Friday, March 22, 2013

Caregiver Series IV: Stating your wishes in a medical emergency.

From the “news you can use” department…

The story last month about the death of an elderly California woman when an aide at her assisted living facility refused to give her CPR caught national attention.  After Lorraine Bayless collapsed, the aide called for an ambulance, but refused to further help Mrs. Bayless.   The 911 operator was outraged and the media questioned “what has our society become?” The deceased’s family has decided not to sue because inaction was in line with the elderly woman’s wishes.  This case should encourage all of us to ask ourselves questions.

What are your wishes for life saving care?  Do you know the wishes of your loved ones?  Does your state have a Good Samaritan law? What are the policies of any care givers you hire, or at the nursing facility where your loved ones may live? Are these consistent with your/your loved one’s wishes? Do you have a living will, and most importantly, do others know about it?

When trying to sort out all of this out, some commonly used terms worth knowing are advance directive, living will and durable power of attorney, and do not resuscitate order.

What is an advance directive?  This document tells your doctor what kind of care you would like should you be unable to make those decisions for yourself. Take note, the laws in Michigan differ from Ohio, or other states on advanced directives.

A living will is one kind of advanced directive.   A living will is a legal document that spells out what medical treatments you wish in a potentially life-ending situation.

A durable power of attorney document is also a kind of advanced directive.  The purpose of a durable power of attorney is to state another person you have selected to make decisions on your behalf when you no longer are able.

A do not resuscitate order also an advanced directive, prompts your doctor to put your directive in your medical chart detailing exact wishes.

Good Samaritan laws are in place to shield doctors, or others who help a person in an impromptu emergency situation from law suits.  Michigan has a Good Samaritan laws, which vary from most other state’s laws.

It turns out the Lorraine Bayless had apparently wished for no emergency life saving to be done in an emergency. But apparently and ironically her wishes were not known.   What seems to have surprised the emergency response 911 operator was the unwillingness of the staff at the assisted living facility to either help, or communicate why the aide wasn’t helping. 

Make sure that all of your nursing and home health resources are in line with your expectations. Some final questions to ask yourself; what level of care can you expect from a nursing facility? Is staff trained and permitted to perform emergency care? What emergency care do you want? Is the facility aware of your wishes?

All Trustiva Health caregivers are CPR trained with current certification and are trained to administer CPR (after calling 911) unless otherwise legally directed.
Here are some additional resources to help you in making medical planning decisions:

AARP Advance Directive Information
U.S. Living Wills Registry

If you have additional resources to share about medical planning we would love to hear from you. 

Friday, March 15, 2013

Caregiver Series III: Better Understanding Memory Loss.

There may be a breakthrough on the Alzheimer’s front, a disease impacting as many as 4.5 million Americans.
British scientists say they are closing in on a “cheap and easy screening” test to detect the earliest stages of the memory erasing disease. The scientists are hoping the test will be available in the next ten years. Until that time, we are left with more questions than answers.
What do you do if you, or a loved one begins down that slippery slope of forgetfulness?  How do you know if you are dealing with the signs of aging versus the symptoms of a disease whose results are loss of memory, thinking, and reasoning skills? 
According to almost all medical research the answer may be fairly simple: memory changes do take place due to aging, but when these memory problems interfere with daily life there may be a problem.  Severe memory loss is not simply the aging mind.
Alzheimer’s Disease was discovered in 1907 by Alois Alzheimer, but was not understood as a terminal disease until the 1970s.  And 40-plus years of research and treatment has taught us many things about common behaviors in the earlier days of the disease. They are:
·         Memory loss that disrupts daily life;
·         Challenges in planning solving problems;
·         Difficulty completing familiar tasks at home, or at work;
·         Confusion with the time and place;
·         Trouble reading, or judging distances;
·         Trouble following or joining a conversation with others;
·         Misplacing items and losing the ability to retrace steps;
·         Decreasing and poor judgment;
·         Removing oneself from social activities;
·         Poor hygiene; and/or
·         Changes in personality and mood, such as fear, depression, anxiety, and suspicion. 
If some or all of these symptoms are present in a family member or friend,  seeking medical confirmation is critical.  As diagnosis and treatment - as early as possible - can mean treatment that can lead to independence as long as possible.
The disease is quite difficult to manage and if independence is no longer a practical option, supervised care should be. Specially trained caregivers will keep an Alzheimer’s patient safe and content. Their care will focus on the realities of today and not the memories of yesterday.  The biggest problem for family members, says Dr. Jacob Mintzer, chairman of the Medical and Scientific Advisory Board for the Alzheimer's Foundation of America,  is often that "they're trying to preserve the person they knew as long as possible." It is indeed a terrible disease.
So much has been written about Alzheimer’s Disease and its progression, advice to patients and caregivers -- it is almost overwhelming.  However, here is a start: 

Alzheimer’s Association of America

Frequently asked questions about Alzheimer's disease from MedicineNet.
An overview of Alzheimer's disease from eMedicineHealth.
An excellent resource for caregivers is The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life.         
If you have additional resources to share about Alzheimer’s Disease, or care giving to someone with Alzheimer’s we would love to hear from you.