states that “Like many other people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies show otherwise.”

He adds, “For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer when you stop trying to live longer.”

Gawande, a practicing physican in Boston, reports that most terminally ill cancer patients have had no discussion with their doctors about their goals for end of life care despite being within months of death. But those patients who enrolled in hospice, suffered less and were better able to interact with others forlonger period of time. “People who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”

Thank You, Hospice!

hands of old and youngIn my last post I mentioned a conversation the medical director of my mom’s assisted living residence had with me. She suggested we enter mom into the hospice program. With some trepidation I agreed and met with the hospice nurse who very gently described to me the program that would follow.

She informed me that a hospice aide would visit with my mom several days a week to help her in any way needed. She, as the assigned hospice nurse, would check in with mom weekly and give me an update. In addition Medicare would provide her with a much more comfortable wheelchair and mattress for her hospital bed.

I stopped in to see my mother one day when the hospice aide was with her. The aide had gently combed her hair, put cream on her dry skin and dressed her in a lovely dress with matching scarf and earrings. She looked beautiful. The aide commented on what a lovely woman she was.

After a number of visits in the following three weeks,I could see that my mother was failing. She had a hard time speaking a full sentence, was asleep most of the day and was becoming increasing unresponsive.

On Sunday morning, November 30th I received a call from the residence that mom was totally unresponsive and was taking rapid short breaths. I called the hospice nurse, picked up my daughter, who was visiting with us, ( my wife was away at a conference) and rushed to the residence.

The hospice nurse on call arrived before we did. He had given mom medication to ease her pain and make her more comfortable. He assured me that he would be available all day to help in any way needed. It was clear to me that the end was near.

My daughter and I spent my mom’s last hours with her. She passed away in comfort, in her own bed, holding my hand. I could not have asked for better circumstances for my mother to leave this life.

A few days later, I though about what would have happened if mom was not in hospice. She would have been transported to the emergency room in an ambulance. A number of nurses and doctors would probably go into action trying to keep her alive. She would die in strange circumstances amidst all the noise and activity of the emergency room, with my daughter and I witnessing her demise from the background.

Thank you, Broad Reach Hospice for making the end of my mother’s life, gentle, loving and peaceful.

Is A Hospice Program Right For Your Mom Or Dad?

Mom's 90th BirthdayWhen the medical director of my mother’s assisted living residence called me I was curious to know what she wanted to talk to me about. After informing me how much everyone at the facility loved my mom she then made a statement that took me by surprise. “I think you mom would benefit greatly by going into a hospice program.”

My thoughts immediately jumped to “Oh my God, she’s about to die. The end is very near.” The next day a hospice nurse visited me and explained to me what hospice was and whom it could benefit. She did state that in order to qualify for hospice an individual is expected to die in 6 months or less. But she added that some patients have been in hospice for a year or more. And in some cases they have improved so much they are taken off of the program.

I learned that Medicare would pay for an upgrade to her wheelchair that would make her much more comfortable and provide for any other medical equipment she needed. A nurse would be assigned to her who would monitor her condition weekly, review her medications and report back to us if any changes in her condition occurred. In addition a home health aid would visit her three to four times a week to bathe her or provide any other personal care that would benefit her.

She would be assigned a social worker that could assist her and our family with any emotional support that was needed. An experienced physician would participate in the development of her care plan and oversee her medical regimen. And all of these services would be fully covered by Medicare.

Within two days the nurse had visited her, made specific recommendations to changes in her meds and brought in a new mattress and a more comfortable wheelchair for her. I was amazed at how quickly she went into action and how knowledgeable she was about the aging process.

I had noticed for a few months that my mother had deteriorated significantly but I wasn’t sure how to deal with this and who to talk to. The hospice nurse made it clear to me she was available 24 hours a day, seven days a week if I had any questions or concerns. I immediately felt much more comfortable knowing that someone was watching her situation closely and would be available whenever we needed her.

If you have a family member who is beginning to show signs of slipping away I would recommend strongly that you find out more about the hospice program and have a hospice nurse visit you to answer your questions. In most cases she will do an evaluation of your loved one at no cost. The website for the National Hospice and Palliative Care Organization (www.nhpco.org) will help you find a hospice organization in your area.

Share Your Wisdom With Your Children

Dad and StephDid your parents share their wisdom with you? Did they make you aware of anything they learned from their own successes and failures? Was it helpful to you? Have you thought about sharing your wisdom with your own children?

Susan Turnbull in her book, “The Wealth of Your Life” reminds us that “What you have learned is as valuable as what you have earned.” If you haven’t taken the time to share the important lessons you learned in life with your children, it’s important to do so now.

