THINKING AHEAD: My Way, My Choice, My Plan

by Timothy L. Gieseke, MD, CMD

In 2008, the project I developed as a participant in the CALTCM LMG (Leadership and Management in Geriatrics) course was to implement the POLST in Sonoma County.  Fortunately, others in my county were on the same page. Susan Keller, a long time and persistent community advocate for improving palliative care wrote and submitted our first grant request for this project.  In the years since then, she has led innovative programs to support faith based palliative care and most recently has worked for improving THINKING AHEAD 2 for those with serious mental illness in collaboration with Sonoma County’s behavioral health division, the Coalition for Compassionate Care of California, and Goodwill Redwood Empire.  The final product is now available and worth your review.

Not only are we caring for more people with serious mental illness, but we also see many frail persons who are poorly prepared for advocating for what they want in terms of crisis care, life support treatment, and end of life choices.  The Part 1: Workbook and Part 2: Forms are written in a patient friendly way that’s very understandable, engaging, and empowering. They properly set the task as a reflective conversation done over time with a trusted friend.  The Forms contain a very understandable and user friendly AHCD (Advance Health Care Directive).  The second form allows documentation of Personal Requests for location at death, EOLC details, as well as disposition of belongings, burial, and remembrance desires.

In addition, THINKING AHEAD 2, includes 2 helpful tools that could be used to prepare patients for our patient care conferences and the care coordinating work of our MDS coordinators.  Both tools are titled Mental Health Supportive Care Plan. One has the checklist version to stimulate more specific thoughts and the other is a free form style to move from checklist choices to more patient specific thoughts.  Though the target of these forms is the mental health population, I believe they actually would work for the majority of our patients. For instance wouldn’t it be nice for our front line caregivers to know the history of what typically upsets their patient and things that typically ease distress and provide comfort.  This information could reduce the risk of behavioral crisis that consume so much of our resources and threaten our staff and other residents.

In our crisis driven health care system which moves patients through locations with different care teams, it’s good to have tools that help our patients THINK AHEAD 2 so we can help them live well in our facilities and in future other settings of care.

Please think about those on you team who could review the workbooks and care plan tools to see how they might be adopted to your setting.  This could be a great Poster Project for next year’s CALTCM Spring Annual meeting.