Download - AAAAA Private Home Care

Webinar:
Wiser Health Care Decisions and Choices through
Knowledge
1. Preparing a Written Agenda
2. Preparing a Medical History
3. Preparing Medication List
4. Health Care Proxy verses a Living Will
5. Life-Sustaining Treatment MOLST Guidelines
6. Planning and Costs for Long-term Care
7. Private care verses Nursing Home Care
Preparing a Written Agenda
Part: 1
Written Agenda – Preparation Benefits
Allows you to stay in
control of the
meeting.
Provides an
opportunity to
learn about your
choices and plan of
action.
Provides an
opportunity to
summarize the
discussion
Shows your
willingness to take
an active role in
your care.
Keeps you focused
on the items you
wish to discuss.
Agenda Preparation - outline
1. Date:
2. Agenda for visit with MD:
3. Objectives:
4. Discussion Topics:
5. Plan of action/next steps:
6. Additional questions:
7. Summary:
Agenda Preparation - Goals
*Date and include MD’s name on your agenda
Objectives
Establish a trusting and mutually beneficial relationship
with the physician
Gain insight into your health care options
Establish health goals presently and for the future
Agenda Preparation
- Discussion Topics
Why you selected this MD over another
Your past medical history and medication
review medical history, previous hospitalizations and
surgeries
review medication list
review list of specialists on my team, preferred hospital,
and pharmacy
Agenda Preparation
- Discussion Topics
Your current healthcare issues and concerns
short of breath, light-headed, recent fall, pain, skin
changes
Preventative care
measurements taken to prevent disease or injuries
(regular check ups, regular physical activity)
Health care goals
avoid vision problems, cancer, improve flexibility, be
more active, weight maintenance, healthy skin
Healthcare proxy/power of attorney/advance
directives
Agenda Preparation – Plan of action
• Follow up appointment in 6 weeks
• Follow current medication plan with close
monitoring of questionable moles on skin.
Action Plan
• Make appointment with dermatologist.
• Additional actions?
Agenda Preparation – MD follow-up
questions
• What relationship does your practice have with
the local hospital?
• How quickly will my messages be received by you
and my calls returned?
Additional
Questions
• What happens if I need to see you on a day when
you are not in the office?
• What happens if I’m hospitalized?
• What other questions should be addressed?
Agenda Preparation - Guidelines (overview)
Make several
agenda copies
for others
attending the
appointment.
Date agenda
and provide
the name of
the MD.
Let the
receptionist
know you
have an
agenda for
the MD to
review prior
to the
appointment,
and have it
placed in
medical
record.
Inform the
MD that you
would like the
agenda
reviewed
prior to the
appointment
so it can
guide the
conversation.
Take notes on
the agenda to
clarify the
details of the
appointment.
Summarize
the
appointment
with the MD
to make
certain
everything
was discussed
and
understood.
Ask if you can
follow-up by
phone or in
person if you
have
additional
questions.
Medical history and
Medication List
Part: 2 and 3
Medical History- outline
1. Medical Conditions – add dates, procedures, conditions:
a. Cardiac
b. Neurology
c. Oncology
d. Orthopedic
e. GI (gastrointestinal)
f. Kidney (Renal)
g. Skin
h. Ear, Nose, Throat (ENT)
i. Eyes
2. Surgeries
3. Hospitalizations
:
:
Medical History – Preparation Benefits
Provides guidelines on
proper treatment. (allergic
reaction, etc.)
Provides guidelines
for MD to respond to
new health signs or
symptoms.
Doctors can avoid
duplicating services
Health history can
easily be shared with
emergency
personnel and new
health care providers
Provides
immunization history
enabling you to keep
current.
Medical History – Preparation conditions list
(dates, treatments, present conditions, and so on.)