Richard Lieder, a highly respected executive coach, wrote in his book, “Life Reimagined, Discovering Your New Life Possibilities”, “As we move through middle age, the uncertainty of the world moves us to focus on what matters; our own purpose and our connection to others”

So where do you start? How do you pass on your legacy to the next generation? By writing them a “Legacy Letter”. It is a letter to your family that defines what has been important to you in your life and what you want to pass on.

First decide whom you want to send the letter to; your children, your spouse, your brothers and sisters

Second make some notes in the following areas:

• Your values and the things you did in your life to act on your values
• Something you learned from your grandparents/ parents/spouse/children
• Something you learned from experience
• A mistake that you made that you learned from.
• Something you learned that you’re grateful for
• Your hopes for the future

Now take these notes and weave them into a letter that is addressed to the audience you want to letter to go to. Don’t forget to add stories from your personal life that expand the points you’re trying to make. And just like that you have created a Legacy Letter.

Share it with your loved ones the next time you get together with them. And always remember, “The gift of communication is the greatest gift you can give your family.”

What will you do with all your stuff?

images-1One of the greatest concerns I have noted amongst older couples is, “What will happen to all our stuff when we are gone?” I can remember having a family meeting with a couple in their 70’s and their four adult children and noticed that mom was getting very anxious. At first I thought her anxiety was due to the fact that she was preparing to discuss her end of life planning with her children.

But when I asked her what her concern was, she responded, “I don’t know what I am going to do with all my stuff! I have several beautiful collections and I don’t want my children fighting over the objects right after my funeral or just putting them out in the yard for a giant tag sale!”

She admitted to me that she hadn’t slept for several nights thinking about this terrible possibility. She confided in me that her husband still wasn’t talking to his sister after 20 years because she had raided the house when their parents died and taken everything of value before he had even arrived. “I don’t want that happening in my family!” she proclaimed.

So what did we do? I asked her to describe her valuable collections to her children at the family meeting. She then created a list of all the items and asked each child to review them. If they wanted an item they were asked to put their name next to it. If more than one wanted something they both listed their names next to it and mom would decide who got it.

Mom collected the lists after the family meeting, reviewed them over the next few weeks and then reported to her children who would get what. No one disputed her decisions. After all, the collections were hers and she could give them to charity if she chose. The next time I talked to her I noticed her anxiety level was significantly less. She told me that for the first time in a long time she was sleeping very soundly.

If you are a parent, don’t do your children a disservice. Don’t leave it up to them to decide what to do with your stuff after you are gone. The loveliest relationships are often spoiled by siblings fighting over the silver forks. Meet with your children and tell them what you intend to do. If you are an adult child, strongly suggest to your parents that they follow the procedure my client did. It will save much grief and anxiety for the whole family.

Consider a POLST Form for an ailing parent

images-1In 2011 I wrote a post that describes DNR’s (Do Not Resuscitate Orders) http://parentcareplanning.wordpress.com/2011/05/26/do-not-resuscitate/

“A do not resuscitate order is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR does not affect any treatment other than that which would require intubation or CPR. Patients who are DNR can continue to get chemotherapy, antibiotics, dialysis, or any other appropriate treatment.

If you have an ailing family member who does not wish to be resuscitated they should complete this document and have it signed by their physician. But please be careful to use the form approved in your state.

This summer I attended an excellent seminar presented by Amy Florian, founder of Corgenius, www.corgenius.com. Amy described another tool that can be used to supplement the DNR. It is called the POLST form.

POLST stands for Physician Orders for Life Sustaining Treatment. It is is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR.

The POLST Paradigm is an approach to end-of-life planning emphasizing: (i) advance care planning conversations between patients, health care professionals and loved ones; (ii) shared decision-making between a patient and his/her health care professional about the care the patient would like to receive at the end of his/her life; and (iii) ensuring patient wishes are honored.

As a result of these conversations, patient wishes may be documented in a POLST form, which translates the shared decisions into actionable medical orders. The POLST form assures patients that health care professionals will provide only the treatments that patients themselves wish to receive, and decreases the frequency of medical errors.

The National POLST Paradigm originated in Oregon in 1991 as leading medical ethicists discovered that patient preferences for end-of-life care were not consistently honored. Recognizing that advance directives were inadequate for the patients with serious illness or frailty– who frequently require emergency medical care – a group of stakeholders developed a new tool for honoring patients’ wishes for end-of-life treatment.

Although the POLST Paradigm began in Oregon, it quickly spread to other states, which tailored the paradigm to fit their unique legal, medical, and cultural contexts. Among the first states to develop POLST Programs were New York, Pennsylvania, Washington, West Virginia, and Wisconsin. These states – and others – have become leaders in improving the POLST Paradigm and demonstrating its importance to achieving patient-centered outcomes.

You can go to the POLST site to determine if there is a POLST program approved in your state http://www.polst.org/programs-in-your-state/