— Mary Gerdt (@marygerdt) December 29, 2019
Another great posting by the Mouse 🐁 Doctor 👨⚕️...
My comment:
Good thinking, Doctor. As an old nurse assessor, I had to assess patients for Vermont Medicaid long term program care eligibility. We often saw the person at their home. Cognitive deficits were the hardest to assess. We sometimes heard from families. The patient wasn’t bathing or uncharacteristically disorganized, left a pot on the stove and forgot things, got lost. Sometimes subtle signs. It was detective work. One man seemed fine. In reality, his candy dish had cat food in it, and he snacked on it. These were mostly Dementia patients. But sometimes a person just couldn’t hold it all together. They were often aware. They often didn’t want us to know or couldn’t put into words they needed help. A teacher was so organized she nearly was denied. It’s sometimes more Focal. For me, the travel, daily grind and heavy decision making exhausted me. Holding it together. Fatigue multiplied the falling apart, the tethered thinking. I think assessment only at clinic visits misses so many signs. Even before home visits, cognitively impaired patients often got up early, covering any signs of falling apart, Pulled it together. Nobody wants to fail any test. Sometimes you can hold it together for a two hour visit. Then they often collapsed after I left, their cognitive reserve spent. This was the hardest type of patient to assess. I really think that a series of computer testing could capture more information. Even a game that required different areas of thinking. Then, over time, you would get more complete information. There are inherent difficulties in trying to measure cognitive function while you’re watching them. They may perform well, then go home and fall apart. If you knew the finer points of their cognitive function, disability qualifications might be easier for the patient and the assessor. I kept a journal of sick days, feelings on those days, how all my energy was spent at my job and nothing left when I got home from work. Fatigue has an impact on cognitive ability as well. It’s all so invisible on the outside.
My comment:
Good thinking, Doctor. As an old nurse assessor, I had to assess patients for Vermont Medicaid long term program care eligibility. We often saw the person at their home. Cognitive deficits were the hardest to assess. We sometimes heard from families. The patient wasn’t bathing or uncharacteristically disorganized, left a pot on the stove and forgot things, got lost. Sometimes subtle signs. It was detective work. One man seemed fine. In reality, his candy dish had cat food in it, and he snacked on it. These were mostly Dementia patients. But sometimes a person just couldn’t hold it all together. They were often aware. They often didn’t want us to know or couldn’t put into words they needed help. A teacher was so organized she nearly was denied. It’s sometimes more Focal. For me, the travel, daily grind and heavy decision making exhausted me. Holding it together. Fatigue multiplied the falling apart, the tethered thinking. I think assessment only at clinic visits misses so many signs. Even before home visits, cognitively impaired patients often got up early, covering any signs of falling apart, Pulled it together. Nobody wants to fail any test. Sometimes you can hold it together for a two hour visit. Then they often collapsed after I left, their cognitive reserve spent. This was the hardest type of patient to assess. I really think that a series of computer testing could capture more information. Even a game that required different areas of thinking. Then, over time, you would get more complete information. There are inherent difficulties in trying to measure cognitive function while you’re watching them. They may perform well, then go home and fall apart. If you knew the finer points of their cognitive function, disability qualifications might be easier for the patient and the assessor. I kept a journal of sick days, feelings on those days, how all my energy was spent at my job and nothing left when I got home from work. Fatigue has an impact on cognitive ability as well. It’s all so invisible on the outside.
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