The Partnership for Patients and the Aging Network

Message from the Assistant Secretary for Aging Kathy Greenlee

Today, Health and Human Services Secretary Kathleen Sebelius announced the Partnership for Patients, a new national public-private partnership with the goals of:

* Keeping patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 

* Helping patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge. 

Through the Community-based Care Transition Program, HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help people with Medicare safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits. In addition, in coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide. 

The aging network – state and local organizations alike -- has a vital role to play in this effort to integrate medical and long-term supports and services and improve care transitions for our clients and their families.  This work also provide an excellent opportunity to integrate other important work you are already doing – including Aging and Disability Resource Centers, benefits outreach and enrollment, caregiving and respite programs, chronic disease self-management and other health promotion/disease prevention programs, and more.  Finally, the partnerships that you build through care transitions work – with hospitals, physician practices, long-term care facilities and other organizations – can also help to position you better for future ACA-related opportunities such as accountable care organizations, health homes, patient-centered medical homes, and more.

Here is how we can work together on this initiative:

* Learn more about the Partnership for Patients and join the partnership by visiting the Partnership website at http://www.healthcare.gov/center/programs/partnership 

* Read our special Affordable Care Act Newsletter which provides you with additional details about the Partnership for Patients and the Community-based Care Transition Program (CCTP).  To access the newsletter, please go to  http://www.aoa.gov/Aging_Statistics/docs/ACA_Enews_P4P_041211.pdf 

* Join us for our next Webinar on Wednesday, April 20, which will offer an overview of the CCTP solicitation, and the opportunities for the aging network that lie within.  (Watch your email for registration details)    

QuickStats: Life Expectancy and Years Free of Activity Limitations,* by Race and Sex --- United States, 2006

* Estimates are based on data from the National Vital Statistics System and the National Health Interview Survey (NHIS). NHIS collects information in household interviews of a sample of the civilian noninstitutionalized U.S. population. Expected years free from activity limitations combines estimates of total life expectancy and prevalence rates of activity limitations associated with chronic conditions, which are determined from responses to several questions in the NHIS Family Core component. Questions and methods used to compute total life expectancy and expected years free of activity limitations are included in the source report.

In 2006, total life expectancy was greater for females than males and for whites than for blacks. Total life expectancy ranged from 80.6 years for white females and 76.5 years for black females to 75.7 years for white males and 69.5 years for black males. Expected years free of activity limitations was greatest for white females (69.1 years), followed by white males (65.7 years), black females (63.4 years), and black males (59.3 years).

Source: Molla MT, Madans JH. Life expectancy free of chronic condition-induced activity limitations among white and black Americans, 2000--2006. National Center for Health Statistics. Vital Health Stat 2010;3(34). Available at http://www.cdc.gov/nchs/data/series/sr_03/sr03_034.pdf .

CIDRAP >> Study Supports Infection Potential of Airborne Flu Viruses

Aerosolized flu viruses, the type that can remain airborne for hours, circulate in places such as doctor's offices, daycare centers, and airplanes in doses large enough to cause infection, researchers from Virginia Tech reported yesterday.
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End-of-life Consultations

Making End-Of-Life Decisions Is Hard On Family Members - Kaiser Health News

By Michelle Andrews

Most people would agree that when the time comes, they want a "good death." But what that means is all too often left up in the air until a crisis strikes or the stricken person is no longer able to communicate his wishes or his advance planning documents are not clear. When that happens, spouses, adult children, siblings and others find themselves in the unenviable role of surrogate decision-makers, trying to divine, sometimes with very few facts and under very emotional circumstances, what people they love would have decided to do if they were able to choose.

The critical role of the surrogate decision-maker deserves more attention and support, say experts. It's incredibly stressful -- on a par psychologically with having your house burn down, says Daniel Sulmasy, a professor of medicine and ethics at the University of Chicago Divinity School and co-author of a commentary on surrogate decision-making in the Nov. 3 issue of the Journal of the American Medical Association. Too often, hospital staff and clinicians want to move into the decision-making phase without taking into account the family members' need to come to terms with the situation, he says.

It's a role that many of us may have to step into. Only about one in four people have signed advance directives that spell out their wishes if they're unable to make medical decisions on their own, according to a 2006 report published by the Pew Research Center for the People & the Press.
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End-of-Life Planning Common in Long-Term Care

By Crystal Phend, Senior Staff Writer, MedPage Today

Advance directives are common among long-term care residents, particularly those discharged from hospice, a CDC report found.

There was an advance directive on record for 28% of home healthcare patients, 65% of those at nursing homes, and 88% of hospice patients, according to an analysis of data from the 2004 National Nursing Home Survey and the 2007 National Home and Hospice Care Survey.

These rates compare very favorably with the 5% to 15% rate among adults overall in the U.S., Adrienne L. Jones, and colleagues at the CDC's National Center for Health Statistics in Hyattsville, Md., noted in the report.

But, they wrote, there's still room for improvement.

The most common forms of advance directives noted in the surveys were living wills and do-not-resuscitate orders.

