ELDER CARE SOLUTIONS - Dave Harmon & Associates Elder Evaluation & Management.
Elder Care Solutions a program of Dave Harmon & Associates Inc., , begins with a Comprehensive Elder Evaluation (Seniors or Geriatrics) by one of our Licensed Professional and is followed by a Psychiatric Evaluation by by one of our M.D's - Psychiatrists. Both evaluations include a review of all available Medical, Psychological, Social, Environmental, Spiritual information. In addition, each patient is screened as well as Evaluation of Functional Components of Daily Living Activities Levels (ADLs) and Instrumental Activities of Daily Living (IADLs). We take care to identify: 1) Elderly patients who are relatively healthy who may suffer from minimal health conditions; 2) Elderly patients who may be relatively frail and/or somewhat disabled but may be addressed through the usual medical approaches; 3) Elderly patients who have multiple interacting comobidities but may respond to a variety of interventions and services and 4) Elderly patients who have serious focal chronic conditions for whom disease management by primary care with input by other subspecialists is appropriate. An example may be an older patient who appears to be on a rapid downward trajectory toward nursing home placement or a previously functional senior who is requiring increasing assistance to accomplish daily tasks.
ElderCare Solutions Program at Harmon utilizes a number of clinical screening instruments applicable to older patients, the timed "up and go" instument a test of one-leg standing balance, (frail patients) as well as brief screening questionnaires. As there is no validated test battery for the frailty syndrome, our Psychiatrist along with the patient's Primary Physician are likely to consult with each other to make a best medical judgment as as to each patient's conditions on frail or pre-frail status. Sometimes a community screening such as may be available through Medicare managed care organizations via enrollment and periodic questionnaires (the Probability of Repeated Admission), and senior "health check" monitoring are helpful. All other medical screenings of hospitals and other settings is helpful to identify at-risk patients. Generally, screening performed identify patients with new or troublesome functional deficits or with challenging geriatric problems such as falls, cognitive status changes, incontinence who then are referred to the most appropriate community setting. An interdisciplinary problem list and care plan is developed based on input from all professionals.
the complexity of the care needed and the high prevalence of incipient disability and geriatric syndromes in the caseload.
Psychiatrists, Therapists, Specialized Counselors and other professionals may be involved. In some cases a variety of prevention-oriented programs of in-home geriatric assessment may be utilized through referral with a goal to link each geriatric patient to the necessary care management resources. Referral to other settings such as an acute hospital, a day hospital, or a nursing home often reevaluated as needs are always changing. The overall focus of our geriatric team members is on developing a list of complex clinical problems with a prioritization so that the most serious are dealt with first. Thus, there is no routine format for the medical history or physical examination: the focus is driven with the input of patients, families, and caregivers on the major complaints as well as the findings of other members of the team concerning the health and functioning of the patient. Development of the prioritized problem list, as important as it is, is not the only goal of the patient encounters as other objectives are counseling for disease prevention, health promotion, determining immunizations, screening for asymptomatic conditions that are prevalent in elderly patients, assessing medication burden, screening for substance abuse, and ascertaining social and psychological problems.
The basic ADLs are composed of self-care activities of dressing, bathing, transferring to and from chair, bed, and standing position, going to the toilet, and eating.
In addition to the required daily activities, IADLs include activities that one may do for oneself or may customarily be done by other members of the household (eg, housework or other domestic chores, managing money, using the telephone, shopping).
In many cases, particularly in ambulatory clinical settings, patients and/or family caregivers are asked to report on these items by filling out questionnaires.
Elsewhere, functioning may receive more extensive clinical evaluation by nurses or occupational therapists. any potentially useful approaches to functional assessment are available, but selection of a single or set of approaches must be made with care.[1-6].
Given the central importance of mobility to executing most functional activities and the high incidence and often harmful consequences of falls in older patients, assessment of exercise practice and activity status, as well as gait and balance, has become an important aspect of functional assessment in most settings.
Two chief streams of useful information flow from the functional assessment component in the CGA.
