How should clinicians respond to a high risk CHESS score with moderate cognitive impairment?

How should clinicians respond to a high risk CHESS score with moderate cognitive impairment?

• A. Immediately discharge the resident
• B. Prioritize comprehensive care planning focusing on medical stabilization, functional support, caregiver resources, and monitoring for decline
• C. Increase only medication
• D. Discontinue all monitoring

Answer: (B)

A high CHESS score signals health instability and a heightened risk of decline, so the best response is to engage in proactive, comprehensive care planning. This means addressing any immediate medical issues to stabilize the resident when needed, while also focusing on functional support to maintain daily living activities and safety. It includes connecting the resident and family with caregiver resources and social supports, so caregivers have the help they need and a plan for ongoing support. Importantly, it involves setting up regular monitoring to detect further decline early and having goals-of-care discussions that reflect the resident’s prognosis and preferences. Discharging immediately would be unsafe given the instability, and increasing medications in isolation doesn’t tackle functional or caregiving needs. Discontinuing monitoring would ignore the risk of further deterioration.

A high CHESS score signals health instability and a heightened risk of decline, so the best response is to engage in proactive, comprehensive care planning. This means addressing any immediate medical issues to stabilize the resident when needed, while also focusing on functional support to maintain daily living activities and safety. It includes connecting the resident and family with caregiver resources and social supports, so caregivers have the help they need and a plan for ongoing support. Importantly, it involves setting up regular monitoring to detect further decline early and having goals-of-care discussions that reflect the resident’s prognosis and preferences. Discharging immediately would be unsafe given the instability, and increasing medications in isolation doesn’t tackle functional or caregiving needs. Discontinuing monitoring would ignore the risk of further deterioration.