The likelihood of having any type of advance directive appeared to differ by age and race or ethnicity.

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Fewer African Americans Plan for End-of-Life Care - AARP Bulletin

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by: Cynthia Ramnarace | from: AARP Bulletin

Older African Americans are less likely to have a plan for their end-of-life care than their white counterparts, a discrepancy that leaves blacks with less control over their final health care choices.

In the first national analysis of racial discrepancies in end-of-life planning, the National Center for Health Statistics reported Jan. 6 that African Americans in home health care and nursing homes were half as likely as whites to have an advance directive such as a living will or a do-not-resuscitate (DNR) order.

Experts say this disparity means African Americans are more likely to endure unwanted medical procedures and experience unnecessary pain and family strife.

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Surrogate Decision Making in the ICU | GeriPal - Geriatrics and Palliative Care Blog

Imagine your loved one is very sick in the ICU. So sick that the ICU doctor believes that there is only a very small chance of survival, and even if your loved one survived, he/she would have significant, permanent disability. If you were placed in this position, how would you want to make decisions about continued intensive medical treatments to support his/her life? Would you want to make it on your own? Would you want to share the responsibility for this decision with the ICU doctor? Would you just want the ICU doctor to make the decision for you with our without your opinion?

Now imagine we ask the same questions to surrogate decision makers of critically ill, incapacitated adults. How do you think they would answer? We now have some idea of how thanks to a study authored by Sara Johnson and her colleagues at UCSF and University of Pittsburgh.

The study, currently in press but accessible early online, presented two clinical vignettes to 230 surrogate decision-makers for incapacitated, mechanically ventilated patients at high risk of death. One vignette was based on a decision regarding life support similar to the one described above, and the other was about selection of specific antibiotic agents to treat an infection.
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Obama to Enact End-of-Life Planning for Medicare - NYTimes.com

Image via WikipediaBy ROBERT PEAR

When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1.

Under the new policy, outlined in a Medicare regulation, the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

Congressional supporters of the new policy, though pleased, have kept quiet. They fear provoking another furor like the one in 2009 when Republicans seized on the idea of end-of-life counseling to argue that the Democrats’ bill would allow the government to cut off care for the critically ill.

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A Caution on Antacids for Older Patients - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

They’re among the most widely prescribed medications in the world. They’re reasonably safe for most people to take. That’s why drugs that reduce stomach acid — used to combat heartburn, acid reflux and ulcers — don’t get much scrutiny from doctors, or from patients.

“When patients were admitted to our geriatric wards, a lot of them didn’t have clear indications for taking these drugs,” said Dr. Ian Logan, a Scottish physician and co-author of a recent editorial on acid suppressants in the journal Age and Ageing. “And they’d remained on them for a lot longer than they should have.” One of his patients had been taking an acid-reducer for 15 years.

Dr. Logan and two colleagues with Britain’s National Health Service decided to sound the alarm — rather, to sound it once more, as researchers began discovering problems with these drugs years ago. “They do have significant side effects, especially in older patients,” Dr. Logan told me in an interview.
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Old Patients, New Joints - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

A tale of two joint replacement surgeries:
Baukje Cohen had been accustomed, at age 76, to jogging in a park near her Manhattan apartment, playing tennis and skiing. But she developed pain in her hip, and “slowly and surely it became worse and more difficult to handle,” she said in an interview. She had to give up running and tennis.

Missing her athletic life, she opted for hip replacement surgery at NYU Hospital for Joint Diseases. After about 10 days, spent in the hospital and then at a rehab facility, “I was walking very well,” she said. “It was not terribly painful.” She returned to jogging paths, tennis courts and mountainsides — until recently, when her other hip began to trouble her. Her surgeon will try a series of injections to relieve the pain, but if they don’t work, Mrs. Cohen, now 82, has decided to undergo a second hip replacement.

Laimonias Betins, a retired construction worker in Ocean County, N.J., had a drastically different experience after two simultaneous knee replacements at age 89. “His primary care physician said he didn’t recommend it — my father had heart disease and hypertension and diabetes that put him at greater risk,” said Mr. Betins’s daughter, Ilze Earner. “So he went doctor-shopping, saw three or four surgeons until he found one willing to do it.”
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Legislation Will Allow New Yorkers to Make Health Care Decisions for Family Members Who Lack Capacity to Decide

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Governor David A. Paterson today signed the Family Health Care Decisions Act (FHCDA) into law. The FHCDA allows family members to make health care decisions, including decisions about the withholding or withdrawal of life-sustaining treatment, on behalf of patients who lose their ability to make such decisions and have not prepared advance directives regarding their wishes.

“I could not be more pleased to sign this bill into law today as it will help ensure patients receive medical care more quickly and will help avoid unnecessary suffering,” Governor Paterson said. “After nearly two decades of negotiations, New Yorkers now have the right to make health care decisions on behalf of family members who cannot direct their own care.”
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A Humorous but Serious Look at End of Life Decision Making and Healthcare

End-of-life care discussions are in patients' best interests ... American Medical News

(American Medical News Ethics Forum) Scenario: What can doctors do to break down barriers to these kinds of talks?