One involves the capacity or incapacity of the patient to perform the specific tasks, wherein incapacity may suggest underlying impairments in organ systems or specific disease processes. In this regard, the nearly ubiquitous screens for cognitive impairment and depression that form the core of the psychological assessment component are helpful (Table 2 ).
The second stream of information involves the nature and degree of help needed for specific tasks to be accomplished. This aspect of the functional assessment draws in additional information from the social and environmental components.
The strength of the patient's social support network, the kind and amount of familial help available, aspects of the home environment, and financial ability to secure paid personal care assistance -- to name but a few considerations -- all inform the functional prognosis and influence the choice of clinical goals and management approaches.
The care plan is formulated only after the data (ie, information from the standardized clinical measures, laboratory tests results, as well as focused clinical impressions) are gathered from all components of the CGA.
An often-underappreciated trait of CGA is that the process is not a three-step sequential procedure of completing the comprehensive assessment, reading the "results," and applying sets of protocols to produce a relatively fixed plan of care.
Over the long-term, given the age, health, and functional status of these patients, there is rarely a plan of geriatric care composed entirely of final therapeutic formulations.
The assessment has no value it does not yield a care plan, and the care plan has no value if not implemented.
The literature on CGA effectiveness suggests that greater benefits tend to be seen where the team/providers performing the assessment are also delivering and managing the care.
Individual assessments, care plans, and interventions themselves are best seen as works in progress, feeding back on one another.
Programmatic formats and settings in which CGA is performed follow a continuum from community locations (including homes and physician practices), through specialized clinics and hospital services of various kinds, to long-term institutional and communitybased rehabilitation and care venues. The resources for CGA and intervention tend to increase along this program continuum, following the increasing burdens of clinical complexity, illness acuity, psychosocial problems, and disability in the patients who tend to enter them through their usual screening or targeting procedures. For example, the hospital is the point of encounter for frail elders who are at particular risk from both their acute illness and the usual hospital procedures. Early identification of these frail, disabled, and clinically complex patients -- either in the emergency department or soon post-admission -- can lead to a more extensive CGA, more effective rehabilitative team intervention, and better post-discharge management. Further, it can be a routine feature of step-down GEM units or of specialized hospital units combining geriatric assessment and management with other subspecialty care (eg, geriatric cardiology, geropsychiatry, stroke units, gero-orthopedic units, and, more recently, geriatric oncology services).[3,39] In contrast, most CGAs in outpatient settings -- given patients' generally moderate illness acuity and clinical complexity -- do not require intensive physician and nurse monitoring of inpatient settings or the range of technological resources. Specialized programs such as outpatient GEM clinics and day hospital programs can provide adequate interdisciplinary team assessments, intervention, and monitoring for many.[40- 43]
Geriatric Psychiatric Evaluation/ Medication Check/Follow-Up Evaluation
Psychiatric Follow-up Evaluation/Med- Check Evaluation, MD, Terry M. Hagan
Geriatric Psychiatric/Mental Health Disorder Evaluation/Reevaluation, KY Licensed/Certified Clinical Professionals
Psychiatric/Mental Health Disorder Evaluation
Psychiatric Follow-up Evaluation
Geriatric Psychiatric/Mental Health Disorder Therapy
Individual Psychiatric Disorder Education
Group Psychiatric Therapy
Family Psychiatric Disorder Specific Edu..
Psychiatric Intervention Therapy
GERIATRIC PROGRAM ACITIVITIES
Medical Care Monitoring/Referral
Art and Craft Planned Activities
Hobbies Development Planned Activities
Leisure Plan Activities
Recreational Plan Activities
Social Plan Activities
Special Day Celebration Activities
Relational Development Plan Activities
Spiritual Development Plan Activities
Dementia Education/Learning Activities
Eating and Drinking Plan Activities
Exercises Plan Activities (Walking)
Entertainment and Parties Activities
Gardening Plan Activities
Indoor Games Plan Activities
Musical Plan Activities
Outdoor Games Plan Activities
Reading & Writing Plan Activities
Sensory Therapy Activities
Medication Therapy/monitoring Activities
Planning Daily Activities
Time Management Activities
Dave Harmon & Associates
4010 Dupont Circle #226
Louisville, Ky 40207-4847