Hospice eNews
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What
the Media Said about End-of-Life Care This Week
Week of May 8, 2005
…a service of
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AHA AND OTHER
GROUPS LAUNCH “PUT IT IN WRITING”
The
Key to AHA’s educational effort is www.putitinwriting.org, an English/Spanish website that provides consumers, hospitals and other providers with information on living wills and advance directives. The site has downloadable information, instructions and wallet cards. New public service announcements in both languages urge everyone to talk with their families about their end-of-life wishes and to complete advance directives.
The site provides numerous links to other
resources. One link leads to an NHPCO
website that has advance directive documents for all 50 states. The NHPCO site also offers a helpline where
consumers may seek assistance. Another link leads to the American Bar Association
website and provides a consumer toolkit for consumer advance healthcare
planning.
Another link, also to the American Bar
Association website, features an article by Charles P. Sabatino, JD, that
debunks the myths about advance directives.
Among the myths are:
* “Everyone needs a living will.” Not without also having a healthcare proxy, Sabatino says. The proxy is actually the more important document, but he suggests having both, or a combination document that addresses both issues.
* “Written advance directives are not legal in every state.” Not true, Sabatino says, but state laws vary widely in “terminology, the scope of decision-making addressed, restrictions, and the formalities required for making an advance directive.”
* “Just telling my doctor what I want is no longer legally effective.” Oral statements “remain important both on their own and as supplements to written directives,” Sabatino says.”
* “An advance directive means ‘Don’t treat.’” Most people do use them to avoid being kept alive under circumstances in which they wouldn’t want to live, but they are also used to “say that the individual wants all possible treatments within the range of generally accepted medical standards.” And in any case, Sabatino writes, “One should always assume (and insist upon) continuing pain control, comfort care and respect for one’s dignity.”
* “When I name a proxy in my Advance Directive, I give up some control and flexibility.” False, as the proxy has no power to make decisions unless the patient is incapable of making them for him or herself.
* “I must use a prescribed Advance Directive form for my state.” Not usually true, though 18 states require their forms to be ‘substantially followed” or to include certain language in the form.
* “I need a lawyer to do an Advance Directive.” Sabatino calls lawyers “helpful resources,” but not the only one and not necessarily the best for all people.
* “Doctors and other health care providers are not legally obligated to follow my Advance Directive.” “Legally false,” Sabatino says, “but as in many endeavors, reality muddies the waters.” Physicians are legally required to follow the document and are liable for damages if they do not. In order to follow them, however, they must know the document exists, it must be clear enough for them to follow, and the physician must not object to provisions in the document for reasons of conscience.
* “If I do not have an Advance Directive, I can rely on my family to make my health care decisions when I am unable to make decisions for myself.” Both true and false, Sabatino says, since some states do assign default decision makers and physicians generally confer with family members about decisions for patients who can’t speak for themselves. But families don’t always make the decisions that patients would want made and may not like being put into a position to have to do so.
* “Advance Directives are a legal tool for old people.” False again, the article says, since the two landmark legal cases in end-of-life legislation were for Karen Ann Quinlan and Nancy Cruzan, both of whom were younger than 30. “The stakes are actually higher for younger persons in that, if tragedy strikes, they might be kept alive for decades in a condition they would not want. The Sabatino article is available at www.abanet.org/aging/myths.html.
AHA
launched the new website on Monday, May 2.
The May 6 AHA News Now announced
that the new website “has attracted more than 11,830 individual visitors since
it went online Monday, with visitors staying more than eight minutes on average… The wallet card was downloaded more than
4,150 times, and the brochure more than 3,550 times. Hospitals are encouraged
to include on their Web sites a link to the site, which contains resources to
help people put their wishes about end-of-life care into advance
directives.” (PR Newswire, 5/2; Put It In
Writing Website; ABA Website;
AHA News Now,5/6 )
ACOVE STUDY SAYS ELDERS GET HALF OF RECOMMENDED CARE
A recent study, Assessing Care of Vulnerable Elders (ACOVE) was conducted by RAND Health. The study “identified 22 conditions that account for the majority of healthcare costs for older adults and analyzed prevention, diagnosis, treatment and follow-up.” When measured by the amount of time that caregivers adhere to quality indicators, “the vulnerable elderly receive only about half of the care recommended.” The study found that for preventive care, measures were followed 43% of the time and treatment indicators were adhered to 81% of the time. Caregivers adhered to quality indicators 83% of the time in acute care situations but only 51% for chronic conditions.
