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| Adopt My Family’s Thanksgiving Tradition
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By Patricia A. Bomba, MD, MACP
In my family, we have a Thanksgiving tradition dating back to 1992 that has nothing to do with food or football, but rather personal beliefs, values and expectations. It’s our annual family discussion of issues related to Advance Care Planning. I encourage every family to embrace this Thanksgiving tradition. These Thanksgiving discussions helped my family and I honor my mom’s wishes at the end of life.
Advance care planning is a gift to yourself and your family. Advance care planning should begin early. Choose the person you trust to make medical decisions if you lose the ability to make medical decisions and share your personal values, beliefs and what matters most with your family and “family by choice.”
Years ago my family started this tradition on Thanksgiving because it’s an American holiday that just about everyone celebrates, attracting family members from far and wide. While at first you might think it’s morbid to discuss such issues at a festive gathering, we’ve found sharing our wishes for end-of-life care actually brings us closer. We each gain peace of mind knowing our own wishes will be understood and honored in the event we can’t speak for ourselves.
In our family, “No pumpkin pie, until you tell me how you want to live until you die.” After the dinner dishes are cleared, the adults in our family stay at the table and talk about what matters most in our lives. We review our advance directives to make sure they reflect our current feelings. We have blank forms handy in case new documents need to be completed and witnessed.
As a medical doctor and health plan administrator with an expertise in palliative care and end-of-life issues, I’m especially passionate about Advance Care Planning. I recommend that everyone 18 and older complete advance directives and keep them on file with their physician, their lawyer and most importantly, their loved ones. Please share my family’s Thanksgiving tradition!
I encourage your family to adopt our Thanksgiving tradition. What better time to start a conversation than at Thanksgiving when your family gathers for the holidays. Discussing and documenting each family member’s thoughts and views on this subject will save heartache and family turmoil in the future. Download a free step-by-step Advance Care Planning Booklet that helps guide the process and contains blank forms for the New York Health Care Proxy and Living Will and explains MOLST at CompassionAndSupport.org.
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| Featured Resource: CCCC Advance Care Planning Video
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The Community Conversations on Compassionate Care video features stories from real patients and families who have experienced serious illness or traumatic events where advance care planning was needed. Some people had completed their health care proxy and discussed their values with their family, while others had not. Listen to these individuals explain the benefits of the advance care planning process using 5 Easy Steps. Watch a playlist that includes a 15-minute video outlining the 5 Easy Steps and ten real personal stories.
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| MOLST FAQ: Not Enough Time to Discuss All Options Listed on the MOLST Form
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If a patient or medical decision-maker can reach a decision on one or more treatment options, but not others, on page 2, the physician should cross out the portion of the form with the treatment option(s) for which there is no decision and write “Decision Deferred” next to those treatment option(s). If a decision is made later, a new form must be completed and signed by a physician.
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eMOLST Champion:
St. Ann’s Community IT Team
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From left: Robert Schinaman; David Moufarrege, MBA; Richard Smith and Matthew Evans, RN
St. Ann’s Community is the largest senior housing and healthcare provider in the Rochester, NY region, offering independent and assisted living, skilled nursing, memory care, short-term transitional care, palliative care, and adult day programs. With more than 1,200 employees, it is also the 23rd largest employer in the region. St. Ann’s Community has been working with the eMOLST system for nearly 5 years and was the first senior-care provider in NYS to adopt the eMOLST system.
St. Ann’s recently also became the first senior-care provider to establish eMOLST access via Single Sign On (SSO) from its electronic health record systems. This integration allows St. Ann’s clinicians and authorized staff to login to eMOLST directly from the EMR without needing to see an eMOLST login screen or remember an additional username and password. St. Ann’s talented IT team was able to deploy this integration independent of their EMR vendor.
The integration is well-liked by St. Ann’s clinicians and staff. David Moufarrege, CIO for St. Ann’s, said, “While we’ve had eMOLST for nearly 5 years, this technical integration improves access to the system for our clinicians; it also adds value for our residents and their families, who know that orders can be retrieved quickly and efficiently in an emergency situation.”
The St. Ann’s clinical staff, under the leadership of CMO Dr. Diane Kane, has incorporated eMOLST discussions into routine patient care for all appropriate residents. Dr. Kane said, “Honoring the wishes of older adults regarding medical treatment is an important part of end-of-life care, and the eMOLST registry ensures there will be shared, informed medical decision-making that reflects the resident’s wishes—which is the ultimate goal.”
In addition to eMOLST integration, St. Ann’s Community has made significant investments in supporting its clinical efforts with technology including implementing a single Enterprise Electronic Health Record system across all care settings, disciplines, and locations.
The eMOLST SSO integration adopted by St. Ann’s is available to all health systems that use eMOLST. Please review the eMOLST SSO Integration Guide and then email Katie Orem for details on available integration options.
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| Community Conversations on Compassionate Care
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Community Conversations on Compassionate Care (CCCC) is an advance care planning program designed to motivate all adults 18 years of age and older, as well as emancipated minors, to start advance care planning discussions that clarify personal values and beliefs; choose the right Health Care Agent who will act as their spokesperson; and complete a health care proxy. CCCC combines storytelling and “Five Easy Steps” that focus on the individual’s behavioral readiness to complete a health care proxy.
CCCC encourages completion of a health care proxy when healthy, as well as review and update the advance directive routinely along the health-illness continuum from wellness until end of life. The population health approach normalizes advance care planning and aligns with recommendations from the 2014 Institute of Medicine Dying in America report.
Prior to the launch of the CCCC program, advance directive completion was measured in the Rochester area through chart audits/surveys of key hospitals, nursing homes, hospice programs, and home health agencies in response to the 1997 Institute of Medicine Approaching Death: Improving Care at the End-of-life. Results were no better than anywhere else in the country and were reported to the community in 2000. The Community-wide End-of-life/Palliative Care Initiative was launched to find an innovative approach to improve advance care planning and the quality of end-of-life care. The CCCC and New York’s MOLST programs were developed and implemented as a result.
CCCC was cited in the 2006 National Quality Forum A National Framework and Preferred Practices for Palliative and Hospice Care Quality as an example of a preferred practice, “Develop and promote healthcare and community collaborations to promote advance care planning and completion of advance directives for all individuals. “Excellus BlueCross BlueShield (EBCBS) has supported advance care planning as a wellness initiative and driven CCCC interventions among their employees and the community for the past 15 years.
CCCC has generated positive outcomes with respect to advance directive completion, particularly for health care proxies, and has been an influence on larger culture change in upstate New York with respect to advance care planning. Data on the success of CCCC is captured through surveys from CCCC workshop attendees, a community-wide survey of upstate New Yorkers, and health care proxy completion among EBCBS employees.
The 2009 BlueWorks® Award for Best Practices in Empowering Consumers and Providers was presented by the BlueCross BlueShield Association to Excellus BlueCross BlueShield in recognition of the health insurer’s Community Conversations on Compassionate Care (CCCC) Program. The judges noted, “The program is valuable not only because it is tackling one of the most important problems in healthcare today, but also because it is available (via the CompassionAndSupport.org web site) to the community beyond Excellus BCBS members.”
To learn more, read Bomba, P.A., & Orem, K.G. (2015). Lessons learned from New York’s community approach to advance care planning and MOLST. Annals of Palliative Medicine,4(1), 10-21.
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