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Director's Message

March 2012 - Patient-centered Care

I have noticed the growing frequency of the term “patient-centered care” in the aging literature, and increasingly in marketing materials as well. But what do these terms mean and how will they affect you?

The concept behind patient-centered care (“patient-directed” or “consumer-directed care”) is to put you, the patient, back at the center of your medical care. Patient-centered care is a paradigm shift, moving decision making back to the patient, creating a partnership between patient and primary care doctor, that moves away from the day when one could not question a physician’s authority. The healthcare environment today includes increasing specialization, little time for patient-doctor communication (and no reimbursement), a bewildering array of options, and a growing number of ethical dilemmas as our ability to sustain life often comes at great economic and emotional cost. Too often physicians will talk with family members across a frail older adult as if he or she does not exist.

Christine Bechtel of the National Partnership for Women & Families, identifies four key features in patient centered care: “whole-person care, coordination and communication, patient support and empowerment, and ready access.”1

To achieve true patient-centered care, there needs to be a primary physician who will coordinate care from all providers and serve as a guide to the patient. Patients and families need to play an active role in medical decision making, but they need reliable unbiased information about options, benefits and risks. Doctors need to know what matters most to each patient and what motivates and helps them to get and stay well. They need to consider a person’s cultural traditions, personal preferences and values, family situation, social circumstances and lifestyles.2

Patient-centered care focuses on helping patients make the best decision for each individual, by helping them be fully informed and involved in the process. Don Berwick, formerly of Institute for Healthcare Improvement, defined patient-centered care as: “the experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.” 3

One example of implementing this new thinking is the POLST (Physicians Orders for Life Sustaining Treatment). This past week I attended a press conference at the University Medical Center at Princeton, which is a pilot site for implementing POLST in NJ. The presentation pointed out that NJ ranks highest in costs, doctor visits and tests in the last weeks of life, without improved patient outcomes. Ageism can also cause some physicians to withhold treatment without talking to the patients about options. The POLST paradigm involves physicians having frank discussions with their patients about their end-of-life wishes and writing a physician’s order based on the patient’s goals, to be honored by all providers across all treatment settings. As Dr. Barile has explained in his presentations at PSRC, designing a treatment plan to support a patient’s desire to finish writing their book is different from using every available test and treatment to sustain life as long as possible without consideration for quality of that life and the patient’s goals. (For more information, go to www.POLST.org or www.goalsofcare.org).

Another model following the patient-centered philosophy is the “medical home” which involves creating a practice team coordinating care across episodes and specialties. It was initiated by the American Academy of Pediatrics to provide “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care to all children…” 4 It emphasizes prevention, primary care and integration; returning control to the patient; and is touted as more cost-effective than current care models.

So what can you do to experience patient-centered care? First, find a physician who is able and willing to

be your partner, who will coordinate the care you receive from any number of physicians, and who will see you as a whole person. Educate yourself about your health and your options for care, and learn how to find reliable information on the internet. Begin talking now to your family and physician about your wishes and philosophy of life, providing the background and context for future decision making. Personally, I worry that physicians will not make the necessary time available without insurance reimbursement, which creates a critical role for social workers, nurses and care managers, as we often have more time to listen and ask questions that can help you clarify your thoughts before you go to the physician to have this conversation. These professionals have focused on empowerment, supporting independence and individualized client-centered care for a long time. Using a tool like the Five Wishes document (agingwithdignity.org) can help you clarify your thinking and start the discussion with family and professionals. Having some idea of your thinking will help your family keep you at the center of your care decisions.

Susan W. Hoskins, LCSW, Executive Director


1. Bechtel, Christine. "If You Build it, Will They Come? Designing Truly Patient-Centered Health Care". Health Affairs as referenced in http://en.wikipedia.org/wiki/Patient-centered_care
2.Institute for Healthcare Improvement http:  http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/   as referenced in http://en.wikipedia.org/wiki/Patient-centered_care
http://www.ihi.org/IHI/Topics/PatientCenteredCare/ PatientCenteredCareGeneral/  as referenced in http://en.wikipedia.org/wiki/Patient-centered_care
3.Berwick, Don. "What Patient-Centered Should Mean: Confessions of an Extremist". Health Affairs Web Exclusive. as referenced in http://en.wikipedia.org/wiki/Patient-centered_care
4. http://www.medicalhomeinfo.org/      
 

Previous Messages

Recharging

GrandPals Celebrate 20 Years!

Multi-generational Households

No One Ages Well Alone

Help at Home

Gratitude

November 2016 Family Caregiving

October 2016 Annual Report

September 2016 Corporate Healthcare

Strategic Planning

Is Your Home Age- Friendly?

