CMSA Today - Issue 5, 2016 - 16
End-of-Life Care
Normalizing End-of-Life Care
with Rich Conversations
BY MICHAEL DEMORATZ, PhD, LCSW, CCM
M
rs. Jones, an 87-year-old female with
a history of congestive heart failure
and chronic obstructive pulmonary
disease, arrives from the assisted living facility
to the local hospital emergency room. It's late
in the evening, she is unaccompanied by family,
in acute respiratory distress and unable to speak
as she is hooked up to BiPap (Bi-level Positive
Airway Pressure) that is forcing air into her lungs.
She has come with no executed instructions or
advance directives to guide medical staff for
preferred intensity of treatment.
ER staff reach a daughter by phone-who
advises that no one has been chosen to make
decisions and her mom has not expressed
what her preferences might be. "It's a difficult
16
CMSA TODAY
conversation we've hesitated to push," she
states. Medical staff advise the daughter
that they will speak directly to the patient
and offer her the option of being placed on
a machine to assist her breathing to at least
get through this crisis. Mrs. Jones nods her
head in agreement. She is immediately placed
on a ventilator and transferred to the ICU.
Discussions on her wishes and goals will have
to wait until family arrives and her clinical
status is better understood.
Even with nearly 50 years of living wills, 40
years of durable power of attorney forms, 20
years of Five Wishes and more than 10 years
of POLST, the above scenario plays itself out
in mini-family dramas in emergency rooms
Issue 5 * 2016 * DIGITAL
from coast to coast every day. We are reaching
a critical tipping point of enormous need and
shrinking resources, and patient desires to have
greater control and autonomy over how their
final act will be played.
Rich conversations surrounding patient
options, choices, and goals in end-of-life
care are becoming a routine part of a case
manager's care coordination assessment.
These conversations are happening with
greater frequency due to the leading edge of
the "silver tsunami of aging boomers." While
they are still difficult discussions to have due
to the highly charged emotional component,
this fast-growing segment of our population
will be expected to have the information, and
Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2016
President's Letter: Leading Through Change
Immediate Past President's Letter: Risks, Challenges and Progress
Association News
CMSA Corporate Partners
Normalizing End-of-Life Care with Rich Conversations
Personal Feelings/Professional Face: The Hidden Grief of the Helping Professional
INDEX OF ADVERTISERS
CMSA Today - Issue 5, 2016 - cover1
CMSA Today - Issue 5, 2016 - cover2
CMSA Today - Issue 5, 2016 - 3
CMSA Today - Issue 5, 2016 - 4
CMSA Today - Issue 5, 2016 - 5
CMSA Today - Issue 5, 2016 - President's Letter: Leading Through Change
CMSA Today - Issue 5, 2016 - 7
CMSA Today - Issue 5, 2016 - 8
CMSA Today - Issue 5, 2016 - Immediate Past President's Letter: Risks, Challenges and Progress
CMSA Today - Issue 5, 2016 - 10
CMSA Today - Issue 5, 2016 - 11
CMSA Today - Issue 5, 2016 - Association News
CMSA Today - Issue 5, 2016 - 13
CMSA Today - Issue 5, 2016 - CMSA Corporate Partners
CMSA Today - Issue 5, 2016 - 15
CMSA Today - Issue 5, 2016 - Normalizing End-of-Life Care with Rich Conversations
CMSA Today - Issue 5, 2016 - 17
CMSA Today - Issue 5, 2016 - 18
CMSA Today - Issue 5, 2016 - 19
CMSA Today - Issue 5, 2016 - 20
CMSA Today - Issue 5, 2016 - 21
CMSA Today - Issue 5, 2016 - Personal Feelings/Professional Face: The Hidden Grief of the Helping Professional
CMSA Today - Issue 5, 2016 - 23
CMSA Today - Issue 5, 2016 - 24
CMSA Today - Issue 5, 2016 - 25
CMSA Today - Issue 5, 2016 - 26
CMSA Today - Issue 5, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 5, 2016 - 28
CMSA Today - Issue 5, 2016 - cover3
CMSA Today - Issue 5, 2016 - cover4
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http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
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http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
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