Hospice Volunteer Training Online: Medicare to fund end-of-life planning consultations with …

Medicare to fund end-of-life planning consultations with …

Tagged with: care providers madeleine

Medicare will now fund end-of-life health care planning consultations. Pre-planning, family discussions of these (end-of-life) issues, won’t ease the pain of dealing with medical crisis; what is does do is lay the groundwork for making informed decisions based on what the patient really wants, what the patient’s priorities and beliefs require. It is a road map through both crisis and longterm care.

Medical care gets a new twist in 2011 with the implementation of paid consultations with physicians to discuss end-of-life planning, and the new law is a far cry from hysteria-triggered “death panel” paranoia that makes frenzied headlines. At its most basic level, it has everything to do with ensuring that patients get the care they choose and families have guidelines on dealing with medical crisis.

On January 1, 2011, new regulations allow Medicare recipients to have once every five years voluntary end-of-life planning, with physicians being reimbursed for time spent in consultation on these important issues. What can be discussed? Hospital versus hospice, type of care and care providers, and virtually every conceivable issue related to health care.

Having had decades of experience with catastrophic illness and the deaths of loved ones, I have learned the valued of meeting these discussions head-on.

End-of-life planning was clearly discussed, sometimes with tears, by editor Christine Anne Piesyk and her mother, Madeleine. “My mother knew exactly what she wanted and didn’t want.”

For many years, before “pre-planning entered the linguistic landscape, my family took care of my grandmother at home. Cooking downstairs, running hot meals upstairs to her apartment, and later, responding in the middle of the night to the tapping of her cane on the floor above us. She needed water. Or assistance to the bathroom. My mother and I ironed her house dresses and aprons, and when her chignon of decades could not be managed, I was the one who cut her elegant, fanny-length silver hair to a comfortable bob.

When the time came, we had few options but to place her in a nursing facility, though we had never discussed it with her. And she would have fought it had she been able, fought it with what was left of her mind. In those days of restraints and what seems now to be archaic care, she passed away in a shadowy room with my mother holding her hand. her end-of-life care evolved, without a plan.

I wish we had talked back then.

The second learning curve began when my father was in the prime of retirement; he lost his leg, but that “prime” left him fighting mad and took him straight into a fiesty recovery. It was less easy when lung cancer and the first of three strokes hit. He survived the first cancer, but relapsed years later when he was simultaneously in irretrievable mental decline. Still, the question was raised, “shall we operate on the lung again?” My mother and I spent hours at his side, though his only communication with us was a look in his eyes. We could read those eyes. Seventeen years and no hope of recovery eased our choice.

We opted to let him go; to provide palliative care to ease pain, but not subject him to further surgery when he could not participate in any recovery. Indeed, cancer surgery would not make him walk again, or restore his mind, and would create more difficulties with no quality of life. His end-of-life care was superb and and peaceful at the hands of Catholic nuns, a fitting match for a man with a strong Catholic faith and heritage. We were learning to talk now.

Over the next few years,many of my friends began to lose their parents, some fighting to prolong life indefinitely, others making irreversible decisions without really thinking about the consequences. Several admitted that end-of-life decisions were never discussed, a taboo subject too painful or difficult to address. I watched, and having been the the first and the youngest in this line of parental loss, I witnessed their struggles and gained early wisdom.

Thus when my uncle, after decades of WWII-induced mental illness flanked by cancer and Alzheimer Disease, came to the end of his life, my mother and I held tight to a plan on how we hoped he would pass. Peacefully. No heroic measures.

We had learn to talk about “it.”

Call it luck. Call it serendipity. Call it good doctors. Or the right facility and staff. There were no challenges, no “try a feeding tube,” no “what about hydration?” questions. In an age of no restraints, he would throw himself off his bed, or slide between his bedrails, creating further injury. The solution, from a creative palliative team, was a bed-less private room with thick cushy physical therapy mats placed wall to wall. No tubes, no monitors, no IVs. Just wall-to-wall softness.

On his last two days, I stayed with him around the clock. Only on his last morning did he fall into that near breathless before death state. My mother, ill herself, sat in a hastily acquired rocking chair, a lap robe tucked around her; I lay on the floor, arms about my uncle, talking to him, placing periodic kisses on his forehead, telling him how much we loved him. I felt his last breath on my cheek. He passed peacefully, just as I hoped he would in those last hours, slipping away from us after far too many painful years.

Thank heavens we had had so many discussions by then.

All of these events were surrounded by ever intensifying discussions of end-of-life, of response to sudden catastrophic illness, and response to slowly evolving illness in aging. We talked about it, became versed in health proxies and medical directives, and knew with absolute certainty that we must direct our path through aging and dying. We asked questions. We filled out and filed paperwork (my information is updated every few years). Today, everyone who might have a hand in my future care knows where my “papers” are and more importantly, what I want. I’ve been quite specific. Yet when I speak to other people, I remain amazed at how many simply can’t have that discussion, not with their doctors, not with their families. It is as if having the discussion makes them vulnerable to the cycle of life when they would rather fight it, deny it or ignore it altogether.

