10/3/2016 PAL L I AT I VE CARE Wha t, Who , Whe re a nd Whe - - PDF document

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PAL L I AT I VE CARE

• Wha t, Who , Whe re a nd Whe n
• Ma ry Gra nt, RN, MS ANP
• Co nne c tio ns Nurse Pra c titio ne r
• Pa llia tive Ca re Pro g ra m Ore g o n Re g io n

WHAT I S T HE DE F I NI T I ON OF PAL L I AT I VE CARE DE F I NI T I ON

• T

he Ce nte r fo r the Adva nc e me nt o f Pa llia tive Ca re de fine s pa llia tive c a re a s:

• Pa llia tive c a re , a lso kno wn a s, pa llia tive me dic ine , is spe c ia lize d me dic a l

c a re fo r pe o ple living with se rio us illne sse s. It fo c use s o n pro viding pa tie nts with re lie f fro m the sympto ms a nd stre ss o f a se rio us illne ss---wha te ve r the dia g no sis. T he g o a l is to impro ve q ua lity o f life fo r b o th the pa tie nt a nd the fa mily.

• Pa llia tive c a re is pro vide d b y a te a m o f do c to rs, nurse s a nd o the r spe c ia lists

who wo rk with the pa tie nt’ s o the r do c to rs to pro vide a nd e xtra la ye r o f suppo rt. Pa llia tive c a re is a ppro pria te a t a ny a g e a nd a t a ny sta g e in a se rio us illne ss, a nd c a n b e pro vide d to g e the r with c ura tive tre a tme nt.

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PAL L I AT I VE CARE F ACT S

• T

he numb e r o f in ho spita l pa llia tive c a re te a ms in the Unite d Sta te s ha s g ro wn d ra ma tic a lly o ve r the pa st d e c a d e .

• T

he pre va le nc e o f pa llia tive c a re pro g ra ms in U.S. ho spita ls with 50 b e ds o r mo re ha s ne a rly triple d sinc e 2000, re a c hing ne a rly 61% o f a ll ho spita ls o f this size .

• Pa llia tive c a re is no w a ke y sta nda rd o f pra c tic e in le a ding he a lth c a re
• rg a niza tio ns.

PC I N L E ADI NG HE AL T HCARE ORGANI ZAT I ONS

• 100% o f the U.S. Ne ws 2014-15 Ho no r Ro ll Ho spita ls
• 100% o f the U.S. Ne ws 2014-15 Ho no r Ro ll Child re n’ s Ho spita ls
• 100% o f the to p 20 NIH-fund e d me d ic a l sc ho o ls
• 97% o f the Co unc il o f T

e a c hing Ho spita ls a nd He a lth Syste ms me mb e r o rg a niza tio n

• 87% o f the Na tio na l Ca nc e r Institute ’ s d e sig na te d c o mpre he nsive c a nc e r c e nte r

WHAT PAL L I AT I VE CARE I S AND I S NOT :

• Pa llia tive c a re is no t ho spic e
• Pa llia tive c a re is no t a “de a th sq ua d”
• Pa llia tive c a re is a multi disc iplina ry a ppro a c h to the pa tie nt’ s c o nditio n a t

this po int in the ir jo urne y

• Pa llia tive c a re a llo ws the pa tie nt to c o ntinue to g e t tre a tme nt a nd to re turn

to the ho spita l fo r se rvic e s if ne e de d.

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GOAL S OF BOT H PAT I E NT S AND CL I NI CI ANS

• Avo id ina ppro pria te pro lo ng a tio n o f dying
• Re lie ving the b urde n o n the fa mily
• Ac hie ving a se nse o f c o ntro l
• Stre ng the ning re la tio nships with lo ve d o ne s
• E

nsuring tha t a ll me dic a l o ptio ns a re c o nside re d in c o ntinuing to fig ht a g a inst the d ise a se .

PAL L I AT I VE CARE I N PORT L AND ARE A---I NPAT I E NT

• It ha s b e e n a n initia tive fo r the Pro vid e nc e He a lth Syste m fo r the pa st 8 ye a rs
• In the me tro po lita n a re a , e a c h la rg e Pro vid e nc e Po rtla nd Me d ic a l Ce nte r a nd

Pro vid e nc e St Vinc e nt Me d ic a l Ce nte r ,ha s a Pa llia tive c a re te a m b a se d in the ho spita l. It is c o mprise d o f physic ia ns, so c ia l wo rke rs, c ha pla ins a nd nurse s.

