by Jay Luxenberg, MD

As clinicians, we are faced with issues revolving around decision-making capacity every day. Capacity is task-specific, so for each task, either consciously or unconsciously we are stating that we believe the decision-maker to understand the nature of the proposed task, the alternatives, the risks and the benefits. The complexity of the task may range from choosing breakfast (usually a low-risk and low-complexity task) to making complicated medical decisions, to giving consent for research.

by Timothy Gieseke MD, CMD

At this year’s annual AMDA meeting in Orlando Florida, attendees heard an exciting presentation on the “Alive Inside” Music and Memory project.  One of the sad aspects of SNF living is the lack of resources for individualized meaningful activities throughout a resident’s day.  As I make rounds on my long-stay residents, I see many of them up in chairs waiting for something meaningful to happen.  I commonly hear patients verbally and non-verbally acknowledge they are “bored.”   For me, music has always been a big part of my life, having grown up in a singing family and currently singing in the local symphonic choir.  While Christmas caroling in NFs, I’ve seen aphasic patients from CVA’s or dementia join the caroling with gusto.

by Karl Steinberg, MD, CMD, HMDC

Readers of The WAVE will recall that last year, a judge ruled Health & Safety Code 1418.8, the Epple law, unconstitutional as the result of a lawsuit (CANHR v. Chapman).  The law permits the nursing home’s interdisciplinary team (IDT) to make decisions and consent to treatments for incapacitated (lacking decision-making capacity), unbefriended (having nobody willing or able to make decisions on their behalf) nursing home residents.  Under the ruling, the law could no longer be utilized to consent for treatment with antipsychotics, or to withdraw or withhold “life-sustaining treatment,” although somewhat perplexingly, it could be used for hospice.  

by Michael Wasserman, MD, CMD

The Education Committee at CALTCM realizes that it is not easy for Northern California members to make it to the Annual Meeting.  We have decided to partner with HSAG to have an educational half-day session on October 29th at UC Davis in Sacramento.  The focus of the session will be on some of the most topical issues that we are facing.