Dr. Cheryl Woodson

Getting the help you need: The Geriatric Assessment

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Can You Surf the “Silver Tsunami?”

The needs of America’s seniors have been called the ‘Silver Tsunami.”
Our families, communities, businesses, political and health care systems can either surf or drown.

Let me give you a surfboard.


Eight years into a ten -year caregiving relationship, my mother looked at me and said, “Do I know you?” I thought I was going to die. I reset her wedding rings into a drop necklace that I have worn almost every day since then, to keep her close, even as Alzheimer’s disease took her away. The necklace was comforting, but it didn’t stop me from drowning in the guilt and fear of caregiving.

Many caregivers feel overwhelmed and guilty, worrying that we’re not giving good care. Are we doing too much and wearing ourselves out unnecessarily, or are we doing too little and committing elder abuse and neglect?  I was lucky; my Geriatrics training told me exactly what to do. Comprehensive geriatrics assessment offers those resources to all caregivers.

Geriatricians are doctors who specialize in the care of seniors, offering a comprehensive geriatric assessment with a team of nurses, social workers, rehabilitation specialists and other professionals.  To help seniors achieve the highest level of independence and quality of life.  In addition to identifying and treating illness, the geriatrics team focuses on self-care, brain function, the ability to get around, as well as the caregiving and financial resources to put plans into place. We also focus on values, as my buddy Ellen Goodman said in the Altarum Foundation presentation on caregiving (see YouTube)

“It’s not just what’s the matter with them; it’s what matters to them.”

The products of the geriatrics assessment are the Level of Care Prescription (LOC RX) and the Family Conference. LOCRx starts with five questions:

  • What’s wrong with this person?
  • Why is it wrong?
  • How much is fixable?
  • How do we fix what we can?
  • What do we do with what’s left?

Then, there are five more questions:

What kind of care do we need? Are we talking about the grandson coming up a few times a week to give the senior a shave, or are we treating pressure sores (bed sores)?

How much care do we need to give? If the challenge is pressure sores, are we just changing the person’s position every 2 hours, or are we cleaning and packing deep wounds?

How often do we need care?  Are we dressing wounds every three days, every day, three times a day?

For how long?  This is where physicians fail families. Many families try to do with one or two people what it takes three shifts of nurses to do in a care facility. The families say,” we can do this; we’ll be there twenty-four hours a day.” They may be able to do this for a few weeks, but can they do it for ten years? Doctors don’t know how long, but we do know the situation won’t resolve with a shot of penicillin. If doctors were clear that the care need will exist for the rest of the senior’s life, families might have more realistic expectations of what they can do.

How much education should the caregiver have? Is it enough for the granddaughter to come in twice a month to write out the bills, or do we need a registered nurse at the bedside twenty-four hours a day, seven days a week?

Level of Care is the care requirement. Locus of Care is where we give the care: intensive care unit, regular hospital room, home, assisted-living, rehabilitation facility, or nursing home. The locus of care depends on the staff required to provide the care and whether there are financial and family resources to offer that intensity at a particular place. Usually, it takes lots of discussion, brainstorming and compromise to set up the Level of Care in the Locus of Care the senior and family desire.

Next time:  The Family Conference

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