Senate Special Committee on Aging Continues the Conversation on Advanced Care Planning with Roundtable Discussion
June 10, 2014 12:13 PM
The Senate Special Committee on Aging recently held a round table discussion, Continuing the Conversation: The Role of Health Care Providers in Advance Care Planning. It was the second hearing on this topic in the past year. This hearing was intended to build on the previous hearing Renewing the Conversation: Respecting Patients' Wishes and Advance Care Planning, which the committee held last June. Panelists focused on the emerging clinical care models for patients with advanced illness and what is needed to accelerate the development and adoption of advanced care planning tools.
Home care and hospice settings are often the first place families and patients are required to make important decisions about the level of care they would like to receive at the end of their lives. Emerging mostly through leadership in the private sector, providers have a number of advanced care planning models from which to choose and can help determine the model that will best serve their clients. Many of these care models are designed to provide support where the patient live, keeping care in the home and community and promoting team-based care.
“Some 25% of seniors loose their entire assets during the last 5 years of life because of the cost of advanced illness care”, according to panelist Bill Novelli, Co-Chair of the Coalition to Transform Advances Care. Research shows that the majority of seriously ill patients want to be at home with family and friends, have their pain managed and their spiritual needs met, and to be sure those who love them are not emotionally or financially devastated as a result of their illness. Although there may be different approaches to end-of-life decision-making, it is widely agreed upon that it is far better to make these choices before a crisis occurs.
Senator Tammy Baldwin, who sits on the Senate Aging Committee, cited in her opening statement that 99.4 percent of citizens in La Crosse, Wisconsin have advanced care planning records that are easily accessible and comprehensive. This was made possible by a bill passed by the House of Representatives in that state that pays providers for periodic end-of-life planning conversations with patients. However there are barriers to achieving that type of success national level.
NAHC supports legislation that would address some of these barriers. Because those who have advance directives are not assured that this legal document will be honored in any state other than the state in which it was executed, an individual is burdened with the responsibility of having the advance directive meet the laws of any state in which that person may be spending time.
NAHC proposes Congress should support legislation that ensures the portability of an individual’s advance directive between health care facilities as well as between states.
Advance directives belong to the individual and should not be interfered with or interrupted by the laws of any particular state or health care facility. As an individual travels or relocates to a different state, end-of-life-care choices should be honored based on the choices of the individual, not based on the location of the individual. Establishing a nationwide policy on advance directives that assures the portability of an individual’s end-of-life care choices strengthens patient self-determination efforts and could encourage more individuals to communicate with families, physicians and health care providers about their end-of-life-care choices.
NAHC also encourages Congress to authorize voluntary advance care planning consultations under Medicare to educate beneficiaries on issues related to end-of-life care and end-of-life care planning. Voluntary advance care planning consultations under Medicare would help to familiarize beneficiaries with end-of-life care choices and the availability of the Medicare hospice benefit and the services available under it so that a beneficiary is more aware of the options available to them if terminal illness should occur.
Regardless of the model used, providers should understand their role is to engage, educate, offer guidance, and support the family and patient in this process – with them in the center of the care and planning. There is no replacement for the role of family and loved ones in end-of-life care and planning, it’s critical that the family drive the conversations and decision-making.
To read NAHC’s official legislative position on Advance Directives, please click here.
For more information on this hearing- including panelists’ and Members’ statements and background information, please click here.
To read more from NAHC Report on this topic, please click here.