Supportive Care: Experts Encourage A Discussion

Cedars-Sinai Medical Center in Los Angeles is reaching out to empower the Caribbean community in Southern California with knowledge about options for end of life health care.

2015_0205_cedar_sinai_600x300Cedars-Sinai Urgent Care 8501 Wilshire Blvd. in Beverly Hills / Photo by L. Johnson

LOS ANGELES: Do you ever wonder, if you were to become terminally ill, would your doctors be able to provide you with the kind of care you would want in the last days of your life? Supportive care may be an uncomfortable topic to talk about, but it’s one that health care providers are encouraging families to discuss, even before the need for such services should arise. Among those committed to helping people better understand their options is long-time Los Angeles resident Rose Lanam. She’s a native of Jamaica who’s provided health care services in Los Angeles for more than 30 years. As owner of the home health care agency “Angeles Vista Hospice,” Lanam is among a growing group of health care providers working to get the word out to the minority community that Palliative care is a benefit they should not be afraid to explore if faced with a serious health crisis. According to a poll conducted by the California HealthCare Foundation, 60% of respondents say that making sure their family is not burdened by tough decisions about their care is extremely important. The state-wide poll shows most Californians have not communicated their end-of-life wishes to the loved ones they would want making decisions on their behalf. While a large majority of those polled (82%) say it’s important to have end-of-life wishes in writing, only 23% say they have done so. Types of Care: Hospice and palliative care are both health care services, but palliative care differs from end-of-life care, which provides the compassionate care and support during the last days and weeks of life. Palliative care is provided by a team of doctors, nurses, and other specialists who work together with patient’s other doctors to provide an extra hand of support. It is focused on providing patients with the relief from symptoms, pain, and stress of serious illness—whatever the diagnosis. At any age and any stage in a serious illness, patients can be provided palliative care along with curative treatment. According to the Coalition for Compassionate Care of California, the goal of palliative care is to improve quality of life for both the patient and the family. Many people are not familiar with the differences between hospice and palliative care. The care given to patients on hospice is palliative care, but hospice is only one small portion of the entire spectrum of palliative care. Hospice provides a subset of special care to improve quality of life for patients whose illness has progressed to a point where curative treatment is no longer desired or beneficial. In hospice, the focus is on caring, not curing—and in most cases, care is served at the person’s home. To be eligible for hospice, two physicians must certify the person’s life expectancy is six months or less. Hospice services are not discriminative towards any patient and are provided in an appropriate comfortable housing of the person’s selection. Hospice care is covered under Medicare, Medicaid (A.K.A. Medical), most private insurance plans, HMOs, and other managed care organizations. Local Resources: Cedars-Sinai Medical Center in Los Angeles is reaching out to empower the Caribbean community in Southern California with knowledge about options for end of life health care. Cedars-Sinai’s Supportive Care Medicine (SCM) program encompasses its Hospice and Palliative services. Cedars-Sinai’s vision for the Supportive Care Medicine is to treasure each day, planning from the heart, and caring deeply for those around us. The program’s mission is to compassionately care for each patient and family member who is facing advanced, life-limiting illness. Cedars-Sinai’s goals with the SCM include Direct Patient Care, which provides high-quality, compassionate, and timely consultative input for patients facing advanced, life-limiting illness; Clinician Education and Research, which empower non-palliative care clinicians with the tools, mentoring, and guidance so they can effectively incorporate “primary palliative care” skills to their everyday practice; and Community Outreach and Engagement, which educates members of the broader Cedars-Sinai and Los Angeles community about the patients right to speak with their primary providers about advance directives and end-of-life issues. People tend to bombard themselves with things to do throughout their day-to-day lives and forget to talk about a living will with their loved ones. As age catches up, they often leave their families in financial burdens and disoriented about what decisions to make. In order to have the proper care or treatment while terminally ill, there must be a present advance care plan that includes an advance healthcare directive, POLST, or healthcare agent to represent what you want for your end-of-life wishes, if you are unable to speak for yourself. Advance Care Planning is a process that should happen over the lifespan of an individual starting at age 18. It involves the decisions to make near the end of

life or when serious medical issues occur and talking about those decisions with loved ones. Then, put those wishes in writing through an advanced healthcare directive (AHCD) or POLST depending on the person’s medical condition. AHCD is a legally binding document and the clearest way to make your healthcare wishes known if you are unable to speak for yourself or prefer someone to speak for you. AHCD serves both functions of durable power of attorney for health care (to appoint an agent) and/or instructions for health care (to indicate your wishes), A.K.A. a living will. The healthcare agent, also known as a healthcare decision maker or surrogate decision maker is a person chosen, legally named, or designated under state law to speak for a person who is no longer able to make his or her own decisions. A POLST is a physician’s orders for life-sustaining treatment and it gives the patient more control over their end-of-life care. The Coalition for Compassionate Care of California researched the intensity of care and high costs at end-of-life and the impacts of Advanced Care Planning, Hospice and Palliative Care, and found those with advanced directives often received less aggressive treatment when death is near, as well as hospice care, and more often died at home. The study showed that 41% of Medicare patients with living wills were also much less likely to die in the hospital. For certain well-defined terminally ill populations, patients who chose hospice care lived an average of 29 days longer than similar patients who did not choose hospice. Coalition for Compassionate Care of California did research in the Intensity of care medical costs at end-of-life and stated, patients staying in the intensive care unit for longer than a week have been increasing. In 1996, 12.5% of California Medicare recipients spent at least a week in intensive care during the last six months of their lives. By 2007, the number was 20.3%. Almost a third of Californians saw 10 or more physicians in the last six months of their lives. Nearly one in three Medicare recipients in the final year of life had surgery during that last year. One in five had surgery in the last month of life. And, one in 10 had surgery in the last week of life. Patients with chronic illness in their last two years of life, account for about 32% of total Medicare spending. According to Dr. Karl Steinberg, vice chair of the Coalition for Compassionate Care of California, Chief Medical officer, and Shea family health, he also works with Cedars-Sinai. Dr. Steinberg stated, faith leaders are very supportive of end-of-life care. He says it’s important to let your loved ones go through the process at end of the life. When people are terminally ill, it is typical that they will request to see their pastor, priest, or other faith leader of choice. Paul Kleyman, director of Ethnic Elders Newsbeat New America Media stated, “Sometimes the residents who are very close to dying, dismiss their family from continuing to visit them on their deathbeds to avoid seeing them dying.” Even if you feel the topic of supportive health care is daunting, experts across the board encourage families to be proactive by discussing options and asking questions before they are faced with advanced, life-limiting illness. References: Cedar-Sinai’s Supportive Care Medicine: Coalition for Compassionate Care of California: Additional research and writing by Nakeesha Richards

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