• T

he y g e t re fe rra ls fro m the spe c ia lists, ho spita lists a nd surg e o ns.

• In o ur two sma lle r ho spita ls, Pro vid e nc e Willa me tte F

a lls a nd Pro vid e nc e Milwa ukie , the re is o ne physic ia n, so c ia l wo rke r a nd c ha pla in who c o ve r tho se fa c ilitie s.

• T

he re fe rra ls c a n b e to d isc uss g o a ls o f c a re , pa in ma na g e me nt a nd e nd o f life d isc ussio ns fo r the se rio usly ill.

PAL L I AT I VE CARE I N T RI

• COUNT

Y ARE A---OUT PAT I E NT

• We ha ve E

a stsid e a nd We stsid e te a m tha t a re c o mprise d o f two Nurse Pra c titio ne rs,

• ne to two so c ia l wo rke rs a nd a c ha pla in tha t c o ve rs b o th sid e s.
• We c o ve r the a re a s tha t Pro vid e nc e Ho me He a lth se rvic e s c o ve r. T

ha t inc lud e s a s fa r we st a s St. He le ns, so uth Willa mina , She rid a n, Mc Minnville a nd Wo o d b urn.

• We wo rk c lo se ly with the Ho me He a lth Pa llia tive Ca re T

e a ms; me e ting we e kly to d o IDG a nd disc uss sha re d pa tie nts.

• We me e t with the Ne wb e rg Ho me He a lth Pa llia tive Ca re te a m o nc e a mo nth fo r

IDG a nd we a re a va ila b le b y pho ne fo r q ue stio ns.

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WHE N I S PAL L I AT I VE CARE APPROPRI AT E WHE RE DO T HE Y RE CE I VE CARE

• We in the o utpa tie nt te a m se e pa tie nt’ s in the ir ho me s, a ssiste d living , a d ult fo ste r

c a re ho me s a nd me e t pa tie nt’ s a nd fa milie s in me mo ry c a re units.

• Whe n we me e t with the pa tie nt we wa nt the fa mily me mb e rs tha t the pa tie nt wo uld

wa nt to b e pre se nt.

• We like c a re g ive rs to b e pre se nt, a s we ll.
• If the y a re g e tting ho me he a lth, we a ppre c ia te the pre se nc e o f tha t te a m a t the

c o nsult.

• Prima ry c a re pro vid e rs ha ve c o me to the c o nsults, a s we ll.

BE F ORE WE ME E T WI T H T HE F AMI L Y

• We will lo o k a t the a c tua l re fe rra l to de te rmine why we a re b e ing se nt o ut
• We ma y ha ve to re a d the pro vide r’ s no te s o ve r a pe rio d o f time to

d e te rmine wha t the y a re a sking us to d o

• We lo o k fo r a n a d va nc e d d ire c tive a nd a POL

ST

• We ma y ne e d to spe a k to the spe c ia list’ s invo lve d a nd a ny o the r c a re

te a ms suc h a s Ho me He a lth pro vid e rs.

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WHO RE CE I VE S PAL L I AT I VE CARE HOW I S A CONSUL T GE NE RAT E D

• Our o ffic e g e ts re fe rra ls fro m prima ry c a re pro vid e rs, spe c ia lists, se lf re fe rra ls fro m fa milie s, skille d

fa c ilitie s.

• Ma ny o f o ur c o nsults we re pa tie nts tha t ma y ha ve b e e n in the ho spita l a nd the inpa tie nt te a m

c o uld n’ t g e t to the m o r tha t the y ha d a c o nsult a nd we a re d o ing a fo llo w up me e ting .

• We will se e a ll e nd sta g e o rg a n d ise a se , a ll ne uro lo g ic a l d iso rd e rs; Pa rkinso n’ s, De me ntia ; a ll c a nc e r

d ia g no sis, a s we ll.

• We d o no t se e pa tie nt’ s with c hro nic pa in unle ss the y ha ve a te rmina l illne ss tha t is invo lve d in the ir

d e c line .

• T

he y d o n’ t ha ve to b e Pro vid e nc e insure d pa tie nts. T he re will b e o ne NP a nd o ne so c ia l wo rke r a t e a c h o ut pa tie nt c o nsult.

