Monthly Archives: July 2015

Priceless Care

Medicare recently announced that it would implement paying physicians for taking the time to have advance care planning conversations with their patients beginning in January 2016. This could have happened in 2009 but certain politicos and pundits warped the intention of this into “death panels” which knocked these important conversations off the table. Now that Medicare will reimburse physicians to have these conversations, I can’t help but wonder about the metrics and outcomes measurements that will also be implemented to track the occurrences of these conversations, as well as their efficacy.

It seems like a step in the right direction to reimburse physicians for the time they spend in these conversations with their patients. These conversations can provide important information for doctors, nurses, social workers, etc. about what their patients want as far as treatment, pain and symptom management, and end of life care. However, the majority of “care” that patients receive may not be provided by their doctor (oncologist, cardiologist, primary care doctor) or the nurses, social workers and psychologists who work inside the healthcare facility.

Medicare’s decision to reimburse physicians for their time may encourage more physicians to take the time to talk with their patients in more depth than time has so far allowed. Physicians and other healthcare providers certainly have a role in discussing risk vs. benefit of treatments, rates of survival, efficacy of drugs, places to receive care, etc. This reimbursement will probably not entice physicians already reluctant to talk about “care vs. cure”. It will not instill the comfort and confidence needed to have these kinds of conversations with patients in some physicians who have not found that comfort and confidence already in their approach.

A conversation in a healthcare setting is only a beginning of much needed consistent and continuing conversations to help a patient and his/her family through chronic illness management and decisions. Physician-led conversations will likely not be as frequent (or appropriate) in the midst of a medical crisis, accident or trauma. Conversations must occur long before these situations happen. There must be more to these conversations than medical considerations.

I continue to believe that the most important aspect of care conversations is the information shared among family and friends who will be the in-home caregivers providing the majority of care. Family and friends who will serve in the role of surrogate decision-maker when the patient is no longer able to make decisions or needs known will reap the benefit of these conversations. There are rare instances where financial reimbursement is available for the time family and friends will spend in caring for a loved one. But when care choices are discussed and prepared for, those experiences can be priceless.

Caring Choices knows that asking questions about values and beliefs can start deep, loving conversations. We created Elephant in the Room™ to help individuals and families begin these important conversations. Start with these three questions from Elephant in the Room™ and see where your conversations lead:

What gives your life purpose or meaning?
Where do you want to be cared for at the end of your life?
If you were suddenly unable to communicate, would your family know what kinds of care you want (or don’t want)?

Last Drop in the Bucket

Imagine your life is a bucket and time is a drop of water.

Perhaps, at one time or another in your life you have felt that there were no answers, no choices, no hope and no point in trying any longer.

But there was still a tomorrow. Drop by drop.

Suppose you found you were at a crossroads with detour signs, one way streets and construction seemingly blocking every possible way to proceed.

But there was still a tomorrow. Drop by drop.

Suddenly you may have become aware that there were no friends, family, counselors, clergy, or available options for you to seek solace, find comfort or peace from turmoil.

But there was still a tomorrow. Drop by drop.

We often hustle into each day with our hopes, dreams, goals, tasks, responsibilities and clocks trying to accomplish something, even if it is to just reach the end of it.

But there is still a tomorrow. Drop by drop.

Imagine now, there is no tomorrow. Your bucket is rapidly approaching its limit.

How would this change your thoughts? What would be most important for you to achieve? Who would you want to share these last hours minutes or seconds with?

It is difficult for me to comprehend there would be no tomorrow. I have Pasta sauce thawing in the refrigerator, there are chapters to read in my class, there is potato salad I want to take to a Birthday party. But then these are the thoughts from a person with a relatively pain free, mostly healthy body, growing spirit of hope, and compassion. A mind eager for continued learning, creativity and consciousness.

Life has shown me many paths. Along this journey I have seen many different people. Each who cope in their own way. Each person has the same number of hours in every day. Yet I see many with vastly different focus, priority, and ambition. They are rightly giving their attention, energy and purpose to a countless array of topics, goals and directions. Among these there is constant debate in the world of who is most wise, wealthy, famous, or attractive. We want to know who is the most talented, strongest, or fastest of all.

Billions of dollars are spent to direct our attention, shift our focus, and recruit our interest. We are consumers after all. Every one of us, from the moment of birth, targeted for advertisement. What we consume most of all is time, every one of us at the same pace every day. Drop by drop. What we often waste most of all is time also. And we often do not put enough value on our time until there is no tomorrow.

Caring Choices hopes that by encouraging conversation between people we can eliminate the barrenness of lost hope when our lives are suddenly faced with the reality that there may be no tomorrow. Long before it becomes hours, minutes, or seconds left, there is opportunity for discussion about choices, hopes, and questions asked that may or may not have answers. But the questions will still then be asked. Questions asked by and with family, friends, counselors or clergy. Questions can be asked about options, hopes, dreams, goals, tasks or responsibilities. Is your bucket of time half full, or is it half empty? Please don’t wait until “The last drop in the bucket” and opportunity is lost.

Not Always about Dying and Death

I recently had the opportunity to provide a Caring Choices presentation titled “Decision-Making for a Loved One.” The people in attendance were strong advocates for elder loved ones in fluctuating phases of aging and health. Some are dealing with varying stages of dementia; others are in end stages of chronic illnesses. Still others have recently experienced acute illnesses that thrust their family members into decision-making roles sooner than they anticipated.

Since becoming a Certified Dementia Practitioner, I’ve also presented a staff in-service and community seminars on the complex, multi-faceted umbrella of neurocognitive disorders (dementias) that afflict many individuals and their loved ones.

I’ve come to really enjoy teaching these sessions and offering educational opportunities to people who are trying to understand the disease process a loved one is going through as well as coming to grips with their role as caregiver or decision-maker.

Caring Choices offers education and support to individuals and their families in order to prepare for whatever their future health concerns might be. We’re not solely focused on the “end stage” of diseases, dying process, or the death bed experience.

Our goal is to help people have conversations about what’s important to them in every stage of their lives as age advances and health declines. Below is one of the slides I presented which seemed to best illustrate the purpose of the conversations we’re promoting. These are some of the decision-making criteria that are important to me. As we reviewed this slide, I could see the “lightbulb moment” for some of my presentation attendees. They started thinking about their own criteria to help their families make decisions if they’re unable due to an acute crisis or other medical emergency. It’s not always about dying and death … sometimes it’s just about what matters most at a particular moment.

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Caring Choices is available to provide education to your group as well as personal consulting to individuals/families. Conversations are important in determining your decision-making criteria. The presentations we offer can help you figure that out and help your loved ones have the knowledge and courage to make decisions when they most need it.