Several organizations are addressing the
issue. Kaiser Permanente has
developed core competencies to address the needs of older adults. Highmark Blue Cross Blue Shield’s Security
Blue, whose PALS (People Able to Lend Support) provides support to help seniors
remain independent. Senior Care Blue,
which concentrates on the needs of seniors in nursing homes; and United Health
Group’s Evercare, are also focusing on independent senior living.
PAIN NOTES
* The New York Times columnist Jane E. Brody explores the risks involved with use of pain relievers. For over a century, Brody asserts, aspirin was the drug of choice. Some experts say that if aspirin had to go through the current FDA approval process, it would never make it because of the number of deaths due to bleeding. All the newer pain medicines can have serious side effects, and even Tylenol, generally considered safe, can cause liver damage if taken in too large a dose or combined with alcohol. (The New York Times, 5/3)
* Critics
are calling unregulated pain clinics “pill mills” and “medical crack houses”
and some are calling for a moratorium until better national oversight can be
established. Doctors who run the clinics
resent the criticisms and say they provide a much-needed service. Pain management clinics treat more than 48
million Americans. (
*
*
END-OF-LIFE,
ADVANCE PLANNING NOTES
*
* Representative
Benjamin Cardin (D-Missouri) is a cosponsor of bipartisan legislation on health
care options and end-of-life choices. The Advance Directives Improvement and
Education Act builds on the 1990 Patient Self-Determination Act, and aims to
increase the number of Americans who have advance directives. (
* One point made by an article about end-of-life documents is that persons creating healthcare proxies need to sign HIPAA authorizations so that their proxy can have access to their medical records. Otherwise, the proxy may not have access to the medical records necessary to make informed decisions. (Registered Rep., 5/1)
*
* The
* Writing
in the
* Two articles in Psychiatric Services examine advance care planning and end-of-life treatment preferences for persons with serious mental illnesses. An editorial on the stigma of mental illness and its effect on end-of-life planning is available online at psychservices.psychiatryonline.org/cgi/content/full/56/5/515. Click on “Table of Contents” and you will be taken to abstracts of the two articles by Foti, et al. (Psychiatric Services, 2005;56(5))
*
PUBLIC POLICY NOTES
* HHS
Secretary Mike Leavitt recently said that having elders write living wills
could reduce Medicare’s “skyrocketing healthcare costs,” but a number of
experts disputed that idea. Joan
Teno, professor of public health at
The Office of Management and Budget is currently reviewing the notice of proposed rulemaking (NOPR) for hospice conditions of participation (COPs). After the NOPR is published, there will be a 60-day comment period. The current COPs were written in 1983 and underwent some minor changes under the 1997 Balanced Budget Act. Expected changes will affect the level of care requirement for hospice inpatient respite care, impact tracking and measuring hospice income and offer clarification of “live” hospice discharge reasons. (Home Health Line, 4/29)
* Attorney Edward Hopkins, of Broad and Cassel, offers tips to help hospices avoid billing compliance errors: 1) Adhere to the prescribed length of stay; 2) Double check E&M coding by physicians; 3) To avoid kickback violations with referrers, establish a fair market value for services; and 4) Be sure that hospice payments to nursing homes don’t overlap with Medicare or Medicaid payments to them. (Home Health Line, 4/29)
OTHER NOTES
* Fritz
Schafer, of
* Nearly
75% of adults over 50 use alternative medicine such as acupuncture or herbal
medicine. Gong-Soog Hong, professor
of consumer sciences at
* Marcia
Lattanzi-Licht, educational specialist for NHPCO, says that kids often don’t
know what to do when friends become seriously ill. But the friend hasn’t “changed as a person,”
and still wants to play games and spend time with pals. Jane Bomberger, who works with Hospice of the
Calumet Area in
* The University of Chicago’s National Opinion Research Center reported that the number of people attending religious services at least once weekly increased by nearly 3% in 2003-2004. The WSJ article says, “Studies show that weekly attendance confers a significant reduction in mortality risk over a given period of time.” (The Wall Street Journal, 5/3)
* Though the Terri Schiavo case resulted in thousands of people contacting organizations asking for advance directives and other end-of-life information, NHPCO’s Jon Radulovic says that his organization has seen no increase in donations to support NHPCO. Radulovic says it will be “interesting to see” if “people look back with a philanthropic eye.” Several organizations express their hopes that foundations will accept the challenge of funding end-of-life initiatives. (The Chronicle of Philanthropy, 3/31)