Archive for: Healthcare reform
Industry Has Responsibility for Helping with End of Life Planning
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. He is also the National Health Care Channel Partner for CEO2. For more information about the author, please see our About page.
If California is reflective of the nation then the results of the 2011 Californians’ Attitudes and Experiences with Death and Dying survey are worth sharing. Compiled by the California Healthcare Foundation, here are some of the highlights (based on level of importance), which relate to people’s experiences concerning the death of a loved one, as well as their own preferences for end-of-life care:
- Making sure my family is not burdened financially by my care: 67%
- Being comfortable and without pain: 66%
- Being at peace spiritually: 61%
- Making sure my family is not burdened by tough decisions about my care: 60%
- Have loved ones around me: 60%
- Being able to pay for the care I need: 58%
- Making sure my wishes for medical care are followed: 57%
- Not feeling alone: 55%
- Having doctors and nurses respect my cultural beliefs and values: 44%
- Living as long as possible: 36%
- Being at home: 33%
- A close relationship with my doctor: 32%
Other key items worth noting include:
- Twenty-eight percent of Medicare spending occurs in the final year of life; 12% occurs during the final two months
- Thirty-eight states have obesity rates over 25%; 42 states have diabetes rates over 7%; one-in-five adults smoke cigarettes, which adds $100 billion in healthcare costs
Eighty-two percent of Californians thought it was somewhat or very important to put their wishes in writing but just 23% had done so. And 92% have never spoken to their physician about this issue.
I found it interesting that just 33% preferred dying at home. Probably based on my own personal beliefs, I thought it would be much higher. But what that means is that patients could very well be in your care, and often are, when the final moments of their life are upon them. As an industry that puts patients and residents first, it just makes sense to take responsibility in assuring that your residents die with dignity.
Last month, citing palliative care, I initiated this discussion as a kind of starter conversation into death and dying. While I alluded to available tools (Engage With Grace: The One Slide Project and Five Wishes), I don’t think I was emphatic enough in stating my belief that the industry must take a role. This California study took me to that level.
Palliative care can lower cost and bridge transitions and conversations
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. For more information about the author, please see our About page.
We hear so much about lowering costs in healthcare today. And yet:
- 93% of physicians practice defensive medicine, ordering diagnostic tests, referring to other specialists, and prescribing medications
- 28% of Medicare spending occurs in the final year of life; 12% occurs during the final two months
- 38 states have obesity rates over 25%; 42 states have diabetes rates over 7%; one in five adults smoke cigarettes adding $100 billion of healthcare cost
We can argue malpractice reform, personal responsibility, and all of that. But we also have to learn to use what we have. And perhaps palliative care can help.
According to presenters at the Governance Institute, implementing a first-class palliative care program can cut costs and provide better quality of life not just for the dying but also those with chronic conditions and serious illness. Using palliative care saves the healthcare system $1,700 per discharged patient.
Waste in medical services is currently estimated at 20% to 35% of total healthcare spending. The following contribute to waste:
- Services necessitated by incorrect and/or unsafe practices
- The use of unproductive or counterproductive interventions
- Failure to use the least-expensive appropriate resources
- Redundant reimbursement
The argument was made that we must have a worldview of palliative care as comprehensive, interdisciplinary care focusing on promoting quality of life. In fact palliative care is the best way to have important conversations with patients and families about the right level of care given the expected outcome.
Of course we are reimbursed in a fee-for-service environment and until the shift to wellness and bundled payments takes place, there is little incentive for providers to change their ways. Yet perhaps if we realize that this could be in the best interests of the patient and truly embrace person-centered care, providers would change.
I think patients know what is right for them and I think families intervene. That is why programs such as Engage With Grace: The One Slide Project are important. It poses five questions designed to help get us talking with each other and with our loved ones about our preferences.
Most people do not die according to their wishes. And they should. That is why they need to put it in writing. And that is where another resource, Five Wishes, comes in.
It lets your family and doctors know:
Who you want to make healthcare decisions for you when you can’t make them
The kind of medical treatment you want or don’t want
How comfortable you want to be
How you want people to treat you
What you want your loved ones to know
Five Wishes has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness.
If we truly put people at the center of care we will embrace alternative care methods such as palliative care and start discussing death and dying in this culture and not avoid it. It is ultimately about quality of life at the end of life.
And providers play a role.
CMS initiative will address use of antipsychotics and behavioral health
CMS has launched a new initiative aimed at improving behavioral health and safeguarding nursing home residents from unnecessary antipsychotic drug use. As part of the initiative, the agency is developing a national action plan that will use a multidimensional approach including public reporting, raising public awareness, regulatory oversight, technical assistance/training, and research. The action plan will be targeted at enhancing person-centered care for nursing home residents, particularly those with dementia-related behaviors.
On March 29, CMS streamed an overview of the initiative live on the Internet. The video, which can be viewed at http://surveyortraining.cms.hhs.gov/pubs/VideoInformation.aspx?cid=1098, included a detailed case study involving a fictional elderly resident who suffers from dementia. After reviewing the case study, a panel of residents, advocates, clinicians, and policy makers discussed how providers, residents, families, and CMS can work together to optimize care for residents like the one depicted in the case study.
CMS administrator resigns
Donald Berwick, administrator of the Centers for Medicare & Medicaid Services (CMS), recently notified colleagues that he will resign, effective Friday, Dec. 2. Berwick has held the position since July 2010, when he was appointed by President Obama during Congressional recess.
As a result of his appointment without Senate approval, Berwick’s term was set to expire Dec. 31, 2011. Many Republicans in the Senate have stated that they would not vote to confirm the Harvard-educated physician. Obama and the White House will nominate CMS deputy administrator, Marilyn Tavenner, as Berwick’s replacement.
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