Teague's Tech Treks

Learning Technology and other Tech Observations by Dr. Helen Teague

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What is Palliative Care?

This post is part of course requirements for Dr. Farzin Madjidi, EDLT724.20, Ethics and Personal Leadership.

Palliative Care is a healthcare option that specializes in the relief of pain, symptoms, and stress of a serious and extended illness. Palliative care recognizes the important role of caregivers and  offers  physical, emotional and spiritual support for improved quality of life to patients and their families facing serious or chronic illnesses. Palliative care may be helpful for those patients suffering with pain and symptoms associated with serious illness, difficult medical decisions or nutritional problems caused by progressive illness problems related to emotional and spiritual suffering.

“Palliative care is appropriate at any age and at any stage in a serious illness. It can be provided together with curative and disease-directed treatments,” said Dr. Victor Hirsch, medical director of Pathways, a palliative care center in Abilene, Texas.

What is Palliative Care?

Patient- and family-centered palliative care optimizes quality of life through anticipatory, preventative, and treatment options such as pain management.  Palliative care is different from hospice care; anyone with a serious, life-limiting or chronic illness can benefit from palliative care, which can extend from a few hours to several years.

“Many people confuse palliative care with hospice care,” said Hirsch, former medical director of a cancer center. “Palliative care is different from hospice in that palliative care is given at the same time as life-sustaining or curative treatments; whereas hospice is only for patients who have chosen to forego life-sustaining treatments. Palliative care is for patients who are at any point in their illness trajectory, while hospice is for patients who have six months or less to live if the disease runs its usual course.”

angel ribbonsIn the palliative care continuum, physicians refer their patients, preferably at an early stage of treatment. An interdisciplinary team including the patient, their family, caregivers, doctors, nurses, social workers, chaplains and other specialists work with a patient’s primary physician to provide an added layer of support for symptom management and support.

 

For more information, visit these online resources:

What is Palliative Care? http://www.cfah.org/prepared-patient/plan-for-your-end-of-life-care/what-is-palliative-care
GeriPal: a geriatrics and palliative care blog http://www.geripal.org/
Palliative
in Practice: http://palliativeinpractice.org
The John A. Hartford Foundation: http://www.jhartfound.org
The American Federation for Aging Research: http://www.afar.org

Palliative Care Picture Source

 

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Highlights in the U.S. Chronology of Aging Policy Events

agingpolicy

This post is part of course requirements for Dr. Farzin Madjidi, EDLT724.20, Ethics and Personal Leadership.

1920: U.S. Civil Service Retirement Act provided a retirement system for many government employees

1935: U.S. Social Security Act provided elderly assistance and elderly survivors’ insurance

1950: U.S. President Harry Truman initiated the 1st National Conference on Aging 

1950: The National Council on Aging founded

1952: U.S. government first appropriates federal funds for social service programs for older persons under the Social Security Act

1954: Meals on Wheels, a home-delivered meal program for seniors begins in Philadelphia, Pennsylvania

1965: U.S. Older American Act (Public Law 89-73) signed into law on July 14. It established the Administration on Aging within the Department of Health, Education and Welfare. Medicare, Title XVIII, Medicaid Title XIX established

1972: Older American’s Act created a national nutrition program for older persons.

1973 Older American’s Act establishes the Area Agencies on Aging

1974: Title XX of the Social Security Act authorized grants to states for social services including protective services, homemaker services, transportation services, adult day care service, training for employment, information and referral, nutrition assistance, and health support.

1974: Housing and Community Development Act provided for low-income housing for older persons pursuant to the Housing Act of 1937

1981: American Federation for Aging Research founded by Dr. Irving Wright to fund research focused on aging processes and age-related diseases

1984: National Institute on Aging created to conduct research and training related to the Aging process, the diseases, and challenges of an aging population

1987: Omnibus Budget Reconciliation Act provides for nursing home reform in the areas of nurse aide training, survey, and certification procedures, and pre-admission screening.

1987: Reauthorization of the Older American’s Act added six service sectors:

In-home services for the frail elderly
Long-term care ombudsman
Assistance for special needs
Home education and promotion
Prevention of elder abuse, neglect, and exploitation, outreach activities

1990: Americans with Disabilities Act extended protection from discrimination in employment and public accommodations to persons with disabilities. Reauthorization of the National Affordable Housing Act HUD Section 202 Elderly Housing program.

