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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