Pre-planning, family discussions of these issues, won’t ease the pain of dealing with medical crisis; what is does do is lay the groundwork for making informed decisions based on what the patient really wants, what the patient’s priorities and beliefs require. It is a road map through both crisis and longterm care.

Advanced care directives are critical components of end-of-life planning.

Despite all the preparations made by my mother and myself, the one thing that still created issues at the end of her life was Alzheimer Disease. In the absence of rational thinking, of pervasive dementia, what was said or written and approved by her lost all meaning for her. It did, however, reinforce my relief in having dozens of earlier “sane” discussions as my guideposts. I had her health proxy; I had a clearly defined set of health directions (if this happens, do that); I had Conservatorship, Guardianship, and Power of Attorney (terms all baby boomers should know and understand) at varying times. Copies were filed with her medical records at the doctors office, at the hospital and the nursing facilities we used. Everything was clearly discussed with her physicians long before implementation became necessary.

After five years of dementia, and with the full pre-arranged support of her physicians and medical staff, my mother passed peacefully, with no heroic measures by her choice; she passed surrounded by children, grandchildren and great-grandchildren, in a room filled with fresh cut lilacs, spring breezes and birdsong. It was exactly what she wanted, and reflected every value she expressed throughout her life. The truth, had she wanted heroic measures, I would have been hard-pressed to implement them.

The work, the decisions, had long since been done. With the planning in place, all attention could be focused on simply loving my mother and easing her passing.

In the new health legislation coming into effect in 2011, and with a surge of baby boomers moving into their senior years, Medicare will now be required to pay once every five years for a medical visit specifically for discussion of end-of-life planning.

I find myself hoping that “legalizing” or medically approving the “the talk” will bring this all-important issue to greater public awareness. I am continually amazed at how many people are afraid or uncomfortable with the subject. I am amazed at the need to insure the ability to have this conversation, since in all of my experiences such discussions occurred as part of regular visits, well-before crisis erupted, no additional office visit required. But if funding this “consultation” will in fact get people talking, it is more than worth the effort and the price.

Apart from addressing the natural process of aging, health care and dying in the normal course of life, such discussion at earlier ages has equal import; so many things can impact the quality as well quantity of one’s life. A skiing accident, car crash, sudden stroke, heart attack — unexpected but life-changing events do happen. What criteria would you want used in determining critical care and longterm medical needs? An individual should wait until retirement to lay their medical preferences on the table. Not being of Medicare age should not preclude having these talks with family, nor should it preclude taking the initiative and filing a health proxy and directive with one’s physician.

The concept of quality of life and lifespan itself have different meaning and value to every individual. There is no “one size fits all,” and failure to plan, failure to have these discussions is to open the door to unwanted treatment or close the door on heroic measures that some people will want.

Congress has validated the need for end-of-life planning, and no one should fail to take advantage of this opportunity.

NOTE: Author/Editor Christine Anne Piesyk holds an M.A. in Individualized Studies in Aging/ Alzheimer Disease and Caregiving. The opinions voiced in this article are solely those of Ms. Piesyk.

If you enjoyed this article, you might also like:

Matthew Walker Comprehensive Health Center, HCA and Tristar to ‘Screen for Life’ Three Tennessee health care powerhouses will combine their resources to improve women’s attention and access to breast cancer detection and treatment. Socio-economic factors negatively impact…

Montgomery County EMS earns Star of Life award NASHVILLE, TN: In 2009, ambulance services in Tennessee responded to over one million 911 calls. The second annual EMS Star of Life Awards Dinner &…

Tennessee Angel Fund relocates to Nashville TNAngel Fund has completed a venture enterprise investment that brings medical high tech start-up Shareable Ink to Nashville. Shareable Ink specializes in digital pen and…

Medicare beneficiaries have coverage options During the month of October many senior Tennesseans received non-renewal notices regarding their Medicare Advantage or Private Fee for Service plans. The Department of Commerce…

New Environment and Planning Chief named NASHVILLE, TN: Tennessee Department of Transportation Commissioner Gerald Nicely named Joe Carpenter as the new Chief of Environment and Planning for TDOT. Carpenter currently serves…

Related posts:
Medicare to fund end-of-life planning consultations with physicians I’m sorry, but the post or page you’re looking...

Daily Kos: Obama administration will enact end-of-life planning … Under the rule, doctors can provide information to patients...

End-of-Life Planning Helps Families Make Decisions After more than 10 years, Ann Kotnour, RN, is still...

Paying for End-of-Life Care How to pay for the rising costs of health care?...

Free Medicare Hospice Program Available For Life-Threatening Illness What You Should Know about the Medicare Hospice Program Hospice...

Related posts brought to you by Yet Another Related Posts Plugin.

Tagged with: care providers madeleine