Seven Clinical Assessments of Functional Contentment

Functional Contentment Team Management Plan Considerations

Life History/Preferences

The life history provides the foundation for Mrs. Doe’s life. Let the life history morph into a dynamic life story that creates a bridge to the present. Create a list and post it by her door (include Mrs. Doe if feasible) that includes key points about who she was, what she prefers now, what her desires are (foods, spirituality, music, etc), and what her special needs are (glasses, assistive devices, etc).


Mrs. Doe’s medical history is without catastrophic events and illnesses. Her physical exam confirmed that she was a relatively healthy 81 years old. The FCM focus is her cognitive impairment, incontinence, hypothyroidism, and osteoarthritis.

Medication Evaluation

Mr. Doe (husband) agreed that essential medication should include only those that would provide her comfort (contentment). Synthroid continued for hypothyroidism to avoid the discomfort of a hypothyroid state. Lipitor, Lisinopril, Metoprolol, Vitamin D, and the Multivitamin were titrated where necessary and discontinued. Ambien was titrated and discontinued without difference in sleep patterns. Aricept and Namenda were discontinued to allow Mrs. Doe to be in a natural state. Tylenol and Senna-s are now given in the evening.

After two weeks of “settling in” the Ativan was discontinued for non-use once non-pharmacologic interventions were in place, such as iPod music therapy and robotic pet (puppy) companionship. Metoprolol and Risperdal were titrated and discontinued and Mrs. Doe exhibited an increase in energy. Adhering to the Slow Medicine philosophy, nine of the previous 13 medications were discontinued over a two-week period; appearing to not adversely affect Mrs. Doe or her behaviors.

Physical Abilities

Physical Therapy, Occupational Therapy, and Speech/Language Therapy evaluated Mrs. Doe’s physical abilities and each professional staff developed goals and a plan for her during her stay that matched the proposed goals for the Person/Family Centered Care plan.

Cognitive Abilities

Despite the low score on the MOCA, the increase in energy from decreasing certain medications and the implementation of the non-pharmacologic interventions, Mrs. Doe’s contentment continued as did her recognition of her husband. Her “yelling out” ceased with the increase in contentment.

Support System

FCM care management team developed a picture of Mrs. Doe’s previous support system and what parts of that system remained or needed to be added. It was determined that Mrs. Doe had a favorite housekeeper and food service worker. Efforts were made to ensure these staff members had time with Mrs. Doe. The robotic puppy calmed her and members of the Care Team, including her children, learned skills to support Mrs. Doe during their time together.

Living a Full Life to the Very End/End of Life Plan

Mr. Doe continued as Health Care POA. The medical director had educational conversations with Mr. Doe and introduced the POLST form. Mr. Doe shared the information with his children and within two weeks he had decided to complete a POLST form which indicated comfort care, while maintaining only medications that were essential for comfort.