Week of
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VA & NHPCO RELEASE REPORT ON EOL CARE FOR VETERANS
“VA Transforms End-of-Life Care for Veterans” is a newly released
monograph that notes the “advancements made in end-of-life care for veterans
and examines successful hospice-veterans partnerships.” A joint project of the Department of Veterans
Affairs (VA) and NHPCO, the report examines the unique needs of veterans and
emphasizes “the importance of quality, compassionate care for dying veterans
and their families.”
US veteran deaths average 54,000 per month, nearly a quarter of all
In a preface to the monograph, VA Secretary Anthony J. Principi, says, “VA’s palliative and end-of-life care offers an opportunity to provide veterans a peaceful journey across life’s last years, as well as an opportunity to provide them the respect and recognition they so well deserve through dignified, quality care. Ours, then, is a final chance to fulfill a last promise.” Dr. Thomas Edes, Chief of Home and Community-Based Care for the VA, says, “We are raising expectations at the national and local levels, so that a terminally ill veteran can go to any VA facility and obtain hospice care. If needed hospice care is not forthcoming, we want them to contact us.”
Saying that the VA has a mandate “to honor veterans’ preferences for
end-of-life care,” Principi noted the following commitments to achieving that
mandate:
* All enrolled veterans have hospice and palliative care as a covered benefit.
* Every VA healthcare facility has either hospice and palliative care consult teams or inpatient units.
* VA purchases, as a standard practice, comprehensive hospice services in local communities.
* Management is actively institutionalizing hospice and palliative care in all VA healthcare operations, including ongoing training of healthcare personnel.
* Home hospice care is included in this year’s annual budget submission to Congress.
* VA uses its Hospice-Veteran Partnership to “build solid working relationships with the hospice community” to provide comprehensive home hospice services. The VA anticipates having working partnerships in every state by the end of fiscal year 2005.
The report says that VAMC’s are largely autonomous and may address end-of-life care according to patients’ needs. National policy and standards stipulate, however, that every VA facility must have the following services:
* A person designated as the hospice contact who serves as “part of an integrated network for local and national communications and information dissemination”;
* Hospice services provided in all settings;
* Inpatient hospice beds or community access to them;
* An interdisciplinary palliative care consult team;
* Referral assistance to area community hospices; and
* Tracking of provided palliative care and hospice services in all settings.
The VA’s current philosophy about hospice and palliative care owes much
to Dr. Kenneth Kizer, Under Secretary for Health from 1994 to 1999. In 1997, Kizer called a VA End-of-Life
* The VA Faculty Leader Project for Improved Care at the End of Life, partially funded by the Robert Wood Johnson Foundation;
* Training and Program Assessment for Palliative Care, in conjunction with the VA’s Office of Academic Affiliations;
* Interprofessional Fellowship Program in Palliative Care, administered by the VA’s Office of Academic Affiliations;
* VA Hospice and Palliative Care Initiative, supported by Rallying Points and NHPCO;
* National Hospice-Veteran Partnership Program, with Rallying Points, and
* Accelerated Administrative and Clinical Training, together with Geriatrics and Extended Care in collaboration with the VA’s Employee Education System and the Office of Academic Affiliations.
Last year, ten state hospice and palliative care organizations received
grants from NHPCO to support their efforts to develop stronger relationships
with VA medical centers. Other
end-of-life advocates also promote these partnerships and the report suggests a
number of ways that community hospices and VA medical centers can work
together.
The press release and monograph are available from NHPCO at www.nhpco.org. Click on “About NHPCO,” then on “Press Releases.” (“VA Transforms End-of-Life Care for Veterans,” NHPCO Press Release, 2/10)
PAIN AND PALLIATIVE CARE NOTES
* This week, the FDA will discuss the fate of
COX-2 inhibitors, painkillers that include Vioxx and Celebrex. Though not proven to be more effective than
NSAIDs, they were believed to have fewer digestive system complications. Recent concerns about adverse cardiovascular
effects have prompted a re-examination.
(
* Researchers at the
* Scientists evaluate whether tropical frogs are poisonous by licking their backs. It’s all for a good cause, because some of the toxins are leading to new painkilling drugs. The raw chemical epibatadine, found in the phantasmal poison frog, is 200 times more potent than morphine. While it can’t be used directly, it does serve as a model for developing other drugs. (Science World, 1/3)
* “DEA war on drugs no help to chronic pain
sufferers” is a headline in the
* Writing in the
* If a budget amendment asking for $500,000 to
support palliative care training in
* Purdue Pharma has begun shipping Palladone, a long-acting hydromorphone formulation, to wholesale drug distributors. The company’s press release says that Palladone should be used only for those patients who are opioid tolerant and are already receiving opioids. Palladone should not be prescribed for the first use of opioids by a patient or for short-term use. (Biotech Week, 2/9)
PAS & END-OF-LIFE NOTES
* A
male infant named Sun, whose skeletal abnormality is slowly suffocating him, is
the center of a court battle over whether to terminate life support. Doctors at Texas Children’s Hospital in
Houston say continuing life support is unethical, but when Sun’s mother, Wanda
Hudson, objected, the hospital agreed to let the court decide and is paying for
his mother’s lawyer. The hospital’s
decision was made, in part, out of concern for
* At a
recent joint hearing of the California Assembly Committee on Aging and
Long-Term Care and the Assembly Judiciary Committee, committee members heard
testimony about whether or not California should enact a law similar to
Oregon’s Death With Dignity Act. Two
state legislators plan to introduce a bill allowing physicians to prescribe
lethal doses of medication to terminally ill patients who wish to choose the
time of their deaths. (
* Michael Schiavo’s attorney, George Felos, says
that the
PUBLIC POLICY NOTES
* The
Wyoming Senate Labor, Health and Social Services Committee wants to put durable
powers of attorney and living wills into one document, using a form created by
the Department of Health. Some support
the move because it would allow persons to designate their healthcare agent
without having to pay attorney fees, but others say that individuals will lose
the ability to tailor the document to their own situations. The bill will go to the full Senate. (
* In the January 28 Federal Register, CMS says that it is open to a demonstration project that allows Medicare beneficiaries to receive hospice care concurrently with life-saving treatment. Private insurance companies and the Medicare Payment Advisory Commission already support concurrent treatment. (Home Health Line, 2/4)
* President George W. Bush’s (R) proposed budget would end copayments for hospice care for US Veterans. (PR Newswire, 2/7)
OTHER NOTES
* Lynette Johnson is a portrait photographer who
takes photographs of terminally ill children and donates them to the families
of the children. She got started
when her sister-in-law asked if she could make photographs of her stillborn
child. Johnson realized that if she
could make photographs of her niece, she could do it for others. She volunteered to make photos at Children’s
Hospital in
* The National Quality Forum recently endorsed a set of voluntary consensus standards for home health performance. Family evaluation of hospice care, though not included, remains under consideration and “will be adjudicated in an additional round of voting according to procedures spelled out in the NQF’s Consensus Development Process.” (PR Newswire, 2/7)
* A new brain-imaging study suggests that “thousands of brain-damaged people who are treated as if they are almost completely unaware may in fact hear and register what is going on around them but be unable to respond.” The study, originally reported in the journal Neurology, “could have sweeping implications for how to care best for these patients… [and] could also have consequences for legal cases in which parties dispute the mental state of an unresponsive patient.” (The New York Times, 2/8)
* The National Minority Health Month Foundation,
in conjunction with former speaker of the US House of Representatives Newt
Gingrich (R) and former
*
* In VistaCare’s report on first quarter
results, the company cited record-high hospice admissions of 4,314 for the
quarter ending
*