WHAT T O E XPE CT F ROM A CONSUL T

• He lp the pa tie nt g e t a nd unde rsta nd info rma tio n a b o ut the ir illne ss
• He lp the pa tie nt c o mmunic a te mo re e ffe c tive ly with the ir pro vide rs a nd

fa mily me mb e rs

• He lp the pa tie nt ma ke impo rta nt de c isio ns a b o ut the ir he a lth c a re , b a se d
• n yo ur pe rso na l va lue s
• Give the pa tie nt e xpe rt a dvic e o n pa in a nd sympto m ma na g e me nt
• Se rve a s a re so urc e fo r yo ur pro vide rs

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WHAT A CONSUL T MAY L OOK L I K E

• We g e t se ttle d a nd ma ke sure the pa tie nt is c o mfo rta b le a nd c a n he a r o ur

disc ussio n.

• We a sk if the y unde rsta nd why we re a re the re ; mo st time s we do a n

e xpla na tio n o f o ur se rvic e a nd who a ske d us to me e t with the m.

• We ma ke sure tha t e ve ry o ne in the ro o m ha s a n intro duc tio n.
• T

he first pa rt o f o ur c o nsult is to g e t to kno w the pa tie nt o n a pe rso na l le ve l, no t just wha t is in the ir c ha rt.

CONSUL T

• We do a sk pe rmissio n to a sk the se q ue stio ns; whe re we re the y b o rn, sib ling s, e duc a tio n,

wa r time e xpe rie nc e , ma rrie d a nd ho w the y me t, wha t did the y do fo r wo rk a nd wha t ha ve the y do ne if the y a re re tire d.

• T

his g ive s us a g o o d ide a o f ho w the ir re c a ll is a nd wha t wa s impo rta nt to the m g o ing thro ug h life .

• We the n a sk the pa tie nt a nd we a sk pe rmissio n to a sk the fa mily, “ho w ha s the pa st six

mo nths b e e n g o ing ? ”

• We a llo w the pa tie nt to re spo nd first a nd the n a sk pe rmissio n to c he c k with the ir fa mily

me mb e rs.

• We no tic e a nd a c kno wle d g e e mo tio ns

CONSUL T

• Afte r he a ring fro m e ve ryo ne , we a sk “wha t do yo u kno w a b o ut yo ur illne ss o r

wha t ha ve the pro vide rs to ld yo u? ” T his g ive s us a n o ppo rtunity to sha re wha t we kno w a b o ut wha t is g o ing o n with the pa tie nt.

• We the n a sk if the y a re ha ving a ny sympto ms tha t we sho uld b e c o nc e rne d

a b o ut suc h a s pa in, diffic ulty swa llo wing , na use a , vo miting , we ig ht lo ss, b re a thing , b o we ls a nd b la d d e r, e ne rg y a nd mo o d . If the y a re ha ving sympto ms, wha t a re the y ta king a nd is it he lping .

• We a sk ho w the y a re func tio ning ; c a n the y do the ir a c tivitie s o f da ily living ;

suc h a s b a thing , dre ssing a nd fe e ding . Ca n the y wa lk with o r witho ut a ssista nc e .

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CONSUL T

• We ma y ta ke tha t time to ta lk a b o ut the d ise a se , tra je c to ry a nd a nswe r q ue stio ns fo r

the fa mily. We d o a lo t o f e d uc a tio n with re g a rd s to this pa rt o f the c o nve rsa tio n.

• We the n a sk a b o ut the pra c tic a l issue s suc h a s the Ad va nc e d Dire c tive a nd the

POL ST . We ma y no t g e t a ro und to c o mple ting tho se d o c ume nts b ut c a n d o a no the r visit.

• We the n pull to g e the r o ur c o nc lusio n a nd pla ns fo r wha t we will wo rk o n.
• A no te will g o to the pro vid e r who re q ue ste d o ur visit a nd o ur re c o mme nd a tio ns.

K E Y COMPONE NT S T O T HE DI SCUSSI ON ADVANCE D CARE PL ANNI NG

• At the a ppro pria te time in o ur visit we d isc uss the ro le o f a d va nc e d c a re pla nning .
• We a sk pe rmissio n to pro c e e d a s ma ny fa milie s a nd pa tie nt’ s e ithe r ha ve no t

d isc usse d it o r d o n’ t wa nt to .

• We a ssist the m in se le c ting a he a lth c a re re pre se nta tive . We e xpla in tha t the y will

no t ma ke a ny he a lth d e c isio ns, a s the pa tie nt will d o tha t, b ut tha t the y will spe a k fo r the pa tie nt.

• We the n a sk if the y ha ve c o mple te d the ir Ad va nc e d Dire c tive a nd e xpla in the

purpo se a nd why the y wo uld like to c o nsid e r d o ing tha t.

