In September, California’s AB 2338 (Gipson) was signed into law by Governor Newsom. This welcome new law in the probate code codifies the legal authority for medical decision-making on behalf of incapacitated patients, although it will likely have little impact on the way these decisions have traditionally been made in health care institutions. CALTCM leaders, along with other stakeholders including the California Medical Association, California Advocates for Nursing Home Reform, California Department of Public Health, and the Coalition for Compassionate Care of California collaborated to finalize the language of this law. For those who want to read the law, it is available here.

In the PALTC space, we commonly care for patients with impaired decision making capacity either due to acute illness, delirium, depression, dementia, serious mental illness or medications. At those times, it’s wonderful to be able to identify someone who can represent them for important decisions that they currently don’t have capacity to make. When a willing representative is not available, we rely on the IDT process to discuss and decide about the use of antipsychotics, decisions to limit life sustaining care options (including DNR and POLST orders), or referral to hospice. This process has been well codified and is required for review of these interventions whether emergent or elective.

As CALTCM grows and changes, we are aligning our infrastructure to match the growing need for internal support. Dominic Lim has done a fantastic job as our Interim CEO, and we thank him for his dedicated service as he transitions into CALTCM’s Vice President position. Dominic will continue with volunteer work for CALTCM and will provide consultant services for projects best utilizing his skill set. Dominic is truly a wonderful person, and we are so honored to have him serve on our Board of Directors with his vast knowledge, skills, and volunteer work dedicated to CALTCM.

This law requires specified types of health care facilities (including SNF and ALF) to allow a terminally ill patient’s use of medicinal cannabis, within the health care facility, subject to certain restrictions.

At a recent town hall meeting for a local Continuing Care Retirement Community (CCRC), I updated our residents on the state of the COVID pandemic in our community.  Compared to the prior 2 years, we are experiencing much less serious medical illness and the deaths in 2022 were about one-tenth of what we experienced in the prior 2 years.  However, the risk of dying from COVID is still about 10 times higher than that for influenza and nearly 9 in 10 COVID deaths have occurred in those over 65 years of age.   The uptake of the new bivalent booster has been disappointingly slow with only 15.4% of the eligible USA population vaccinated.  As of January 9, this booster uptake in CA has been 22.7%, which is higher in elders, but is still low.  In Sonoma County, of those over 65,  53% are boosted, but this drops to 29% of the 50-64 y/o and further drops to 8-11% for those in the 6-34 y/o age ranges.