Does for-profit status make a difference between life and death in long-term care?

Does for-profit status make a difference between life and death in long-term care?

Conversation Sabbath - In November 2015 #EOL

Many Critically Ill Patients Lack 'Do Not Resuscitate' Orders

Many Critically Ill Patients Lack 'Do Not Resuscitate' Orders

End-of-Life Care More Than Just a Conversation, says IHI

End-of-Life Care More Than Just a Conversation, says IHI

(EMTs) and paramedics in Pennsylvania that raised some questions from POLST Programs

(EMTs) and paramedics in
Pennsylvania that raised some questions from POLST Programs



Media Resources: Studies Find Emergency Doctors and Param... - Wolters Kluwer Health

How do you want to die? A mission to make death part of popular conversation

How do you want to die? A mission to make death part of popular conversation

A growing national movement to normalize end-of-life
discussions among family and friends has gained traction in recent months. As
Medicare considers whether to cover such conversations with physicians, The
Conversation Project, a Boston-based non-profit, is highlighting the importance
of talking openly about dying.

Rethinking end-of-life care

Rethinking end-of-life care

There’s a Hole in the Bucket

There’s a Hole in the Bucket  regarding #EOL conversations

The Physician’s Role and End-of-Life

The Physician’s Role and End-of-Life  @bfrist #EOL - great article and reference material

My right to direct my own health care as guaranteed by the U.S. Constitution! State laws do not matter?

I just reviewed another software product that claimed to follow state laws when creating Health Care Directives.  This software is sold by, in my opinion, a well-respected company that used well-respected suppliers, to create the software content. 

NOTE: I am not naming the companies and I blocked out some information from screen shots because my intent is to inform people of the risks, not, in any way, harm the software companies.

So what happen to make me write this blog?  After using the software, I printed out my Health Care Directives document had it this clause:

“I intend this document to be my Declaration under Ohio law. However, if any of my health care instructions go beyond what Ohio authorizes, I request that those instructions be respected and followed in keeping with my right to direct my own health care as guaranteed by the U.S. Constitution.”

So I thought, Wow!  That would be great if a simple sentence like this would solve all the state laws on Health Care Directives issues.  So I did some research and bummer L.

The United States Constitution does not set forth an explicit right to health care, and the Supreme Court has never interpreted the Constitution as guaranteeing a right to health care services from the government for those who cannot afford it. Source

Then I came across this same kind of “don’t worry about state laws” in another software company’s Health Care Directives website that had these messages….

“Someone” that might make this type of claim might be the state Attorney Generals!  Maybe we should ask them – here is the list. 

 

 “Doesn’t follow some rules on the form that you were supposed to use or the signatures of witnesses or notaries that you were supposed to get” – WOW!  The wording is seems to be very defensive and almost childlike.   Instead of taking the time to learn the state laws and provide a solution that complies with state laws, it seems the software developer thinks it is OK to just add a generic statement on the document. 

Can you imagine if TurboTax just stated “in certain states, this data is required and in others don’t have to provide it – you figure it out! 

 This is not about good or bad software companies.  This is about you.

You took the time to have the conversation and document your individual preferences so that your family, friends, and caregivers would not have to go through it without them knowing what you want.  Imagine the stress to your family and caregivers, the people that you care about and the reason why you took the time to write advance care directives, when the provider (EMS, ED, ICU, SNF, LTC) cannot honor your wishes due to a failure to comply with a state law requirement(s) that a software developer simply did not spend the time to put into their software.  All the health care planning goes out the window.  The impact on you personally is “do everything default level of care” and you get aggressive care that you did not want.  The effect on your family and friends and care givers is that now we have to “ask everyone their opinion.”    You do not want your family to go through that level of stress, which is probably higher than if there were never any document created.  “We thought all of this was taken care of” and now the one child that has lived out of state and not been around for over 20 years gets a say in the matter?  FYI – there are specific state laws on who can be your Health Care Power of Attorney.

 If you are a hospital or post-acute provider, will you honor an Advance Directive that does not comply with state law?  If you are an insurance payor, will you pay for aggressive services rendered that where not desired?  How are you going to manage a network that crosses state lines?

On Nov 26, 2014, CMS updated surveyor guidance for advanced directives. F-155, related to advance directives and experimental research, is one of the most heavily revised regulations, including one of the key elements for severity determination for F155 includes “Resident received treatment based on the consent of an individual who was not the resident or his/her representative, in accordance with State Law.”   Source. So the buck stops with you and your employees instead of the software vendors that allowed your patient to create documentation that does not comply with state laws!

Governmental regulations – whether adopted by federal or states – can be daunting and present a profound challenge to the way you do business and manage personal affairs. State and Federal laws change frequently and often with little or no general warning.   It only makes sense that compliance with state and federal laws should be the responsibility of a software vendor, not you and not your employees.

This is my personal opinion

Many Americans Face Pain, Depression in Their Final Year

Many Americans Face Pain, Depression in Their Final Year

Study finds significant
increase in symptoms, despite efforts to improve end-of-life care

More Than 2 Million Years of Life Saved With Organ Transplants, Experts Estimate

More Than 2 Million Years of Life Saved With Organ Transplants, Experts Estimate