Notes
Conditions
Cardiac
Neurology
Urology
Orthopedic
GI (gastrointestinal)
Kidney (Renal)
Skin
Ear, Nose, Throat (ENT)
Eyes
Surgeries
Hospitalization
• Hypertension (high blood pressure)
• Occasional swelling of feet and ankles
1.12.12 blood pressure meds side effects
• Prior hemorrhagic stroke
2.12.13 stroke
• Frequent urinary tract infections
• Osteoarthritis, right hip replacement
• Spinal stenosis of cervical and lumbar spine
• GERD (gastro-esophageal reflux)
• Diverticulosis
10.11.11 surgery on hip
• Stage III Kidney disease
• Excessive thinning, dryness
• Fungus of toe nails
• Post nasal drip
9.11.10 eye virus treatment
• Dry eyes
• Pacemaker insertion
• Left hip replacement
• For all surgeries
• Fall resulting in hip fracture
Sept. 2011,
April 2013
Medication History – preparation benefits
Provides information on
medications taken and
assists with selfadministered medications
Provides insight on
potential allergic
reactions and
conflicts with
medications.
Provides an
opportunity to
summarize the
discussion
Provides insight on
potential conflicts
with herbal
supplements and
vitamins.
Keeps you focused
on the items you
wish to discuss.
Medication List
Client: Jane Doe
DOB: 06/01/41
Allergies: Morphine, Bactrim DS, Seasonal Allergies (Pollen)
Daily Medications
Medication
• Aspirin
• Atorvastatin
(Lipitor)
For Medical
Condition
• For Heart
• For Heart
Prescribing
Physician
• Dr. Salem
Date Started
• Sept. 2012
Dosage &
Frequency
• 325 mg - 1 x
daily
Notes
• a.m. intake
• p.m. intake
Medication List
Client: Jane Doe
DOB: 06/01/41
Allergies: Morphine, Bactrim DS, Seasonal Allergies (Pollen)
Vitamins, Herbal Medications & Nutritional Supplements
Medication
• Multivitamin
• Cranberry
Capsules
• Vitamin D
For Medical
Condition
• Prevention
• Prevention of
UTI
• Osteoporosis
and Cancer
Prescribing
Physician
Date
Started
Dosage &
Frequency
• Dr. Brown
• Dr. Smith
• Sept. 2012
• Oct. 2011
•
• Dr. Smith
• Oct. 2011
• 500 mg.
2 caps – 1x
daily
Notes
• a.m.
• a.m.
• a.m.
Medication List
Client: Jane Doe
DOB: 06/01/41
Allergies: Morphine, Bactrim DS, Seasonal Allergies (Pollen)
Occasional or as Needed Medications
Medication
• Tylenol
• Lidocaine
Patch
For Medical
Condition
• Pain
• Back Pain
Prescribing
Physician
• Dr. Brown
• Dr. Brown
End/Start
Date
• Sept. 2012
(start)
• Sept. 2012
Dosage &
Frequency
• 350 mg – 3x
daily
• 500 mg.
Notes
• 6 a.m./2 p.m./8
p.m.
• 12 hrs on, 12
hrs. off.
Medication List
Client: Jane Doe
DOB: 06/01/41
Allergies: Morphine, Bactrim DS, Seasonal Allergies (Pollen)
Previously Taken Medications
Medication
For Medical
Condition
• Flonase nasal
spray
• Nasal
congestion
• Atopicalir
• Eczema
Prescribing
Physician
• Dr. Brown
• Dr. Brown
End/Start
Date
• Sept. 2012
(start)
• Jan. 2010
Dosage &
Frequency
• 1x daily
• 2x daily
Notes
• Each nostril 2
weeks only.
• 12 hrs on, 12
hrs. off.
health Care Proxy vs.
a LIVING WILL
Part: 4
Health Care Proxy vs. Living Will
Both advanced directives,
HCP and LW allow
individuals to retain
control over medical
decisions.
Some states allow
individuals to make
their own Health
Care Proxy, but does
not legally recognize
Living Wills (LW).
Both the HCP form
and the LW once
signed remains valid
unless you revoke
them.
Health Care Proxy
(HCP) designates
another person to
make medical
decisions should you
be unable to do so.
LW allows you to list
medical treatments
that you would or
would not want if
you became
terminally ill and
unable to make
decisions.
