Minutes of ESCOTA General Meetings

Minutes from the May 14, 2009 General Membership Meeting

Date of Meeting: Thursday, May 14, 2009
Presentation: Older and Wiser: Working Together to Inform Older Adults about Intelligent Health Care Choice
Speaker: Eileen R. Chichin, PhD, RN and Betty B. Lim, MD

Reeva Mager called the meeting to order at 3:35pm. She introduced Amy Lowenberg, Director of Senior Services at Stanley Isaacs, who gave an overview of the services for the elderly in her agency.

Announcements:

Carla Holub Tarantino of Select Care, a private licensed home care agency, is seeking a part-time and full-time RN. Responsibilities include patient assessments, home visits and HHA supervision. Health and dental insurance are available for the full-time position. For more information, please call 212-505-3640.

Presentation:

Reeva Mager introduced the speakers, Eileen R. Chichin, PhD, RN (Co-Director of the Greenberg Center on Ethics and Palliative Care at Jewish Home and Hospital) and Betty B. Lim, MD (Assistant Professor of the Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine). This presentation focused on challenges by those who work with older adults and is particularly necessary for non-physicians who are involved in end-of-life care when a cure is not an option. Given the patient’s diagnosis, prognosis, and current condition, the patient or family needs to determine the goals of care. The healthcare team’s role is to make recommendations to achieve that goal. Comfort may be the primary goal.

Common treatment options and their potential consequences are:

• Cardiopulmonary Resuscitation (CPR): Depending upon the age and general condition of the patient, resuscitation may be ineffective. The CPR success rate for nursing home patients is approximately 1-2%. Families often feel that agreeing to a Do Not Resuscitate (DNR) is a death sentence. In reality, CPR simply does not work with a frail older person.
• Hospitalization for nursing home residents is useful for treatable conditions when function can be restored. For example, if a person had a heart attack but is not terminally ill, give treatment only available in a hospital, such as to pin a hip fracture or to give comfort care that cannot be provided in the home or nursing home. However, hospitalization of a frail older adult is often associated with serious risks related to infection, development of pressure ulcers and loss of function.
• Diagnostic tests: If the results of diagnostic tests will not change the plan of care, tests should NOT be used. If use of follow–up on the results will not be used, no purpose is served by using the tests which are often uncomfortable.
• IV fluids and tube feedings provide water and nourishment when a person can no longer eat or drink. They are useful when a patient will recover from current illness. For a terminally ill individual, they may prolong death and increase discomfort. Dying people generally want very little to eat or drink. This is not painful and they are not hungry or thirsty.
• Intravenous antibiotics: The American Medical Directors Association (AMDA: 2003) stated that for frail older persons, oral antibiotics are often as effective as IVs. Many manifestations of infestations in the frail elderly, especially those with advanced dementia often respond well to analgesics, antipyretics and oxygen.

Views of end-of-life care, experience of pain, and attitude to pain management may vary in different cultures. Patient autonomy and truth-telling may differ as well.

We need to help patients and family in decision-making by focusing on three factors:

• What would the patient want?
• What is in the patient’s best interest?
• What would result in the least burden and greatest care to the patient?

Families should not feel that they must make medical decisions and are the judge, jury and executioner of their loved one. The clinic team must help patients and families determine the goals of care and how to achieve that goal.

Next Meeting:

Date: Thursday June 11, 2009; 3-3:30pm (Networking); 3:30-5pm (Meeting)
Location: Hunter College School of Social Work, Room 1010, 129 East 79 Street (between Park and Lexington)
Presentation: DFTA Funded Case Management: The East Side Case Management’s Consortium’s First Year
Speaker:

Respectfully submitted by Connie Gemson

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