Surrogate Decision Making

Surrogate decision making should be someone who knows your history, has clinical expertise, knowledge of the health care delivery system, that can interpret your diagnosis and treatment plan, has expertise in the older population, has the time and psycho-social expertise to help a family make difficult decisions and above all puts your personal desires above those of the institution? The only profession with established criteria for educational expertise and required certification currently available are members of The National Association Of Geriatric Care Managers (NAPGCM) of which I am a member and on the Board of Directors.

This study, conducted by JAMA, demonstrates “as the population ages, a greater number of hospitalized older adults will have impaired cognition due to a rising prevalence of Alzheimer disease,1 delirium,2 and other related disorders. Such patients often face major decisions about their medical care at a time when they cannot communicate their preferences or participate in decision making. Prior research examining hospitalized adult patients of all ages has shown that between 25%3 and 40%4 lacked the capacity to make medical decisions based on standardized assessment, and 1 study of hospitalized older adults report that 43% had some degree of cognitive impairment.5

When patients cannot make decisions, clinicians turn to surrogate decision-makers. The surrogate decision making should be is most commonly a close family member who in some cases has been chosen by the patient as a health care power of attorney.”

From our experience, these surrogate decision-makers are overwhelmed and not prepared to make the critical, frequently life threatening or at the least life altering decisions demanded quickly by health care professionals in a hurry.  Family members, frequently living at a distance and doing this telephonic, are trying their best to fulfill this role. The use of  “Dr. Google” seems to lead most families into a state of overwhelming inadequacy when they realize how complex the health care system has become to the average consumer, let along a older adult who is use to deferring to the doctor on all health care decisions. This is where a Geriatric Care Manager comes into place to guide and direct the cleint and families through this process. Geriatric Care Managers are typically licensed by another profession such as Registered Nurses or Social Workers and have advanced degrees in their speciality along with the required certification in Care Management. Most have worked in the field in another capacity for over 20 years and are viewed as experts.Unfortunately, we have seen others trying to capitalize on this need by claiming to be “Patient Navigators” or “Health Care Navigators” . Caveat emptor! Please review the education, qualifications and years of experience of anyone you are choosing to fulfill this role.