Progressive’s Advance Care Planning program is designed for our patients and their families to regularly facilitate conversation when there has been a decline in the patient’s health status. The purpose of this program is to discuss the patient’s individual goals of care and their preferences when they are admitted to home care. Our dedicated team meets with patients and their families to educate and be a resource while also providing guidance. A medical social worker is also available to assist family to locate necessary recourses.
WHAT ADVANCE CARE PLANNING OFFERS
Advance Care Planning offers a variety of services to patients and their families, such as advance directive for DNRs and a durable power of attorney. Additionally, the program provides plans of care when a sudden life threatening condition is diagnosed (eg. stroke, cancer, heart attack), when a patient’s health is gradually deteriorating, and when a patient is considering palliative care or comfort care and hospice.
WHO IS ADVANCE CARE PLANNING FOR?
Many different patients may qualify for Progressive’s Advance Care Planning program, including those with:
- Congestive Heart Failure (CHF) — Includes symptoms of CHF at rest and ICU admission for exacerbation
- Chronic Obstructive Pulmonary Disease (COPD) — Includes Cor Pulmonale (right side heart failure associated with COPD), ICU admission for exacerbation, new dependency in two activities of daily living due to COPD symptoms, and chronic hypercapnia (PaCO2 greater than 50 mmHG)
- Dementia — Includes dependence in all activities of daily living (ADLs), inability to walk, limited language of a few words, acute hospitalization (especially with pneumonia), difficulty swallowing with recurrent aspiration, and tube feeding due to dementia
- Cancer — Includes poor physical performance and dependence with ADLs, multiple tumors, metastatic cancer in the liver or brain, bowel obstruction due to cancer, and pericardial effusion due to cancer
- Other High Risk Indicators — Includes frequent emergency room visits and hospitalizations over the course of six months, sudden and major decline in functional status with no identified reversible cause, primary diagnosis of metastatic cancer with chronic pain and poor ADL function, semi-comatose or comatose state, inability or difficulty taking oral meds, minimal oral intake and lack of appetite, and debility and decline in condition
ADVANCE CARE PLANNING PROFESSIONALS
We have a public notary on staff to ensure the advanced directive documents are signed and witnessed in the comfort of home as well as a team of advance care planning professionals, including:
- Registered Nurses
- Medical Social Worker
- Attending Physicians
- Hospice Physician
- Physical Therapist
- Occupational Therapist
- Speech Therapist
- Attendant Care Aides