Health Care Proxy - Things to Consider
Proxy becomes
effective when MD
determines you are
incapable of making
or communicating
health care issues.
You do not need a
lawyer to complete
Healthcare Agent
form or make it
legally binding.
Must be 18 to assign
an Healthcare Agent
who is designated to
ensure your wishes
are honored.
Healthcare Agents or
Alternate Agent can be
anyone over 18,
except the
administrator,
operator, or employee
of a health care
facility, unless that
person is related to
you by blood,
marriage or adoption.
Proxy must be signed
by two adult
witnesses, neither of
whom can be your
Health Care Agent or
Alternate Agent.
Healthcare providers
are bound to honor
your Healthcare
Agent’s decisions as
if they were your
own.
Make a minimal of
four copies of the
form. One for
yourself, your
Healthcare agent,
your alternate agent,
your physician and
others.
Living Will – Things to Consider
Provides guidelines
to MDs, Healthcare
Agents and others on
certain lifeprolonging
treatments you
desire should you be
in a permanent
vegetative state.
Does not become
effective unless you
are incapacitated.
The individual
designated to invoke
healthcare decisions
on your behalf -- so
make certain they
fully understand
what your desires
are.
Usually requires
certification by your
MD and another MD
that you are
terminally ill or
permanently
unconscious before
become effective.
Requirements for
LW vary by state, so
consider having a
lawyer prepare it.
In situations where
you are not
completely
incapacitated, you
should have a health
care power of
attorney or a health
care proxy act on
your behalf.
Share your LW
document with
those who can
administer your
wishes. If no one
knows your wishes
they can’t be
honored.
MOLST
Massachusetts Medical Orders for LifeSustaining Treatment
Part: 5
MOLST - Guidelines
Massachusetts Medical Orders for Life-Sustaining Treatment
Not designed for healthy
individuals. Suitable for those
with advanced illness (lifethreating disease, chronic
progressive disease, dementia or
suitable for a DNR order.)
Standardized form
containing valid medical
orders for life-sustaining
treatment based on patient’s
own preferences and goals
of care.
MOLST form must be honored as
any other medical order. If other
orders “Comfort (CC) Care” or “
(DNR) Do not Resuscitate” exist
the most recent order must be
honored.
Using MOLST is
voluntary. Patients or
Health Care Proxies can
revoke MOLST at any
time.
Keep copy of form with the patient
at discharge or between care
settings. Keep it in a place it can be
easily seen (door, bedside, or
refrigerator) or in the patient’s
purse or wallet. A copy should also
be with the medical records.
Massachusetts Medical Orders for Lift-Sustaining Treatment (MOLST)
A
Cardiopulmonary Resuscitation: for a patient in cardiac or respiratory arrest
O
B
C
Do Not Resuscitate
O Attempt Resuscitation
Ventilation: for a patient in respiratory distress
O Do Not Intubate and Ventilate
O Intubate and Ventilate
Transfer to Hospital
O Do Not Transfer to Hospital
O Transfer to Hospital
(unless needed for comfort)
D
Patient or
patient’s
representative
signature
Required –
Fill in every
line for valid
orders
Select one circle below to indicate who is signing Section D:
O Patient O Health Care Agent O Guardian O Parent/Guardian* of minor
Signature of patient confirms this form was signed of patient's own free will and reflects his/her wishes and goals of care
as expressed in the Section E signer. Signature by the patient’s representative (indicated above) confirms that this form
reflects his/her assessment of the patient’s wishes and goals of care, or if those wishes are unknown, his/her assessment
of the patient’s best interests. *A guardian can sign to the extent permitted by MA law. Consult legal counsel with
questions about guardian’s authority.
Signature____________________________
Legible Printed Name of Signer______________________
Date________________________
Date _______________________
Massachusetts Medical Orders for Lift-Sustaining Treatment (MOLST)
Clinician
signature
E
Required
Fill in every
line for valid
orders
Signature of Physician, Nurse Practitioner or Physician Assistant confirms that
this form accurately reflects his/her discussion(s) with the signer in Section D.