1990: Age Discrimination in Employment Act made it illegal for companies to discriminate against older workers in employee benefits

1992: Commissioner on Aging position elevated to Assistant Secretary for Aging

•• To serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and across the federal government
•• To collect and disseminate information related to problems of the aged and aging
•• To gather statistics in the field of aging that other federal agencies are not collecting
•• To stimulate more effective use of existing resources and available services for the aged and aging, and to coordinate federal programs and activities
•• To carry on a continuing evaluation of the programs and activities related to the objectives of the OAA, with particular attention to the impact of Medicare, Medicaid, the Age Discrimination in Employment Act, and the National Housing Act relating to standards for licensing nursing homes and other facilities providing care for vulnerable individuals
•• To provide information and assistance to private organizations for the establishment and operation by them of programs and activities related to the OAA
•• To strengthen the involvement of the Administration on Aging in the development of policy alternatives in long-term care by participating in all departmental and interdepartmental activities concerning development of long-term-care health services, review all departmental regulations regarding community-based long-term care, and provide a leadership role for AoA, state, and area agencies in development and implementation of community-based long-term care.
Source

1993: Dr. Fernando M. Torres-Gil becomes the 1st Assistant Secretary for Aging in the Department of Health and Humans Services

1997: Dr. Jeanette Takamura becomes the 2nd Assistant Secretary for Aging in the Department of Health and Humans Services

1999: International Year of Older Persons: A Society for all Ages

1999: Olmstead Decision of the US Supreme Court regarding ADA and community-based care

2000: Older American’s Act reauthorized to establish The National Care Givers’ Support Initiative

2001: Josefina G. Carbonell becomes the 3rd Assistant Secretary for Aging in the Department of Health and Humans Services

2006: Kathy Greenlee becomes the 4th Assistant Secretary for Aging in the Department of Health and Humans Services

2006: Older American’s Act reauthorized under the Senior Independence Act of 2006

2009: The Elder Justice Act of 2009 becomes part of the Patient Protection and Affordable Care Act, or “the Health Reform Act”

2012: Administration on Aging (AoA), reorganized as a division within the Administration for Community Living . Sen. Bernie Sanders (I-VT) first to introduce the bill for reorganization

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For more information, click on these links:

ElderCare Locator: http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx

Center for Advancing Health: http://www.cfah.org/blog/ 

John A. Hartford Foundation: http://www.jhartfound.org/  

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Advanced Care Directives

This post is part of course requirements for Dr. Farzin Madjidi, EDLT724.20, Ethics and Personal Leadership.

Advanced Care Directives

Advanced Care Directives are written wishes of patient and potential patients, but particularly the elderly regarding medical treatment, end of life decisions, and financial preferences. Also known as advanced healthcare planning, advanced care directives communicate

You may not be able to make health care choices for yourself if you are very ill or injured. The form tells doctor, medical staff and emergency medical attendants in advance how to proceed with medical care and end-of-life choices. Most hospitals have Advance Directive forms, such as the ones at the links below. Studies show that most people believe having an advance directive is a good idea; yet, most people have not created one for themselves.

With an advance directive, you can let your doctor and your family know what medical treatment you want and don’t want. You can change your decisions at any time. Be sure to tell everyone involved — family, proxies, and health care providers — if a living will is changed. Copy, save, and share the new instructions with them.

What to consider before completing an Advanced Directive:

  • Know and understand your treatment options
  • Decide future treatment options you may want
  • Consider becoming an organ donor. You can fill out an organ donation card and also have this choice listed on your driver’s license.
  • Discuss your choices with your family

What to do after completing an Advanced Directive

  • Carry a copy of your Advanced Directives with you
  • Let your family know that you have Advanced Directives in place.
  • Keep a folder in a central place in your home with a copy of your Advanced Directives, your doctors’ names and contact information and any and all medicines currently prescribed, including dosage amounts.

The following information is from the Texas Hospitals’ Association website

There are four types of advance directives. You can execute one, or several, depending on your needs and situation. Download and complete the Texas forms below in English or Spanish. Share copies with your doctor and your family, and take copies with you to the hospital.

Directive to Physicians and Family or Surrogates (PDF in English | PDF in Spanish)

  • This directive allows you to specify for the provision, withdrawal or withholding of medical care in the event of a terminal or irreversible condition.
  • Your condition must be certified by one physician.

Medical Power of Attorney (PDF in English | PDF in Spanish)

  • This directive allows you to designate another person as your agent for making health care decisions if you become incompetent.
  • You do not have to have a terminal or irreversible condition for a medical power of attorney to be used.

Out-of-Hospital Do-Not-Resuscitate Order (PDF in English | Instructions in Spanish)

  • This directive allows competent adults to refuse certain life-sustaining treatments in non-hospital settings where health care professionals are called to assist, including hospital ERs and outpatient settings.
  • You should carry a photocopy of your written form or wear a designated ID bracelet.
  • This directive cannot be executed for minors unless a physician states the minor has a terminal or irreversible condition.
  • Note: The PDF form in English must be properly executed in accordance with the instructions on the opposite side (download Spanish instructions separately) to be considered a valid form by emergency medical services personnel.

Declaration of Mental Health Treatment (PDF in English | PDF in Spanish)

  • This directive allows a court to determine when you become incapacitated, and when that declaration becomes effective.
  • You may opt not to consent to electro-convulsive therapy or to the use of psychoactive drugs.
  • The declaration expires in three years, unless you are incapacitated at that time.

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References

Kapp MB. Ethical and legal issues. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia,Pa: Saunders Elsevier; 2007:chap 6.

Texas Hospitals Association website. Retrieved From: http://www.tha.org/generalpublic/advancedirectives/whataremyoptionsfor09c0/

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