What Matters What Really Matters Cherie Warriner, MSW, LCSW
Introduction Cherie Warriner, MSW, LCSW is a Clinical Social Worker with The Center for Healthy Aging. She specializes in providing counseling to older adults coping with significant life changes, challenges and loss. While employed with The Center for Healthy Aging she has assisted with the development and implementation of a Dementia Education Series for caregivers and participated in Ascension’s development and scale-up of the Institute for Healthcare Improvement’s Age-Friendly Health Systems initiative. Cherie earned her Bachelor of Social Work from Ball State University in 1991 and Master of Social work from Indiana University School of Social Work in 1995. She spent most of her career serving individuals who have had complex health issues in various settings.
Disclosure This speaker has no conflict of interest to disclose.
What Matters The four essential elements of an Age-Friendly Health System are known as the 4Ms Framework for Age-Friendly Care: What Matters: Know and align care with each older adult's specific health outcome goals and care preferences including, but not limited to end-of-life care, and across settings of care. Medication: If medication is necessary, use Age-Friendly medications that do not interfere with What Matters, Mobility, or Mentation on across settings of care. Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across care settings. Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters.
Everyone Physician NP Nursing Staff Social Worker Case Manager Who Matters Physician NP Nursing Staff Social Worker Everyone Case Manager Office Staff Physical Occupational Speech Therapist
How Matters How you ask is not as important as that you ask. Healthcare Representative Living Will POST Power of Attorney Out of Hospital DNR Advance Directives What are your healthcare goals? What makes life worth living? What would make tomorrow a really great day for you? What concerns you most when you think about your health in the future? What is important to you at this stage in your life? What brings meaning and purpose to your life? Is there something you’d like to do or accomplish but you feel your health prevents you from doing it? Ask “What Matters?” not “What’s the Matter” How we “measure” “WHAT MATTERS” matters. Advance Directives: Duh. We all know everyone should have their advance directives. Continue to ask about and encourage completion of advance directives Barrier is often that ADs are hard to find in the chart and often do not get transferred from setting to setting—leaves the responsibility to the patient/family Examples What are the things that are important to you right now? Resource: Vital Talks/Tips App How you ask is not as important as that you ask.
Age Prognosis When Matters Average life expectancy for those without Multiple Chronic Conditions Age 65: 19 years Age 75: 10 years Age 85: 6.6 years Age Where is your patient in the disease process As prognosis and function changes, so may the individual’s goals Prognosis Age/Prognosis—Dr. Healey is going to talk later about how prognosis impacts care but I’ll just touch briefly here about how when you ask “what matters” may impact decision making and care planning. Patient dx with CA—no discussion re: What matters before aggressive tx. Tx fails and due to side effects of chemo cannot do what he would have preferred to do--travel
Why Matters Asking What Matters: Enhances patient centered care and allows clinicians to look at the person as a whole; not just their disease process (Person-in-environment) Improves a clinician’s ability to assess the social determinants of healthcare (transportation, access to medication, basic needs, etc.) Increases the patient’s engagement in the treatment plan Increased adherence The person-in-environment (PIE) theory is an important concept and philosophy in the field of social work. Essentially it theorizes that a person's behavior can largely be understood by looking at their current and past environment.
Why Matters—continued Allows clinicians to assess insight and a transition into more difficult conversations about prognosis—”the palliative care dance” Improves patient satisfaction Lowers inpatient utilization (↓54%) and ICU stays (↓80%), increases hospice use by 47.2%, and improves patient satisfaction (Agency for Healthcare Research and Quality (AHRQ 2013) The concept of asking “What matters to you?” is simple, yet profound. Essential to the establishment of deep, personal engagements with patients and their families, and provides providers with an in-depth understanding of what really matters to them. This inevitably leads to the development of genuine patient-doctor and other HCP partnerships for shared decision-making in healthcare.
What Matters Makes a Difference STORIES Counseling pt—travel, death of spouse, diagnosis Diane’s SNIF patient—”I want to walk” What would you do if you could walk?” “Go out to dinner with my husband” Diane’s Office patient w/ dementia– finding out she likes anything Disney—now can incorporate into redirection and engaging in activity. Diane’s patient re: boating and walking
“You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.” -Hunter “Patch” Adams
References Age-Friendly Health Systems:The 4Ms | ConsultGeri Assessment Tool. (2018, November 02). Retrieved from https://consultgeri.org/try-this/general-assessment/issue-35 Lum, M., & Lum, M. (2018, May 30). Has Your Doctor Asked What Really Matters To You? – Star2.com. Retrieved from https://www.star2.com/health/2018/05/30/has-your-doctor-asked-what-really-matters-to-you/ Why is it important to ask 'what matters?' (n.d.). Retrieved from https://www.whatmatterstoyou.scot/why-is-it-important-to-ask-what-matters/ Overview. (n.d.). Retrieved from http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx Social Security. (n.d.). Retrieved from https://www.ssa.gov/oact/STATS/table4c6.html