May 2016 Director's Message Part 2 - We Need Your Help

May 2016 - Part 1 - Going Solo

April 2016 - Volunteering

March 2016 - Partners In Caring

February 2016 - PSRC's Strategic Plan

January 2016 - Hope

December 2015 - Gratitude

November 2015 - Helicopter Children

October 2015 - Is Princeton An Age Friendly Community?

September 2015 - Annual Report

July & August 2015 - Family and Community

June 2015 - A Gift that Keeps Giving

May 2015 60 Is the New 60

April 2015 - Spring

March 2015 - Being Mortal

February 2015 - Mentoring

January 2015 - Winter Blues

December 2014 - Leaving A Legacy

October 2014 An Age Friendly Future

September 2014 Annual Report

July - August 2014

June 2014 - Romance After 50

May 2014 - Your Virtual Estate

April 2014 - Memory and Forgetting

March 2014 - Aging in Community

Observational Stay

February 2014 - Family Caregiving

January 2014 - Attitudes about Aging

December 2013 - Giving

November 2013 - Healthcare Marketplace

October 2013 - Annual Report 2013

September 2013 - Total Brain Health® Fair

July - August 2013 My cat, My Father and Me

June 2013 - Age Friendly Communities

May 2013 - Navigating a Changing HealthCare Landscape

April 2013 - Becoming Visible

March 2013 - Navigating Life’s Transitions

February 2013 - Partners in Caring Princeton

January 2013 - Men as Caregivers

December 2012 - The Safety Net

November 2012 - Going Solo

October 2012 - Documenting Your History

September 2012 - A Journey of Transformation

July - August 2012 - Gratitude & Moving

June 2012 - Diversity

May 2012- Aging in America

APRIL 2012 - TEN YEARS

March 2012 - Patient-centered Care

February 2012 - Can you Spare an Hour?

January 2012 - Challenges & Opportunities

December - Are you Prepared for Emergencies?

November - We need YOU!

October - Chocolate for Memory

September- Looking Back and Looking Forward

July - August 2011; Ageism

June 2011 - Accessibility

May 2011 - Paper retention

Knit Wits, April 2011

Lessons and Legacies, March 2011

Independent Living February 2011

Home Safety January 2011

Witness to my Life December 2010

Elections, benefits and open enrollment November 2010

Retire in 3D!

Strategic Planning September 2010

Am I Old? July 2010

Memory Clutter June 2010

Aging In America May 2010

Volunteering April 2010

Spirituality March 2010

Estate Planning February 2010

Encore Careers January 2010

Hiring Home Care December 2009

Annual Giving by Sharon Naeole November 2009

Flu Pandemic 2009 October 2009

Healthy Memory, Healthy Mind September 2009

A Personal Perspective on Caregiving July/August 2009

TRANSPORTATION May 2009

Wei Ji: Crisis, Danger and Opportunity April 2009

Write your own obituary March 2009

Hobbies February 2009

Hope and Vision in Challenging Times
January 2009

Medicare Changes 2008: Take A Look! December 2008

Scams, Frauds and Rip-offs November 2008

Engaged Retirement: Beyond Financial Planning October 2008

September 2008 Caregiver Dilemmas

Finding Rhythm and Purpose July/August 2008

Spring Cleaning II June 2008

V + OA = ER (Volunteering + Older Americans=Engaged Retirement)May 2008

Spring Cleaning April 2008

Have You Had the Talk Yet? March 2008

Get Moving with FitRhythms™! February 2008

My Condolences January 2008

Advocacy December 2007

What Are Social Services? November 2007

Sensitive Topics October 2007

Plan for the Future September 2007

The Up-side of Aging Summer 2007

Volunteering June 2007

Strategic Plan May 2007

National Conference on Aging: Let's ReThink Aging April 2007

Brain Health March 2007

Resiliency February 2007

Transportation January 2007

Season of Giving December 2006

Medicare Part D November 2006

April Hill McElroy October 2006

Civic Engagement September 2006

Change June 2006

White House Conference on Aging May 2006

Hearing Loss April 2006

GrandPals March 2006

Lets Talk February 2006

Eldertopia January 2006

Hoarding December 2005

Annual Report: November 2005

Are You Prepared? October 2005

Planning Ahead October 2005

Watch Your Language September 2005

Medicare Part D Summer 2005

Sue Tillett June 2005

The End of the Journey May 2005

Clutter March 2005

New Dietary Guidelines February 2005

Transitions January 2005

Funding December 2004

Caregiving November 2004

Civic Engagement with GrandPals October 2004

A New Look September 2004

Safe Driving Summer 2004

Food Safety June 2004

Communication June 2004

The Challenge of Giving Care May 2004

Seniors On The Move April 2004

Depression March 2004

McGreevey February 2004

Medications January 2004

Random Acts of Kindness December 2003

Civic Engagement November 2003

Reverse Mortgages Oct 2003

Emergency Preparedness, Jan 2003


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