Get Continuing Education Credits This Series is made possible through funds from United Healthcare AlohaCare and the University of Hawaii Department of Geriatric Medicine from the GWEP grant Health Resources and Services Administration HRSA Grant Nos U1QHP28729 ID: 1045002
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2. FREE!Ask all your questions!Get Continuing Education Credits!This Series is made possible through funds from United Healthcare, AlohaCare, and the University of Hawaii Department of Geriatric Medicine from the GWEP grant (Health Resources and Services Administration (HRSA): Grant Nos. U1QHP28729)From the convenience of your own home!Opportunity to learn from each other!Learn from experts
3. Confidential & SafeFor case presentations- Do not share patient names or birthdates.Your questions can be anonymous.SAFE learning and sharing- no shame or blame.ECHO case discussions are not official doctor consults. This is for teaching purposes only.
4. zoom LOGISTICSClick on the Chat Tool (bottom of screen). Enter your name(s) and others joining today’s session. Press Enter.Click on Mute (bottom left) when you are not speaking. You may click again to Unmute to speak.
5. DATETOPICFebWho Knows What Matters? MarUnderstanding What MattersAprAddressing What MattersMayCare Plans that MatterCare Homes ECHO Schedule3rd Thursday of each month2:00- 3:00 pm** Session Topics subject to changeWhat Matters Series- 4 Parts
6. Continuing EducationCreditsYou can receive Certificates of Attendance, CMEs, and NASW continuing education credits!Register: https://tinyurl.com/register-ch-echoComplete an Evaluation: https://geriatrics.jabsom.hawaii.edu/care-homes-echo/** Some systems do not allow access to google forms. Fillable PDFs can be found on our website. Please send to Jon at Nakasone@hawaii.edu
7. INTRODUCTIONS- HUB TEAMAida Wen, MDDepartment of Geriatric Medicine, Associate Professor, Course Director for ECHO Geriatrics ClinicWannette Gaylord (President, Care Home Operator Association)Maribel Tan (President, Foster Family Homes Association)Juliana Caldwell (AlohaCare Service Coordinator)Shane Anderson Leila Ventar (United Healthcare Health Coordinator Manager)
8. Hope Young- Kokua MauINTRODUCTIONS- GUEST SPEAKER
9. COVID CORNERAida Wen, MD4/18/2022
10. https://health.hawaii.gov/coronavirusdisease2019/Infection Rates 7-day average daily cases around 193 (as of 4/18/22)(38.8% received a booster)
11. Community Transmission in Hawaii is still Substantial to Highhttps://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=Hawaii&data-type=CommunityLevels&null=Risk(as of 4/18/2022)
12. Booster Shotshttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.htmlSame for Moderna except everyone 18 years and olderAfter the first booster you are considered “UP TO DATE” with COVID vaccinations
13. Booster Shotshttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.htmlIf you got the J&J shot, the BOOSTER shots should be either the Pfizer or Moderna (mRNA vaccines)
14. Why get a Booster?It prevents you from getting severely sick or being hospitalizedIt makes you less likely to spread the virusWhy CHOOSE to wear a Mask? The relaxation of indoor mask mandates DO NOT apply to healthcare settings.The new variants are VERY Contagious. COVID is still spreading- now on average 190 cases per day. It makes you less likely to spread the virus to those with weaker immune systemsBOOSTER^
15. A note on Boosters for children…ONLY Children ages 5-11 who are fully vaccinated and immunosuppressed are authorized for a booster at this time.Last week Pfizer announced that it planned to submit a request for EUA for a booster for all other children ages 5-11… So stay tuned!
16. Wellness RestRestoreCreateConnectThese are important to put back into your life – Which one will you choose?DO IT THIS WEEK!Small acts of creativity (having fun) in everyday life increases our sense of wellbeing! re-kindle or strengthen old friendshipsRandom acts of kindness helps restore your faith in humanity- and boosts well-being!Allow yourself to rest–not just for when you have time-- sometimes you need to draw the line and fight for it.
17. What Matters Series – Part 3Addressing What Matters Most
18. Let’s Talk Story!! Kokua Mau’s Let’s Talk Story ProgramAdvance Directives and POLSTHope YoungAdvance Care Planning Coordinator
19. Advance Care Planning Why is it important?No one knows when they may become “Very ill”Helps companions to find their voiceHelps prepare them and their family for what’s comingEase the burden for others having to make tough choicesHelps assure their wishes are followedCOVID 19 has changed they way health care is provided
20. “I’m not afraid of death; I just don’t want to be there when it happens.”~Woody Allen