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ADVANCE D CARE PL ANNI NG

• We the n a sk a b o ut the POL

ST a nd if the y kno w wha t it is a nd if the y ha ve c o mple te d o ne .

• If the y ha ve o ne , we re vie w it to b e sure tha t tho se c a re c ho ic e s se le c te d

a re still c urre nt fo r the m.

• We c a n fill o ut a ne w o ne fo r the m if it is da te d o r the ir c ho ic e s ha ve

c ha ng e d.

• We g o into a disc ussio n o n e a c h se c tio n a nd ha ve fo und tha t ma ny time s no
• ne ha s e xpla ine d the c ho ic e s to the m.

ADVANCE D CARE PL ANNI NG

• We ma y wa it a nd d o the Adva nc e d Dire c tive a fte r the y ha ve c o mple te d a

POL ST fo r the e a se o f c o mple tio n.

• We a sk tha t the y sha re the ir wishe s with the ir fa mily, he a lth c a re

re pre se nta tive a nd the ir pro vide r.

• We will do c ume nt b o th o f tho se disc ussio n in the c ha rt so tha t a ll the te a m

unde rsta nds the wishe s.

SYMPT OM MANAGE ME NT

• We ide ntify sympto ms a nd whe re the pa tie nt fa lls o n the Pa llia tive

Pe rfo rma nc e sc a le

• We a sse ss the sympto m b urde n; wha t c a n the y do o r c a nno t do fo r

the mse lve s a nd the ir fa mily.

• We initia te a sympto m ma na g e me nt pla n with the prima ry c a re pro vide r o r

re fe rring spe c ia list.

• We will re a sse ss the sympto m b urde n within two we e ks o r so o ne r if ne e de d

a nd a d just the ma na g e me nt pla n.

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SYMPT OM MANAGE ME NT

• We c o ntinue to a sse ss a nd pla n fo r inc re a se d sympto m b urde n a s the ir

dise a se pro g re sse s.

• We d o c ume nt in the c ha rt the pla n o f c a re a nd a ny furthe r

re c o mme nda tio ns.

• If we a re a ssisting with pa in ma na g e me nt in a pa tie nt with a pa in issue , we

do n’ t write the pre sc riptio ns fo r a ny na rc o tic s. We c a n ma ke re c o mme nda tio ns a nd disc uss it with the physic ia n re q ue sting info rma tio n.

CARE GI VI NG

• T

his is a multifa c e te d to pic in pa llia tive c a re

• We a sse ss the c urre nt living situa tio n; who is c a ring fo r who m, is the e nviro nme nt sa fe

fo r a ll invo lve d .

• We a sse ss the c urre nt c a re g ive rs suppo rt a nd c a re g ive r fa tig ue
• We a sse ss fina nc ia l re so urc e s in o rde r to pla n fo r future c a re ne e d s.
• We a sse ss wha t the future c a re ne e d s ma y lo o k like ; b e d b o und , una b le to fe e d

the mse lve s o r d o a ny o f the ir a c tivitie s o f d a ily living .

CARE GI VI NG

• We a ssist with ide ntifying c o mmunity re so urc e s tha t ma y b e a b le to o ffe r

c a re g iving re lie f.

• We sta rt a ssisting the fa mily a nd c a re g ive rs to lo o k fo rwa rd to wa rd wha t the

ne e ds will b e a nd will the y ha ve to c o nside r o the r o ptio ns fo r c a re We do c ume nt wha t the c a re g iving lo o ks like no w, wha t it ma y lo o k like in the future a nd wha t pla ns a re e ithe r in pla c e o r a re b e ing e xplo re d.

• We try to e nc o ura g e fa milie s to think a b o ut this b e fo re it b e c o me s a c risis

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SPI RI T UAL SUPPORT

• We like to a sse ss spiritua lity—do the y ha ve a fa ith c o mmunity in whic h the y

pra c tic e

• We like to e xplo re me a ning o f life a t this time , wha t is the ir ho pe a nd ho w

a re the y c o ping .

• We like to a sk “wha t g ive s yo u stre ng th a s yo u g o thro ug h this pa rt o f yo ur

jo urne y?

• We e xplo re the impa c t o f the ir dise a se o n the ir b e lie fs

SPI RI T UAL SUPPORT

• We a ffirm the ir b e lie f b a se d c o ping .
• We a sk a b o ut g rie f suppo rt fo r the fa mily e ve n prio r to the e nd a s the y a re

g o ing thro ug h pre -e mptive g rie f a nd who a ssists the m with pro c e ssing .