Health Care Agent Printed Name___________________ ___________ Telephone Number ______
Primary Care Physician Printer Name___________________________ Telephone Number_______
Optional
Expiration
date and
other patient
care contacts
This form does not expire unless expressly stated. (Expiration date (if any) of this form:__________
Health Care Agent Printed Name ____________________________________ Telephone Number ________
Primary Care Printed Name _________________________________________ Telephone Number ________
SEND THIS FORM WITH THE PATIENT AT ALL TIMES.
HIPAA permits disclosure of MOLST to health care providers as necessary for treatment.
Massachusetts Medical Orders for Lift-Sustaining Treatment (MOLST)
Statement of Patient Preferences for Other Medically-Indicated Treatment
F
INTUBATION AND VENTILATION
Select one
circle
Refer to Section B on Page 1
O Use intubation and ventilation as checked
in Section B, but short term only
O Undecided
O Did not
discuss
NON-INVASIVE VENTILATION (e.g. Continuous Positive Airway Pressure – CPAP
Select one
circle
Refer to Section B on Page 1
O Use intubation and ventilation as checked
in Section B, but short term only
O Undecided
O Did not
discuss
DIALYSIS
Select one
circle
O No dialysis
O Use dialysis
O Use artificial nutrition, but short term only
O Undecided
O Did not discuss
O Use artificial nutrition
O Use artificial nutrition, but short term only
O Undecided
O Did not discuss
ARTIFICIAL NUTRITION
Select one
circle
O No artificial nutrition
ARTIFICIAL NUTRITION
Select one
circle
O No artificial nutrition
O Use artificial nutrition
O Undecided
O Use artificial nutrition, but short term only
O Did not discuss
Other treatment preferences specific to the patient’s medical condition and care ____________
Massachusetts Medical Orders for Lift-Sustaining Treatment (MOLST)
PATIENT or
Patient’s
representati
ve signature
G
Required
Fill in every
line for valid
orders
Select one circle below to indicate who is signing Section G:
O Patient O Health Care Agent O Guardian* O Parent/Guardian* of minor
Signature of patient confirms this form was signed of patient’s representative (indicated above) confirms that this form
reflects his/her assessment of the patient’s wishes and goals of care, or if those wishes are unknown, his/her assessment
of the patient’s best interests. *A guardian can sign to the extent permitted by MA law. Consult legal counsel with
questions about guardian’s authority.
______________________________________________________________
Signature of Patient (or Person Representing the Patient)
_____________________________________________________
Legible Printed Name of Signer
___________________________
Date of Signature
_______________________
Telephone of Signer
CLINCIAN
signature
Signature of physician, nurse practitioner or physician assistant confirms that this form accurately reflects his/her
discussion(s) with the signer in Section G.
H
____________________________________________________
Signature of Physician, Nurse Practitioner, Or Physician Assistant
________________________
Date of Signature
_____________________________________________________
Legible Printed Name of Signer
_______________________
Telephone of Signer
Required
Fill in every
line for valid
orders.
Additional Instructions For Health Care Professionals
Follow orders listed in A, B and C and honor preferences listed in F until there is an opportunity for a clinician to review as described below.
Any change to this form requires the form to be voided and a new form to be signed. To void the form, write VOID in large letters across both
sides of the form. If no new form is completed, no limitations on treatment are documented and full treatment may be provided.
Re-discuss the patient’s goals for care and treatment preference as clinically appropriate to disease progression, at transfer to a new care setting
or level of care, or if preferences change. Revise the form when needed to accurately reflect treatment preferences.
The patient or health care agent (if the patient lacks capacity), guardian*, or parent/guardian* of a minor can revoke the MOLST form at any time
and/or request and receive previously refused medically-indicated treatment.
Part 6 & 7
Long-term Care
Costs and
Home Care vs.
Nursing Home
Care
Private Home Healthcare vs. Nursing
Home Care
In-home care has risen at less than (1) one
percent annually during the past five years
according to Genworth Financials 2013 annual
Cost of Care Survey. Average hourly rates
($19 to $21) for HHA/CNA will vary depending
on location and skills required. Also, LPN and
RN rates will be higher and vary depending on
care level required.