21. If the unexpected happened,Who would speak for you?
22. Would they know what you would want?Or possibly what you would not want?
23. Did you know…Everyone over the age of 18 should have an Advance Health Care Directive (AD or AHCD) which appoints a Health Care Agent Without an AD, precious time could be spent trying to designate a Health Care Agent from “interested parties”, there is no next-of-kin hierarchy in the state of Hawaii. If the “interested parties” cannot come to an agreement, it could become a guardianship case, which could take 6 months to resolve
24. Cover all your bases!Source: Nidus Personal Planning Resource Centre and Registry
25. Advance Health Care DirectiveAvailable to download on Kokua Mau Website: www.kokuamau.org
26. Advance Health Care Directive (AHCD)Legal document completed only when you are of sound mindAppoints a Health Care Power of Attorney (s)State instructions for future choices on your end of life decisions
27. AHCD – Part 1:Health Care Power of Attorney (HCPOA) Who do you trust to make health care decisions for you when you cannot?Familiar with your personal valuesWilling and able to make decisionsDoesn’t need to be a family member.Select alternate
28. AHCD – Part 2Section A: End of Life DecisionsBecomes effective only when:If I have an incurable and irreversible condition that will result in my death within a relatively short time, ORIf I have lost the ability to communicate my wishes regarding my health care and it is unlikely that I will ever recover that ability, ORIf the likely risks and burdens of treatment would outweigh the expected benefits
29. Choice – Prolong or Not to Prolong Life“ I want to stop or hold medical treatment that would prolong my life” OR“I want medical treatment that would prolong my life as long as possible within the limits of generally accepted health care standards”
30. AHCD – Part 2 Section B: Artificial Nutrition & Hydration
31. Artificial Nutrition and Hydration: Important considerationsIndividual and personal decision.In some illnesses (e.g. stroke, esophageal/ throat cancer) artificial nutrition can prolong life.In others (Parkinson’s, dementia, terminal cancer) artificial nutrition may not prolong life.
32. Section C & D: Relief of Pain and OtherImportant considerationsPain medications to ensure comfort at the end of life can hasten death.This is considered ethically acceptable by most medical professionals to provide comfort.Again, this is a personal and individual decision.
33. AHCD Part 2 – Section E: What is Important to Me?What makes life meaningful?What would make quality of life unacceptable?If a trial of support is wanted – how long would they want?
34. Must be signed in the presence of:A Notary Public ORTwo WitnessesWitnesses must be 18 years or olderCannot be your health care agent, a health care provider or an employee of a health care facilityOne witness cannot be a relative or have inheritance rights
35. What is POLST?ProviderOrders for LifeSustainingTreatment
36. Who Would Benefit from Having a POLST Form?Chronic, progressive illness Serious health conditionMedically frailA person for whom you would issue an in-patient DNR order“Would you be surprised if this patient died within the next year?”
37. POLST in HawaiiOne form for entire state.Use not mandated.Honoring form is mandated.Provides immunity from civil or criminal liability.
38. POLST in HawaiiEffective 2009, Updated 2014
39. HI POLST Form – Information
40. **Person has no pulse and is not breathing**Section A: Cardiopulmonary Resuscitation (CPR)
41. Section B: Medical Interventions**Person has pulse and/or is breathing**
42. Diagram of POLST Medical InterventionsCPRFull Treatment*DNARComfort MeasuresLimited Interventions*Consider time/prognosis factors under “Full Treatment” “Defined trial period. Do not keep on prolonged life support.”Full Treatment*
43. Always offer food and liquid by mouth if feasible and desired.Section C: Artificially Administered Nutrition
44. POLSTSection D – Important Signatures!Physician or Advance Practice Registered Nurse (APRN) andPatient or their Legally Authorized Representative (LAR)LAR - Agent designated for Health care Power of Attorney ; - Parent of a Minor - Patient-designated Surrogate - Surrogate selected by consensus of interested persons - Guardian
45. Section E: Surrogate InformationSection E only needs to completed if the patient lacks capacity and has not designated a health care power of attorneyNon-Designated Surrogate: This individual is appointed in accordance with HRS 327E, & has limitations placed upon him or her with respect to decisions about withholding or with-drawing artificial hydration & nutrition.
46. Practical considerationsRecommended to be printed on lime green paper (but any color, including black and white is acceptable)A copy of the POLST form is legalRecommended to be kept in a visible place at home:RefrigeratorBedroom doorBedside tableMedicine cabinetA copy should be given to EMS personnelPOLST is not transferable from state to state
47. Advance Health care Directive vs. POLST
48. Where Does POLST Fit In?Advance Care Planning ContinuumComplete an Advance DirectiveComplete a POLST FormAge 18Treatment Wishes HonoredDiagnosed with Serious or Chronic, Progressive Illness (at any age)Update Advance Directive PeriodicallyC O N V E R S A T I O N
49. Can POLST be Changed?Individual with capacity can request alternative treatment or revoke a POLST at anytime.Legally recognized decision maker may request change based on condition change or new information regarding patient wishes.
50. POLST Conversations Opportunity to increase awareness of different courses of action possibleIntroduce concept of Palliative Care and HospiceChange the question: “What’s the matter with me?” to “What matters TO me?
51. Kokua Mau Resources http://www.kokuamau.org/
52. Kokua Mau ContactJeannette Koijane, Executive Directorjkoijane@kokuamau.org 808-585-9977Hope Young, ACP Coordinatorhope@kokuamau.org808-221-2970www.theconversationproject.org
53. THANKS FOR CARING! OPEN FOR SHARING & QUESTIONSHope you had a
54. LOOK FOR 3 THINGS:#1#3#2
55. DOCUMENTHOW MANY HAVE?TOTAL# RESIDENTSPower of AttorneyAdvanced Care Planning (e.g. DPOA HC)POLST formYou will receive a link to fill out an online survey form to share how many of your residents have these 3 documents.Please try have someone screen all your residents before our next session.Please try to complete this, it helps us demonstrate that you are doing a good job helping residents achieve their wishes! Please Share with our Team:
56. NEED HELP?FRIDAY, 4/22/22 10am2pmMONDAY, 4/18/22 2pmMibrao@hawaii.edu
57. Wellness RestRestoreCreateConnectThese are important to put back into your life – Which one will you choose?DO IT THIS WEEK!Small acts of creativity (having fun) in everyday life increases our sense of wellbeing! re-kindle or strengthen old friendshipsRandom acts of kindness helps restore your faith in humanity- and boosts well-being!Allow yourself to rest–not just for when you have time-- sometimes you need to draw the line and fight for it.