• If the y ne e d us to c o nne c t the m with c ha pla in o r with c o mmunity re so urc e s

we c a n a ssist with tha t

• We do c ume nt this in the c ha rt fo r the who le te a m to b e info rme d.

E MOT I ONAL SUPPORT

• T

his is whe re the te a m a sse sse s fo r c o ping , a nxie ty a nd de pre ssio n

• We ma y a sse ss a ny g rie f tha t e ithe r the pa tie nt o r the fa mily is e xpe rie nc ing ,

lo ss a nd ro le c ha ng e s.

• We will a sse ss ho w the fa mily is c o ping with distre ss.
• We will o ffe r a nd pro vide lo ss a nd g rie f c o unse ling fo r a ll invo lve d with the

pa tie nt. We c a n, a lso , re fe r whe n ne c e ssa ry.

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E MOT I ONAL SUPPORT

• We will do c ume nt a pla n fo r o n-g o ing suppo rt a nd pro vide fo llo w up a s

ne e de d.

DI SE ASE T RAJE CT ORY

• First is to ide ntify the life -limiting illne ss o r illne sse s fo r the pa tie nt a nd fa mily.
• T

he re is the ne e d to a sse ss the pa tie nt’ s unde rsta nding o f the dise a se a nd wha t the y ha ve b e e n to ld a b o ut the dise a se pro c e ss.

• T

he re is the ne e d, the n, to a sse ss the fa mily’ s unde rsta nding o f the dise a se . T his c a n b e impo rta nt if the y ha ve n’ t b e e n g o ing to the me dic a l a ppo intme nts with the pa tie nts o r if the pa tie nt ha sn’ t b e e n fo rthc o ming with the ir dise a se —”Do n’ t wa nt to b o the r the m, the y a re b usy”

DI SE ASE T RAJE CT ORY

• T

he ne xt ste p is to disc uss the no rma l dise a se tra je c to ry with the pa tie nt a nd fa mily.

• T

he ne xt ste ps a re to disc uss whe re the pa tie nt fa lls o n tha t tra je c to ry a nd wha t the future will lo o k like a s the dise a se pro g re sse s.

• T

he fina l ste p is to do c ume nt the pa tie nt a nd fa mily unde rsta nding a nd a ny q ue stio ns tha t the y ma y ha ve fo r the me dic a l te a m.

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E ND OF L I F E PL ANNI NG

• We a sk pe rmissio n to disc uss e nd o f life a nd we a sse ss pa tie nt’ s prio r

e xpe rie nc e with e nd o f life e ithe r a frie nd o r fa mily me mb e r.

• We a sse ss the fa mily’ s prio r e xpe rie nc e suc h a s ta king c a re o f a lo ve d o ne in

the ir ho me , a nd the ir unde rsta nding .

• We disc uss re so urc e s a va ila b le a nd po ssib le e nd o f life sc e na rio s.
• We d isc uss ma na g e me nt o f e nd o f life , suc h a s Ho spic e a nd wha t tha t wo o l

lo o k like a nd do c ume nt the ir wishe s in the c ha rt.

F AMI L Y

We a sse ss a nd ide ntify who is “fa mily” fo r the pa tie nt a nd a sse ss the ir le ve l o f invo lve me nt with the pa tie nt. We ide ntify the ro le s o f the fa mily in the c a re o f the pa tie nt. We a sse ss a nd tre a t a ny a ntic ipa to ry g rie f tha t ma y b e o c c urring . We a sse ss fina nc ia l issue s d uring a nd a fte r d e a th a nd e ng a g e c o mmunity re so urc e s tha t ma y b e a va ila b le . We do c ume nt tho se fa mily func tio ns in the c ha rt

HI ST ORI CAL PE RSPE CT I VE

• Be twe e n 1900 a nd 2000 the life e xpe c ta nc y in the US ro se fro m 47 ye a r o f

a g e to 77 ye a rs o f a g e .

• T

his ha s g re a tly a ffe c te d the huma n e xpe rie nc e o f illne ss a nd dying .

• T

e c hno lo g y ha s re mo ve d the m fro m b e ing the e nd o f life to so me thing tha t c o uld b e pre ve nte d.

• T

he re a re limita tio ns o f te c hno lo g y a nd mo d e rn me d ic ine tha t ha ve b e e n re a lize d in me e ting the ne e ds o f pe o ple a t the e nd o f the ir live s.

