Addressing the healthcare needs of “unrepresented” elders

In Paula Span’s column today in the New York Times’ New Old Age column, Near the End, It’s Best to Be ‘Friended’, she discusses the increasingly common situation of elders who have no representatives assigned to make healthcare decisions on their behalf.

She encourages seniors to dig deep into their social networks to find an appropriate candidate to become a healthcare proxy or to keep detailed directives in a location that’s accessible to healthcare providers.

Span notes state efforts to increase the number of people who can step into such a role — some states allow for a “close friend” or a niece, nephew or grandchild to become a medical decision-maker.

Healthcare organizations such as the Cleveland Clinic have created protocols to assist teams in medical decision-making for “unbefriended” elders who are without the capacity to express their own wishes. As the medical decisions become more serious — such as a surgery or a do-not-resuscitate order — two medical professionals and an ethicist must agree that the procedure is in the patient’s best interest. Withdrawing treatment requires two physicians and the approval of a subcommittee of the hospital ethics committee.

Long-term care facilities would benefit from establishing similar protocols and committees for what will undoubtedly become a more frequent circumstance as baby boomers — who are less often married and more often geographically isolated from relatives — enter our care in greater numbers.

For Paula Span’s article, visit: Near the End, It’s Best to Be ‘Friended’


3 thoughts on “Addressing the healthcare needs of “unrepresented” elders”

  1. I enjoyed your info on family centerd care. I am working on address families with a focus providing care to them as part of the program. If the family is contented there will be less problems. when the family understand the plan of care and how it will be provided. I hope to have less concerns from caregivers and families. Can you provided any suggestions?
    Thank You.

    • I’m glad you found the family-centered care article helpful. Aside from the suggestions offered in that McKnight’s LTC News column, I’d add that it’s important to alter the early initial perception from families that LTC facilities are going to mishandle the care of their loved ones. It’s understandable that they’d have this impression from the reports they hear in the news and that they’d be quite anxious regarding this. Anything that can be done to provide initial reassurance is beneficial — from the way they’re greeted at the door to how the telephone is answered to the ease of speaking with staff. You might consider doing a formal or informal survey of your families and asking them about their experiences when they got to the facility to find out what’s working and what could be improved. As I mentioned in the article, while the facility can provide some support and info meetings for families, it’s also worthwhile to offer resources from an outside authority (such as my book, The Savvy Resident’s Guide) that families can turn to on their own to get a sense of how the facility works and how to negotiate within it.


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