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Challenges (and Solutions) With Medication Management
Written by: Gary Rich, RPh, MBA
One of the tasks that can become more challenging for adults as they age is managing the medications they are prescribed. Former US Surgeon General C. Everett Koop, once said “Drugs don’t work in people who don’t take them.” While true, it oversimplifies the more complex issue of medication non-adherence, defined as the failure to take medication as prescribed. Some of the reasons for medication non-adherence include:
Taking multiple medications
Bothersome side effects
Diminished vision, hearing, or memory
Confusion with directions
High prescription costs/complex insurance
In the US, medication non-adherence affects as much as 50% of people taking chronic medications, and accounts for up to 25% of hospitalizations and 125,000 preventable deaths each year. Unfortunately, family members or friends often don’t live close enough or have the time or knowledge to provide adequate assistance to their loved ones.
I have been a practicing pharmacist for over 40 years, and the primary caregiver for my parents as they aged. I am very aware of the difficulties older adults face managing their medication regimens. Often, utilizing a weekly pill planner can be helpful for a patient to remember to take their medications every day and reduce the potential for accidental duplicate doses. Smartphone apps can also be useful tools to improve adherence.
Gary Rich is the President and Founder of MyPharmaGuide. His company helps make sure that patients take their medication at the right time, in the right way, and with the most cost-effective approach. To learn more about MyPharmaGuide, please call 201.981.4978 or visit: https://www.mypharmaguide.net/
New(er) Tool for End-of-Life Planning
Written by: Lisa Bayer, J.D., CCM
I recently attended a professional presentation on end-of-life care and questions arose regarding the procedure to follow when someone dies. A last will and testament typically speaks to this. But, what if there is no will? What if there is a will but is it not in the possession of someone available to interpret it? If not, who gets to decide what happens to a loved one’s body? What if one family member wants cremation and another wants a traditional chaplain service and cemetery burial?
I have been practicing care management for more than 17 years and while this has never come up, I can see instances where it might. Twice I had the honor and privilege of being with the family when my client passed away. In both instances, everyone was in agreement, and we knew who to call and what to do.
But what if there is no one? I have a client who is a solo ager with no family. So as not to burden his friends, he named his accountant as his power of attorney and health care representative. I know where he keeps a copy of his will in his home, but I have no authority myself to make any decisions—nor can I even enter his home without permission.
At the professional presentation mentioned above I learned about a new planning tool to help with this scenario and I have started sharing it with my New Jersey clients at onboarding when appropriate. It is called an “Appointment of Agent to Control the Funeral and Disposition of Remains” and it is in accordance with **N.J.S.A. 45:27-22. What is important here is that the client is in control of, and decides who will oversee, what happens to his or her body after death. The form does need to be witnessed and notarized so there could be some logistical challenges if it is necessary to bring a notary to the client and, of course, the client needs to have sufficient cognitive capacity to understand and sign such document.
While this form may not be right for everyone, it allows me as a professional an opportunity to provide support to, and promote autonomy of, choice, for my clients and their families which is a hallmark of my care management philosophy and practice.
If you would like to learn more about end-of-life planning or if you live in New Jersey and would like us to send you a link to this form please reach out to us at: Hello@LMReldercare.com or call us at: 973.533.0839.
**While the form mentioned above is specific to New Jersey, other states have similar forms and regulations.
End of Life Planning For Your Pets
By: Lisa Bayer, J.D., CCM
Over the years as a geriatric care manager, I have been in hundreds of client’s homes. I also think that I have seen everything! I recently encountered a situation that truly threw me for a loop.
I was engaged by the legal guardian of a client who lives out of state to be her “boots on the ground” with respect to her loved one, Margaret. Margaret had a catastrophic event and suffered a TBI (traumatic brain injury) which requires skilled, nursing home level care. Before the TBI she was living independently in her own home with her dogs. She had never married, has no children, and has no other local involved family members.
One of my responsibilities was to help coordinate the emptying and selling of her home. The (living) dogs were surrendered to a local rescue but nothing prepared me for the 16 boxes of cremated pet remains that we found all over the home.
Part of the issue is that Margaret’s sister could not relate and would have thrown them in the trash if it were up to her. However, as the court-appointed legal guardian she was required to respect Margaret’s wishes, known or unknown, to the best of her ability. So, what to do?
Margaret’s sister had engaged an amazing realtor who partnered with me throughout the process to find solutions to each scenario that we encountered. And there were many!! In this case, we contacted local pet cemeteries to inquire about process and cost for burial. One of them was sympathetic and worked with us to keep the cost down by offering to combine plots of more than one pet. This was the best way that the guardian could think of to respect what Margaret may have done, or directed, if she had been able to.
Personally, I learned from this experience something that I will bring to my practice in the future. While many wills address what happens to pets after a person passes, most power of attorney documents (especially older ones) that I have seen do not always address how the agent should care for the living pet(s). And I have never EVER seen one that addresses how to treat pet remains when your loved one loses capacity and cannot speak for themselves. I always ask clients as part of onboarding to share their planning documents with me. As a trained attorney, I am able to make meaningful suggestions when it comes to any updates to make sure that the documents will work if needed. After this recent experience I will be more cognizant of not just living pets but how to handle their remains if a client is no longer able to do so him or herself.