• A ne w fie ld o f me dic ine c a lle d Pa llia tive Ca re to lo o k a t the c a re pa tie nt’ s

ne e d to re c e ive a t the e nd o f life .

• It is fro m the L

a tin wo rd “pa llia re ” to c lo the .

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HOSPI CE

• T

he te rm ho spic e fro m the L a tin “ho spitium” me a ns a pla c e to ho st, re c e ive a nd e nte rta in g ue sts o r stra ng e rs.

• Whe n tra c e d to me die va l time s the o rig ina l ho spic e s we re ho use s o f re st a nd

she lte r fo r pilg rims a nd usua lly ke pt b y re lig io us o rde rs

• T

he e a rlie st ho spita ls a nd ho spic e s we re usua lly o ne e ntity.

• St. Ba rtho lo me w’ s Ho spita l in L
• ndo n, fo unde d in 1123 b e c a me a se c ula r

ho spita l in 1546 “ fo r the a yde a nd c o mfo rte o f the po o re , sykke , b lynde , a g e d a nd impo rta nt”.

• T

he mo d e rn ho spic e mo ve me nt b e g a n with Cic e ly Sa und e rs in L

• nd o n,

F lo re nc e Wa ld in Ne w Ha ve n a nd E liza b e th K ub le r-Ro ss in Chic a g o .

• T

he se thre e wo me n we re a b le to b ring pro fe ssio na l a nd pub lic a tte ntio n to the so c ie ta l a b a ndo nme nt o f the dying a nd the ir fa milie s.

HOSPI CE

• Sa unde rs wa s a nurse , so c ia l wo rke r a nd physic ia n. She is the a c kno wle dg e d

fo unde r o f the mo de rn ho spic e a nd pa llia tive c a re mo ve me nts.

• 1967 she fo unde d St. Christo phe r’ s Ho spic e a nd she ma nda te d e duc a tio n

a nd re se a rc h a s a c o re c o mpo ne nt

• In 1963 a t the re q ue st o f F

lo re nc e Wa ld, she g a ve a le c ture a t Ya le Unive rsity to me dic a l stude nts, nurse s, so c ia l wo rke rs a nd c ha pla ins o n spe c ia lize d c a re o f the dying .

• In 1968 Wa ld to o k a sa b b a tic a l a t St Christo phe r’ s a nd re turne d to Ame ric a

to sta rt the ho spic e mo ve me nt.

• In 1974 Wa ld fo unde d the Co nne c tic ut Ho use . It pro vide d b o th ho me a nd

inpa ite nt c a re .

• 1982 c re a tio n o f the Me dic a re Ho spic e b e ne fit.

COGNI T I VE I SSUE S I N PAL L I AT I VE CARE

• Ma ny o f o ur c o nsults ha ve to do with pa tie nt’ s with e ithe r mild c o g nitive

impa irme nt o r de me ntia

• T

his is a diffic ult time fo r the pa tie nt a nd the fa mily a s fa r a s c a re g iving , sympto m ma na g e me nt a nd e nd o f life pla nning .

• Ma ny fa mily me mb e rs e ithe r ha ve no t b e e n invo lve d with the pa tie nt e ithe r

due to ma rria g e o r se pa ra tio n.

• Onc e the spo use o r c a re g ive r die s, the n the c a re fa lls o n the o the r fa mily

me mb e rs who a re o ve rwhe lme d a b o ut wha t to do .

• We utilize d the SL

UMS o r MMSE tha t ha s b e e n g ive n to the pa tie nt e ithe r in the ho spita l, c a re fa c ility o r the ir prima ry c a re pro vide rs o ffic e .

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COGNI T I VE I SSUE S

• We a ssist the fa mily in ma king sa fe c ho ic e s fo r living situa tio ns fo r the ir lo ve d
• ne s
• If the situa tio n is no t sa fe , we a re ma nda to ry re po rte rs a nd will le t Adult

Pro te c tive se rvic e s kno w o f the situa tio n.

• T

his c a n inc lude issue s a ro und no t just living c o nditio ns b ut physic a l a b use , se lf ne g le c t a nd fa mily ne g le c t, a s we ll.

• If yo u ha ve c o g nitive ly impa ire d pa tie nt’ s in yo ur pra c tic e , it is impo rta nt tha t

the ir fa mily ha ve the ir a dva nc e d c a re pla nning in o rde r.

• And ma ke sure tha t the fa mily unde rsta nds the tra je c to ry o f the dise a se .

QUE ST I ONS