More than a quarter of older Medicare beneficiaries have yet to document their advance care planning (ACP) wishes, according to a recent study by researchers at the University of California, San Francisco. Latinos, African-Americans, those with lower education levels and people with lower incomes were at greatest risk of not discussing or carrying out ACP.
That leaves many people subject to receiving end of life care that they may not want and may go against their values and wishes, according to Alexander Smith, M.D., senior study author and an associate professor of medicine, geriatrics and palliative care at UCSF. Continue reading
Until the 1920s, most Americans died relatively quickly and at home, surrounded by things and people – including their minister, priest or rabbi – they knew and who knew them. And, because they died where they lived, and among those who cared for them, the fear, pain, relief and release that death brought was common knowledge.
Today, however, death and the dying process are a mystery to most Americans. Only rarely, and usually in a crisis situation, do we get a peek behind the curtain at the anger, fear, pain, guilt, yearning, etc., that dying people experience, whether they are being cared for in a health care facility or at home. Continue reading
While the veil has been lifted somewhat on end-of-life and advance care planning discussions, many providers are still not having conversations with patients and families in time to maximize effective care for chronically and terminally ill patients. At a recent briefing, a coalition of policymakers and experts called on Congress to enact legislation that would ensure that patients and families get comprehensive advanced illness planning and care in the manner, setting, and place of their choosing.
The Coalition to Transform Advanced Care (C-TAC), an alliance of 130 organizations promoting better palliative and end of life care, is calling for lawmakers in the Senate to support the bipartisan Care Planning Act, as a means to achieve this. Continue reading
Photo: Mary IsaacsonPowwows provide a good venue for Pine Ridge elders to discuss advanced care planning and wills.
A unique outreach program is helping elders of the Lakota nation to address issues of palliative and end of life care among residents of reservations throughout South Dakota. The program incorporates culturally appropriate language and uses peer educators to promote advance care planning and wills.
When Mary Isaacson, an assistant nursing professor at South Dakota State University, began exploring the issue with older adults from the Pine Ridge reservation in 2014, she found an overwhelming need for education and materials. Within a year, Pine Ridge elders Patricia Catches The Enemy, Valaria Red Cloud and Garfield Apple collaborated with Isaacson to develop a Lakota-specific advanced directive brochure and received training to be advance directive coaches. While attending events, such as powwows and flea markets, and visiting community centers where elder meals are served, they hope to start conversations about advanced care planning and wills. Continue reading
Hospice use is a common indicator of quality end-of-life care. The timing of hospice enrollment is an important component of that care, and a recent study finds wide variations among states.
Researchers from Yale University compared 2011 hospice use data on a state-by-state basis of 660,000 Medicare patients during the last six months of their lives. They identified several key trends among states in the rates of very short or very long hospice stays (reflecting late or early enrollment) and of patients leaving hospice before their deaths. Continue reading