Using the 4Ms to Plan Ahead Before or After a Serious Illness Diagnosis



Planning ahead can include:

1. Advance care planning

2. Personal care and living arrangements

3. Work and retirement planning

4. Focusing on the 4Ms: What Matters, Mentation, Mobility, and Medications


Advance Care Planning

If planning is left until late stages of disease or near the end of life, it will be too late for many patients to participate (dementia, and/or cognitive impairment due to the burden of any progressive serious illness).

Planning can occur at any time but should occur at least as soon after the diagnosis of a serious illness as possible. The plans should also be revisited periodically as the illness progresses. This will maximize meaningful participation by the person while they retain decision-making capacity.


Planning ahead can help to ensure that values and preferences are known and followed. One of the most stressful parts of caregiving is the need to make decisions for a loved one while under time pressure (during a crisis) or without guidance about what the loved one wants.

Advance care planning is a process in which people

· Identify someone who should make decisions for them if they cannot

· Think about their personal values, beliefs and goals

· Consider what types of care they would or would not want in different medical situations

· Discuss their preferences with their loved ones and clinicians

· Ask: “If sometime in the future, you could no longer recognize or interact with your family and loved ones, what should we prioritize? Would you want your care to focus primarily on your comfort at that point in your life, or would you prefer to continue all life-prolonging treatments?”


Personal Care and Living Arrangements

A person with serious illness, and their family, should start putting a plan in place for personal care and long-term care. This might include identifying financial resources (long-term care insurance), family or paid caregivers, and community resources.

Identify which friends, family, and neighbors may be willing to help as the disease progresses, recognizing that caregiving responsibilities often require more than one person.


Work and Retirement Planning

Some patients find that working helps them feel better both physically and emotionally. Others feel differently. The key is to allow time for you or your loved one to consider any possible implications of work-related decisions, including:

· Risks to safety associated with working

· The ability of the company to provide support and accommodations

· The possibility of changing or reducing duties

· Effect on benefits and other entitlements


Using the 4M’s Framework

All older adults and all people living with a serious illness require care illuminated by the principles of prevention and mitigation of common issues/hazards associated with both the illness itself, and with the unintended consequences of some medical care and medications.

Using the 4Ms can help to serve as a reminder of the importance of reducing risks to cognitive and functional independence, which is often the highest priority for many people.


What Matters: Know and align care with your specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across all settings of care.


Medication: If medication is necessary, speak with your provider about the use of "Age-Friendly" medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across all settings of care.


Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium.


Mobility: Ensure that you or your loved one move safely every day in order to maintain function and do What Matters.


Best Concierge Nurse Case Management can assist you and/or your loved one in implementing the 4Ms Framework. Our services exist to help you put the pieces together and reduce your stress.







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