GREATER NAPLES LEADERSHIPMasters Class XVIII

Healthcare Day, February 5, 2014Dr. Michael Gloth Presentation

Senior Living and Care: Living and Dying in the State of

Comfort and Dignity

F. Michael Gloth, III, MD, FACP, AGSF,

Greater Naples Leadership Masters Class VXIIHEATHCARE DAY

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– Chronic Care

• Dependent Care

Prescription Management for the Elderly

• Medications To Be Avoided– Beers Criteria

• Number Of Medications• Individual Assessment

– Complications– Interactions– Age– Diet– Cost (Financial and Personal)

©Hagar the Horrible. Dik Browne.

End-of-Life Concerns

• Palliative care

• Hospice Care

• Living Wills

• Health Care Proxy

Palliative Care

• Emphasis on Comfort and Dignity

• Cure is Not Focus (feasible or possible)

• May involve elements of care

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 MedicareKiely, D. K., et al. JAGS. 2010; 58: 2284–2291. doi: 10.1111/j.1532-5415.2010.03185.x

Hospice Criteria

• Prognosis less than 6 months

• Functional Risk Factors

• Nutritional Parameters

• Disease Specific Criteria

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)

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

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”

Resources (for you or others)

• Hospice– AVOW and VITAS

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.

©Shoe. Jeff MacNelly. Tribune Media Services, Inc. 1999.