1. GREATER NAPLES LEADERSHIP
Masters Class XVIII
Healthcare Day, February 5, 2014
Dr. Michael Gloth Presentation

2. Greater Naples Leadership Masters Class VXII
HEATHCARE DAY
Senior Living and Care:
Living and Dying in the State of
Comfort and Dignity
F. Michael Gloth, III, MD, FACP, AGSF,

3. Settings for Senior Living
• Independent Living
– Most living environments after college
• Assisted Living
– Some Assistance with Some Activities of Daily
Living
• Bathing, Dressing, Transferring, Toileting, Feeding
• IADLs
• Skilled Nursing (Medicare) vs. Nursing
Home
– Rehabilitation

4. Prescription Management for the
Elderly
• Medications To Be Avoided
– Beers Criteria
• Number Of Medications
• Individual Assessment
– Complications
– Interactions
– Age
– Diet
– Cost (Financial and Personal)

5. ©Hagar the Horrible. Dik Browne.

6. End-of-Life Concerns
•
•
•
•
Palliative care
Hospice Care
Living Wills
Health Care Proxy

7. Palliative Care
• Emphasis on Comfort and Dignity
• Cure is Not Focus (feasible or
possible)
• May involve elements of care

8. Hospice
• Palliative Care at the End of Life
• Comfort and Dignity
• Medical, Social, Spiritual, Volunteer, &
Bereavement components
• DME, Medications, Respite
• Medicare benefit with 6-month
prognosis
• Entitlement under Medicare
Kiely, D. K., et al. JAGS. 2010; 58: 2284–2291. doi: 10.1111/j.1532-

9. Hospice Criteria
• Prognosis less than 6 months
• Functional Risk Factors
• Nutritional Parameters
• Disease Specific Criteria

10. Living Will/Advance Directive

An advance directive is a written or electronic
document or oral directive that:
1. Appoints a health care proxy (agent) to
make health care decisions - and/or –
2. States the patient’s wishes about medical
treatments when the patient no longer has
capacity to make decisions (living will)

11. Authority of a Health Care Agent
• The advance directive determines when the
health care agent has authority
– “When I can no longer decide for myself”: The
individual may decide whether one or two physicians
must decide about incapacity
– “Right away”: When the document is signed, the
agent has authority

12. Basis of Agent’s Decisions
• The health care agent is to make decisions
based on the “wishes of the patient”
• If the patient’s wishes are “unknown or unclear,”
then decisions are to be based on the “patient’s
best interest”

13. Resources (for you or others)
• Hospice
– AVOW and VITAS

14. SUMMARY
• Living Settings
– Independent Living, Assisted Living, Skilled
Nursing, and Prescription Management for Older
Adults
– Prescription Management for Older
Adult
– Type and Number
• End-of-Live
– Hospice care, Palliative care, Living Wills, and
Health Care Proxy.

15. ©Shoe. Jeff MacNelly. Tribune Media Services, Inc. 1999.