Assisted Living, Nursing home,
Majority of people over age
costs have increased by more
65 will require some type of
than (4) four percent a year
long-term care, and 40
based on Genworth Financials
percent will require a period
2013 Cost of Care survey. Rates
of care in a nursing home
($108 to $230 per day) vary
according to Centers for
depending on location and type
Medicare and Medicaid
of facility. Adult day center
Services.
averages $67 per day.
Planning for long-term care
should take place long before
need arises because youth is not
a guarantee that long term care
will not be required.
Over the past 10 years there has
been a steady move away from
traditional nursing home care to
less-expensive options that include
in-home care and adult day care.
Long-term Care Funding Fundamentals
Seniors and families
facing nursing home
decisions should first
determine if Medicare is
an option; however, it
only pays for “approved”
agencies (VNA, etc).
Health and Disability
Insurance often only
covers very limited and
specific types of longterm care, and disability
policies don’t cover any
at all.
Many long-term care
insurances have limits
on what they will pay (25 years) while others will
pay as long as you live.
Most forms of insurance
(Private/HMO) follow
same rules as Medicare.
If Insurance covers longterm care, it’s typically
only for skilled, shortterm medically
necessary care.
Even if you or your loved
one does not need care
today, it’s wise to look at
the costs now and in five
years to gauge what the
financial impact would
be.
If you are in poor health
or already receiving
long-term care services,
you may not quality for
long-term care
insurance. However,
coverage at a higher
“non-standard” rate may
be purchased.
Life Insurance options
for long-term care
coverage.
*Combination (life/longterm care) products
*Accelerated Death
Benefits (ABDs)
*Life Settlements
*Viatical Settlements
Long-term Care Funding Fundamentals
Paying Privately through
* reverse mortgages
* annuities
*trusts
Reverse Mortgage
provides cash (lump-sum
payment, monthly
payment, or line of
credit) against one’s
home value without
selling the home. Many
pros and cons to this
option; seek professional
advise.
Deferred Long-term Care
Annuity available for
those up to 85 years old.
In exchange for a single
premium payment, one
receives a stream of
monthly income for a
specified period of time.
Annuities are provided
by insurance company to
pay for long-term care.
* Immediate annuity
*Deferred long-term
care annuity
Deferred Long-term Care
Annuity creates two
funds (one-term care
expenses and separate
fund to be used as one
desires).
Immediate annuity is
available for purchase
regardless of your
current health status.
Single premium payment
is turned into a monthly
income for a specific
period of time or the
rest of your life.
If long-term care fund is
not used it can be
passed onto heirs.
Annuity may not be
enough to pay for longterm care expenses.
Annuity can affect your
eligibility for Medicaid.
Speak with a specialist
about your options.
Long-term Care Funding Fundamentals
Trusts are legal entities
that allows a person
(the trustor) to
transfer assets to
another person
(trustee).
Trusts are used to
provide flexible
control of assets for
the benefit of minor
children or older
adults or a person with
a disability.
Charitable Remainder
Trust value will only
payout the amount
based on your donation.
When you pass the
funds in the trust go to
the charity you selected.
Donation may affect
your Medicaid eligibility.
Two types of trusts can
help pay for long-term
care.
*Charitable Remainder
Trusts
*Medicaid Disability
Trusts
Medicaid Disability
Trusts are limited to
those with disabilities
who are younger than 65
and qualify for public
benefits. This type of
trust is exempt from
rules regarding trusts
and Medicaid eligibility.
Charitable Remainder
Trusts allow you to use
your assets to pay for
long-term care
services (while you
are alive) and also
contribute to a charity
of your choice and
reduce your tax
burden at the same
time.
If beneficiary with
disability receives
Medicaid Disability
Trust, the state can
recover any amount
remaining in the trust
when he or she dies.
See a specialist advice
prior to setting up a
trust.
End
Questions