The Professional Geriatric Care Manager’s Blog

Quality of Life Decisions-in the Week of the life of a Geriatric Care Manager…….

This past week I made my usual visits to my clients and all seemed to be status quo. Except for when I visited R. R had progressed to his maximum level following a stroke this past summer. Physical Therapy and Occupational Therapy were ready to discharge him. R was doing well in many ways and was beginning to resume some of his more enjoyable activities; a Christmas Party at his office and lunch with some business friends and family.
The beginning of the New Year presented an opportunity for conversation about what R wanted to do about his frequent visits to the Emergency Room. R continued to have seizures that were thought to be due to his stroke and were being managed on a twice daily dosage of Kepra. The frequency and the duration of these seizures were lessoning yet his family continued to call 911 and bring him to the Emergency Room. Seldom was there anything more than a brief examination by the ED MD and then a call to R’s Neurologist with an adjustment to his Kepra dosage. R expressed frustration as his most recent visit to the ED this past weekend was being described by him to me. He emphasized that it was the 5th time in 5 months with his right hand in full extension exaggerating the number 5! We talked about his option of not going to the Emergency Room for seizures that resolved more quickly and what that might mean. I suggested that he discuss this with his children and then with his Neurologist.

We then at R’s request began to discuss options to continuing Physical and Occupational Therapy at home. R could continue privately or could continue to work with the program that had been designed for him with his Caregiver from a schedule that was logged and tracked. R was actively participating in decisions about his care. He was considering what made sense to him based on personal choices of comfort and stress experienced. He clearly did not want to deal with the winter weather participating at outpatient physical therapy sessions. He also did not see the need for more in home instruction when he clearly had a prescribed regimen that he participated in daily.
The goal was to keep R and his wife at home together as long as possible. That goal was being realized and R was ultimately in control of attaining this. He was managing his situation with the coordination of care from our services with the support and input from his family. R had been in control of his life until his stroke and now he was back in control with quality of life choices that were being made by him.