Thursday, September 5, 2013

The Importance of Conversations for End of Life Care

We all know the importance of clients and families having conversations about instructions for end of life care, but for many, that conversation is incredibly difficult. The ABA Commission on Law and Aging Consumer's Tool Kit for Health Care Advance Planning (2d ed.) provides "scripts" for these important conversations.  We also know that it is important that patients and their health care professionals have similar discussions, and although the  Patient Self-Determination Act requires health care providers to inquire about the existence of advance directives (among other things), doctors and patients need to have forthright discussions.  I don't even want to type the next two words for fear whispers will start up again..."death panels".... (and please, please, please, do not take issue with me for the website I linked to for that phrase.  Oh and the use of the phrase is spreading beyond the ACA.)

But I expect that the whispers (but in all likelihood, it won't be whispers) will start again (if they haven't already) but not as part of the Affordable Care Act. Instead Representative Blumenauer has introduced HR 1173, which would include in Medicare and Medicaid coverage  a patient's consultation with her doctor about end of life issues.  An August 1, 2013  editorial in the LA Times notes that such provision makes sense, is important to have these one-on-one talks, and a significant number of Americans support Medicare and Medicaid's coverage for these consults.

Paula Span made this bill the subject of her August 28th, 2013  New Old Age Blog. Titled  A Renewed Push for End-of-Life Discussions , she noted that the bill, Personalize Your Care Act also includes provisions for grants for POLST programs. There is a similar bill introduced in the Senate by Senators Warner and Isakson.

Whether such proposal will be successful this time remains to be seen. As the blog post quotes the Representative: "Mr. Blumenauer thinks the death-panel fever has abated: 'It’s been debunked so many times that people who used the term are a little embarrassed.'”

By the way, as you probably know, the govtrack site offers a summary as well as helpful "status" "progress" and "prognosis" (chances of passage) for bills.  Serious bummer for this bill if they are right.

Becky Morgan

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