It's incumbent upon physicians to help patients understand end-of-life care options, even though the coding and payment system for these discussions is lagging behind. Discussions about options have been shown to lessen depression, pain and anxiety for patients in their final days. A formal payment code would help in tracking such vital data.

Reply:

Recently proposed federal legislation on health reform would have allowed physicians to code and get paid for discussing end-of-life care options with patients. This idea was not welcomed; instead, it was met with alarm and bizarre misunderstanding -- the "death panel" inference and cries of "health care rationing." The provision has been removed from current reform bills.

The rationale behind the proposal was the assumption that allowing doctors to bill specifically for discussions about goals and advance directives for health care planning would motivate them to have those discussions. If this assumption is correct, then how do we convince the public that we are not trying to "pull the plug" on old people who get sick and are viewed by some as a drain on society's resources, but that advance planning discussions are in their best interest?
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Voluntary End-of-Life Measures Banned at Catholic Hospitals - The New Old Age Blog - NYTimes.com

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By PAULA SPAN

In the 600 Catholic hospitals and hundreds of Catholic nursing homes around the country, such issues may grow more contentious in the wake of a new directive adopted by the United States Conference of Catholic Bishops.

As Harris Meyer recently reported in Kaiser Health News, the directive establishes “an obligation to provide patients with food and water, including medically assisted nutrition and hydration” for those who can’t eat or drink, and it specifically includes patients in “chronic and presumably irreversible conditions.”

Patients whose advance directives prohibit feeding tubes if they have terminal illnesses or have entered a persistent vegetative state (as mine does) would either have to accept such treatment or transfer to another facility.
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Deficiencies In End-Of-Life Care Across U.S.

from Medical News Today

Approximately 66 percent of respondents to a Maryland telephone survey do not have advance medical directives, according to a new report by researchers from the Johns Hopkins Bloomberg School of Public Health's Department of Health Policy and Management. Younger adults and blacks were less likely than older adults and whites, respectively, to report having an advance directive, which includes the living will and health care power of attorney. Advance directive is an end-of-life planning tool that provides instructions for types of medical treatment that are desired and/or who can make decisions about medical care should someone be unable to do so for him or herself. The results will be published in an upcoming issue of Health Policy and are available online at the journal's website.

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H.R. 3826: To amend title XVIII of the Social Security Act to provide payments under the Medicare Program to... (GovTrack.us)

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To amend title XVIII of the Social Security Act to provide payments under the Medicare Program to licensed health care practitioners for unscheduled telephone consultation services in the case that such payments are determined to be cost and quality effective.

Sponsor: Rep. Judy Biggert [R-IL13]
Cosponsors: Lois Capps [D-CA23]

Text

Status:

Introduced Oct 15, 2009
Referred to Committee on Ways and Means

Updates

End-of-Life Advice Not Always Welcome - Forbes.com

(HealthDay News) -- When deciding whether to turn off life support for a loved one, family members aren't always interested in their doctor's advice, new research shows. The finding runs counter to assumptions among critical-care providers that families making such a heart-wrenching choice would welcome a physician's impartial opinion. Read More

Health Business Blog » Blog Archive » DIY death panel

by David E. Williams of the Health business blog - Well it looks like the scaremongers have succeeded in removing provisions for voluntary end-of-life counseling from the pending health care reform legislation. (Although their broader goal: killing health care reform, remains elusive.) That means you may be on your own to figure things out. Luckily the Wall Street Journal has a good piece today on Advance Directives (Preparing for the Final Hours). “Everybody knows they’re going to die, but it’s really scary to think about how,” says Audrey Seeley, a registered nurse in the stroke unit at Inova Hospital in Falls Church, Va., who sees many patients who are suddenly seriously incapacitated. “A lot of people say, ‘If I get to that point, I don’t care what happens to me.’ But your family does.” Indeed, advance directives are as much for the living as for the dying. Without specific instructions, family members may have to decide whether you would want to be kept alive artificially, what level of disability you’d be willing to live with and how to let you die if you had no hope of recovery. Advance directives are a tricky business. No one knows what sort of end-of-life situation they’ll find themselves in or whether their wishes will be taken into account at all. And end-of-life isn’t always so easy to define except in retrospect. When someone’s told they have six months to live it’s often off the mark. It seems straightforward to say –as the nurse quoted above does– that, “If I get to that point, I don’t care what happens to me.” But I don’t even think people can say that with confidence. When you’re healthy and strong, it seems like it would be much better to die than to sit around partially-demented, incontinent and in pain. But when you actually get to that point, you may look at things differently: that extra few months with your family –or even alone in your thoughts– may be worth the trouble. By that time you may not be able to express yourself so well. Some people set out general principles. Others take the path of leaving everything up to a loved one. Other people leave strict instructions that they want every measure taken. Sometimes that’s for religious reasons and sometimes it’s because they don’t trust their relatives or doctor