Saturday, February 04, 2012

Posts Tagged ‘Dr. Eric Coleman’

The Transitional Care Dilemma: Good News

Sooner or later aging parents get swept into the complex currents of transitional healthcare. It may be a simple back and forth between the primary care provider and one or more specialist, or it could be a major health setback that sends them into a crisis cycle of hospitalization, rehabilitation care, and finally back home. Big or small, acute or chronic, all of these transitional events require multiple “handoffs” between medical professionals, hospitals, skilled nursing homes, and caregivers, and there’s the rub.

The stories of what can and does go wrong with these transitions are legendary, maddening, and in most cases preventable. The sad truth is that older adults many times wind up back home with defective marching orders regarding their medications, recovery plan, and follow up care. Given the frequency and severity of the problems surrounding transitional events, what can make this better?

The good news is that Dr. Eric Coleman from the University of Colorado Health Science Center has a compelling answer: The Care Transition Program. His program is based on what he calls the Four Pillars?, an integrated transition management system that prevents medication problems, insures information continuity between handoffs, clear, follow up orders, and a protocol that identifies red flags that could crash the process.

It is a practical, brilliant solution that is gaining a growing population of followers across the country.

One key element critical to the program’s success is a Transition Coach?. This is usually a geriatric nurse practitioner that provides in-hospital coaching to both patients and their caregivers to help both parties prepare for the transition. As important, the Transition Coach? does follow up visits to skilled nursing facilities or the patient’s home to insure continuity across the transition.

To learn more about Dr. Coleman’s remarkable program and download a copy of his “Transition Survival Skills,” click here: http://www.caretransitions.org/transitionskills.asp

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Communicate

No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link http://www.dsolie.com/articles/reframing.html will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this.

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.