The Hospice e-News

What the Media Said about End-of-Life Care This Week

Week of June 27, 2006

…a service of Florida Hospices and Palliative Care

 

 

 

HEALTH SYSTEM SHOULD BRACE FOR ELDERLY BOOM

 

Writing in the Kansas City Business Journal, Myra Christopher, president and CEO of the Center for Practical Bioethics, says that the news reports about avian flu and a possible pandemic reminds her of the coming crisis in health care.  That “inevitable train wreck won’t be caused by chickens,” though, but by “our lack of preparedness for the end of the baby boom generation, which certainly may be exacerbated by a pandemic, natural disaster, or war and global crisis.”  The 72 million seniors who will be 80 or over by 2030 may result in “44 states just like Florida is today,” some experts say.  To do nothing is to allow the “most technologically advanced and expensive health care system in the world” fail the generation that built it.

 

Christopher recently participated, says the article, in a technical advisory group, that was convened to make recommendations to the US Department of Health and Human Services about Medicare and end-of-life issues.  Among the problems identified were:

          *  Too few trained geriatricians and too much overspecialization in health care.

          *  Failure to finance case management and supportive services, while rewarding episodic intervention.

          *  Too few persons planning for end-of-life with needed documentation and family discussions.

          *  Hospice and palliative care services are underutilized.

          *  Financing is limited for skilled nursing home care.

          *  There is poor symptom control and pain management for those who are chronically or terminally ill.

 

The group came up with several suggestions for change, staying within the stated parameters of no re-engineering of the Medicare benefit, and keeping proposed changes “incremental and cost neutral.”

          *  Forgive the educational debt of physicians who become primary care physicians.

          *  Eliminate, or at least expand, the six-months hospice limit.

          *  Require hospice and palliative care consultations for people with certain diseases.

          *  Require end-of-life documentation and discussion of a surrogate before certain procedures are performed.

          *  Establish community health record repositories so information can be more easily transmitted between institutions and physicians.

          *  Establish high-quality end-of-life care standards.

          *  Establish quality-based purchasing mechanisms and pay-for-performance.

 

Christopher says that “it will take a shift in cultural expectations, political leadership and moral will to make these changes.  None of this will come easily.  One participant suggested that boomers are going to demand ‘personal death trainers and a latte for the road.’  Maybe that’s a more fitting approach than prolonged stays in intensive-care units and one more round of chemotherapy days before we die.”  (Kansas City Business Journal, 6/16)

 

 

PALLIATIVE CARE TEAMS WORK WELL INSIDE, OUTSIDE HOSPITAL

 

The Oregonian recently reported on a study, due for publication this summer in the Journal of Palliative Medicine, which finds that palliative care teams improve the quality of life for the dying both inside and outside hospitals.  Researchers reviewed 292 cases in which Oregon Health and Science University’s palliative care team was involved in designing the treatment plan.  All the patients were very ill from diseases such as emphysema, CHF or advanced cancer.  Nearly two-thirds were able to leave the hospital, with only 10% being forced to return, and only 5% dying in the hospital.

 

Dr. Susan Tolle, director of OHSU’s Center for Ethics in Health Care and a co-author of the study, calls the results “remarkable in light of the fact that about half of US deaths occur in hospitals.”  The article says, “Previous studies have found that palliative-care teams work well in the hospital.  The OHSU study is the first to show they also improve comfort care outside the hospital, enabling even very sick patients to be home for their final days.” Researchers said, “We demonstrated that a majority of patients who wished could be discharged, even when death occurred within two weeks.”

 

Dr. Charles Van Gunten, director of the Center for Palliative Studies at San Diego Hospice and editor of the Journal of Palliative Care, says that palliative care improves care for patients and also saves money by keeping patients at home and freeing up hospital beds for acutely ill patients.  Dr. Erik Fromme, the study’s lead author, says that the availability of hospice care in Oregon is crucial.  “The only way this works is if you have a hospice that takes over immediately after discharge from the hospital,” Fromme said.  (The Oregonian, 6/21)

 

 

END-OF-LIFE AND PALLIATIVE CARE NOTES

 

*  National Quality Forum members have received a review draft of the report, “National Voluntary Consensus Standards for Symptom Management and End-of-Life Care in Cancer Patients.”  The deadline for public comment is July 5 and NQF members have until July 12.  See www.qualityforum.org/activities/home.htm for more information.  (National Quality Forum Website, 6/2006)

 

*  The number of hospice and palliative care providers in the metropolitan Detroit area has doubled in five years.  Smaller nonprofits are “competing against larger and newer hospices that have a big marketing budget,” one hospice director said.  Steve Larkin, marketing director for the nonprofit Hospice of Michigan, says, “It’s getting harder from a balance sheet perspective.  (The Detroit News Website, 6/19)

 

*  Revised guidelines for physicians on “Forgoing Life-Sustaining Treatment for Adult Patients” have been issued by the joint Committee on Biomedical Ethics of the Los Angeles County Medical Association and Los Angeles County Bar Association.  The guidelines were modified to bring them into closer compliance with the California Health Care Decisions Act of 2000.  (Southern California Physician, 6/2006)

 

 

PUBLIC POLICY NOTES

 

*  A bipartisan group of senators has introduced a bill to help rural health care providers with the financial burdens of caring for small communities.  The Rural Hospital and Provider Equity Act of 2000 makes changes to Medicare regulations for rural hospitals and providers in the areas of reimbursement for lab, ambulance, home health care, hospice and rural clinics.  (US Fed News, 6/20)

 

