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Learning Module Group Project: Medical Power of Attorney © SWG 598, Spring 2010 Elizabeth Miller, Sandra Naylor, Melody Griffith, Stephanie Cordova, Wendy.

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Presentation on theme: "Learning Module Group Project: Medical Power of Attorney © SWG 598, Spring 2010 Elizabeth Miller, Sandra Naylor, Melody Griffith, Stephanie Cordova, Wendy."— Presentation transcript:

1 Learning Module Group Project: Medical Power of Attorney © SWG 598, Spring 2010 Elizabeth Miller, Sandra Naylor, Melody Griffith, Stephanie Cordova, Wendy D’Anna Robin Bonifas, PhD, MSW Assistant Professor College of Public Programs SCHOOL OF SOCIAL WORK

2 Medical Power of Attorney  Definition  Designation of a surrogate decision-maker (3) for “any future period of mental incapacity”. (8)  Establishes a “health care proxy” for the patient. (9)  Designated person uses a substituted judgment, or best interest, standard. (9)  Purpose  Medical power of attorney is a type of “advance directive”  Allows a patient to make determinations about their care prior to it being necessary.  Living will is another common advance directive.

3 Impact on Older Adults  U.S. has a growing population of older adults and more people will be facing end-of-life decisions. (3)  Older adults with decreased cognitive functioning are less likely to complete medical power of attorney. (3)  Population of older adults with decreased cognitive functioning is expected to increase proportionately with general growth of this group. (3)  Social workers are “major contributors to quality patient care” for older adults. (1)  Knowledge and experience with policy mandates are essential.

4 Assessment  Advantages of medical power of attorney:  Enhanced patient empowerment (9)  Patient is assured their specific wishes will be carried out by the specific person they designate. (8)  Medical power of attorney formalizes a role that loved ones are likely already playing. (3)  Fewer detailed decisions need to be made by the patient in advance. (3)  Relatively simple process with basic paperwork and typically little confusion. (3)  Potentially reduces confusion and expended resources. (8)

5 Assessment (con’t.)  Social workers are vital to interdisciplinary treatments. (1)  Health care social workers, trained in bio-psycho-social aspects (1), are one of the best resources for a patient contemplating end-of-life-decisions.  Research indicates that social workers have “high to moderate” awareness about medical power of attorney and hold positive attitudes about it. (1)  It is common for the patient and family to discuss their options with a social worker. (1)

6 Assessment (con’t.) Culture plays a role in advance directives:  Similarities among patients can reflect a “common American core culture”, including: »Dying patients deserve a say in their care. »Advance directives serve that role. (6)  Differences can represent unique ethnic cultures, including: »The health care system controls the process. (6) »Advance planning is unnecessary. (6) GOAL: A well-structured advance care plan especially including medical power of attorney information needs to be specifically tailored to the individual’s needs.

7 Intervention Strategies

8 Intervention Strategies (con’t.) Communication between patient and social worker:  Accurately convey relevant information to patients.  Educate patient and family whenever opportunity arises. (1)  Facilitate open discussion. (1) Awareness of social worker:  Social workers with more experience working with older adults have higher knowledge of medical power of attorney policy. (1)  Hospice and nursing home social workers have the most positive attitudes about medical power of attorney. (1)  Structure planning sessions in accordance with “the patient’s specific ethnic views”. (6)

9 Intervention Strategies (con’t.) Training and education for health care social workers:  Small group workshops, role-playing and structured planning discussions make a significant difference in patient attitudes towards medical power of attorney. (4) Simple alternatives to the conventional process:  Mailing informational pamphlets significantly increases patients’ completion of medical power of attorney. (7) Some patients may prefer a living will:  Often a more detail-oriented advance directive (8)  Many complications and complexities exist that are not present in medical power of attorney. (8)

10 Conclusions Some keys to remember:  Informed discussion for end-of-life decisions is essential.  Appreciate and respect cultural differences to create a customized process for the patient. Necessary skills:  Experience working with older adults  Relevant training ensures patients are satisfied with their end-of-life decision-making process. (4)  A positive attitude  Accurate knowledge  Awareness of limitations in a patient’s medical power of attorney to ensure proper compliance.

11 References  1) Baker, M.E. (2001). Knowledge and attitudes of health care social workers regarding advance directives. Social Work in Health Care, 32(2), 61-74.  2) Crum, R.M., Anthony, J.C., Bassett, S.S., & Folstein, M.F. Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level. JAMA : the journal of the American Medical Association, 269(18), 2386-2391.  3) McGuire, L.C., Rao, J.K., Anderson, L.A., Ford, E.S. (2007). Completion of a durable power of attorney for healthcare: What does cognition have to do with it? The Gerontologist, 47(4), 457-467.  4) Morrison, R.S., Chichin, E., Carter, J., Burack, O., Lantz, M., Meier, D.E.(2005). The effect of a social work intervention to enhance advance care planning documentation in the nursing home. Journal of the American Geriatric Society, 53(2), 290-294.  5) Mungas, D., Marshall, S. C., Weldon, M., Haan, M., & Reed, B. (1996). Age and educational correction of Mini Mental State Examination for English and Spanish speaking elderly. Neurology, 46, 700–706.  6) Perkins, H.S., Geppert, C., Gonzales, A., Cortez, J.D., Hazuda, H. (2002). Cross-cultural similarities and differences in attitudes about advance care planning. Journal of General Internal Medicine, 17(1), 48-57.  7) Rubin, S.H., Strull, W.M., Fialkow, M.F., Weiss, S.J, Lo, B. (1994). Increasing the completion of the durable power of attorney for health care: A randomized, controlled trial. JAMA, 271(3), 209-212.

12 References, continued  8) Spears, R., Drinka, P.J., Voeks, S.K. (1993). Obtaining a durable power of attorney for health care from nursing home residents. Journal of Family Practice, 36(4), 409-413.  9) Srebnik, D.S., La Fond, J.Q. (1999). Advance directives for mental health treatment. Psychiatric Services, 50(7), 919-925.  10) Zarit, S.H., Zarit, J.M. (2007). Mental disorders in older adults. New York: Guilford Press.

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