*  The California Senate Judiciary Committee recently held an informational meeting on the question of allowing physician-assisted suicide in the state, and a committee vote is expected this week.  The hearing addressed two issues:  1) whether an assisted-suicide law would “affect the value that society places on life,” and 2) whether such a law would conflict with a doctor’s ethical or legal responsibilities and duties.  (Sacramento Bee, 6/21; The San Francisco Chronicle, 6/20,6/21)

 

*  The New Hampshire Legislature passed, and Governor John Lynch (D) signed, legislation overhauling the state’s laws on advance directives.  In addition to allowing residents to specify the kind of treatment they want, the new law clarifies and updates the forms, eliminates the necessity for notarizing end-of-life papers, establishes rules for medical orders that bar using CPR for resuscitation and gives doctors and nurse practitioners the right to make decisions about CPR if a person’s agent cannot be contacted and if CPR would unnecessarily harm the person.  (The Concord Monitor, 6/20; The Boston Globe, 6/19)

 

*  An article by Ezekiel J. Emanuel examines the recent decision by the District of Columbia Circuit Court which says, “Dying patients have a right to any experimental drug that has passed the safety phase of human testing, … even while the drug’s effectiveness is still unproven and undergoing research.”  Emanuel says that the decision in favor of the Abigail Alliance puts patients at risk of drugs that may actually worsen their conditions, opens patients to the possibility of tragedies like thalidomide and makes it difficult to get people to enroll in the kind of carefully controlled studies needed to prove the effectiveness of new medicines.  (The New Republic, 7/3)

 

 

RESEARCH AND RESOURCE NOTES

 

*  A group of pain specialists, convened by MedPanel to discuss the “challenges and future” of neuropathic pain treatment, asserts that cannabinoids (from marijuana) “are the most promising approach to treating nerve injury pain.  They also view FDA approval “of a cannabinoid drug as a thorny process that will be hampered by politics, prejudice and a lack of education on the part of the FDA, Drug Enforcement Agency (DEA) and general public concerning the nature of cannabinoid agents.”  (PR Newswire US, 6/21)

 

*  “Love-Lies-Bleeding,” a play by Don DeLillo, starts by examining the debate about the rightness or wrongness of euthanasia.  Produced at the Kennedy Center in Washington by Chicago’s Steppenwolf Theater, the ultimate goal of the play is the discussion of “the idea that the evolution of tools and knowledge has contributed to the impression that society can exercise sovereignty over everything, be it the natural world or even death.”  (The Washington Post, 6/20)

 

*  The AMA’s Ethical Force Program has issued a consensus report as the first product of its patient-centered communication initiative.  The report “describes the importance of communication to health care and how organizations can take steps to ensure effective, patient-centered communication.”  See www.ama-assn.org/ama/pub/category/16245.html for more information.  (AMA Website, 6/19)

 

*  PBS recently aired “Lion in the House,” a four hour documentary on the lives of five young cancer patients.  Julia Reichert, a documentary filmmaker, nearly lost her daughter to cancer and her experience was the impetus for the film.  Reichert, herself in remission from a rare, aggressive lymphoma, says, “I’ve made a lot of films.  But this is the film of my lifetime.”  (USA Today, 6/20)

 

*  Aetna and the Aetna Foundation have awarded $2.25 million in grants, mostly to nonprofit organizations in large urban areas, to support programs addressing end-of-life care and depression.  More information is available at www.aetna.com/foundation.  (Yahoo! Finance Website, 6/20)

 

*  The VA Health Services Research & Development Department is focusing on end-of-life services at its website at www.hsrd.research.va.gov/news/spotlight/palliative.cfm.  (VA Health Services Research & Development Website)

 

 

OTHER NOTES

 

*  Laura Sollenberger recently became the first person in central Illinois to be certified as a thanatologist, a specialist in dying, death and bereavement.  Thanatologists are certified by the Association for Death Education and Counseling, and applicants must meet rigorous educational standards, demonstrate excellence in counseling and pass a comprehensive board examination.  (The State Journal-Register, 6/19)

 

*  Gentiva Health Services Inc., a home health care provider, has purchased Lazarus House Hospice Inc. and a home infusion pharmacy company, Carolina Vital Care.  Lazarus House will become part of Gentiva’s Wiregrass Hospice unit.  (Newsday, 6/23)

 

*  The Association of American Medical Colleges has recommended that US medical schools increase their enrollments 30% by 2015.  It also recommends “studying the geographic distribution of U.S. physicians to identify strategies to address area shortages; increasing the number of National Health Service Corps awards by at least 1,500 per year to address the need for physicians in underserved areas; and exploring a voluntary process for evaluating foreign medical schools that chiefly enroll Americans.”  (AAMC Website, 6/19)

 

*  The Eighth Great Obituary Writers’ Conference was held recently in Las Vegas, New Mexico.  The obituarists “take pride in the fact that God is their assignment editor, [and] are basking in the news that obits are anything but a dying art form these days.  In fact, they’re very much alive.”  You can find obit websites (obitpage.com), clubs (Atlanta’s Friends of Obits) and blogs (obituaryforum.blogspot.com).  A new magazine, Obit, plans to start publishing in January.  (USA Today, 6/21)

 

Thanks to Ann Jackson and Jonathan Krutz for contributions.

 

Glatfelter Insurance Group is the national sponsor of Hospice News Network for 2006.  Glatfelter Insurance Group provides property and liability insurance for hospices and home healthcare agencies through their Hospice and Community Care Insurance Services division.  Ask your insurance agent to visit their website at www.hccis.com.