Category Archives: Health Care Decisions

Palliative Care Services Increasing Across the U.S.

Palliative care services are now more accessible to patients with serious and chronic illnesses in the United States. The Mayo Clinic defines palliative care as offering pain and symptom management and emotional and spiritual support when a patient faces a chronic, debilitating or life-threatening illness. Increasingly offered to patients of any age with a range of chronic illnesses such as cancer, multiple sclerosis and Parkinson’s disease, palliative care may be provided at the same time as curative medical regimens to help patients tolerate side effects of disease and treatment, and proceed with everyday life. According to a recent December 22, 2014 Wall Street Journal article, palliative care programs have increased three fold over the past decade. Many hospitals have specialized palliative care programs and 80% of hospitals with 250 beds or more provide such a program.

The provision of palliative care with or without curative treatment can lead increased patient and health care provider satisfaction, equal or better symptom control, less anxiety and depression, less caregiver distress, and potential cost savings. A patient’s quality of life can be enhanced with active and effective pain and symptom management. The need for aggressive pain and symptom management often lead patients to seek out a palliative care program to manage their symptoms during a chronic or terminal illness. Some patients also choose to utilize hospice care towards the end of their life journey after receiving services from a palliative care program. With the better availability of palliative care, those patients seeking pain relief and symptom control at any stage of their chronic or terminal illness care are able to find the services to address their needs including assisting the patient and the family to navigate the often complicated medical system.

CMS Issues Guidance on CPR in Nursing Facilities

The first Survey & Certification memo for nursing facilities was issued for Fiscal Year 2014 on October 1, 2013. S&C 14-01-NH requires nursing facilities to adopt a policy that implements basic life support measures such as basic CPR for residents in accordance with the individual resident’s advance directives. Some nursing facilities have previously adopted a policy that when a resident is found without vital signs and the resident was a full code, the facility called 911 and waited for a response from the emergency personnel. CMS has affirmatively stated that the facility implement CPR when cardiac arrest occurs for residents in accordance with their advance directives and merely waiting for emergency personnel to respond to the 911 call is inadequate. CPR certified staff must be available at all times to provide CPR when necessary. Facilities will be cited under F155 for violating a resident’s right to formulate an advance directive if the facility does not develop and successfully implement policies and procedures to assure that residents will be resuscitated in accordance with their individual advance directives.

You can find a copy of  the letter here —> S&C 14-01-NH

For more information on the Survey Letter or related issues, please feel free to contact Janet Feldkamp or any member of our health care practice group for a further discussion.

New York Passes The Family Health Care Decisions Act

On February 24, 2010, the Senate of the State of New York passed (S.3164/A.7729), The Family Health Care Decisions Act (the “FHCDA”). The New York Assembly passed the bill in January.  This important piece of legislation allowing for surrogates to make health care decisions in certain circumstances has been in the works since 1993.  NY Governor David A. Paterson applauded the passage of the FHCDA.

Consumers and health care providers have historically had to rely on a patchwork of common law decisions and the Health Care Proxy and Do-Not-Resuscitate laws to address personal health care decisions. New York common law (in a line of well know court decisions) provides that life-sustaining treatment cannot be withdrawn or withheld, unless clear and convincing evidence of the patient’s wishes can be produced. An advance directive could serve as that evidence but way too often patients have not completed one when they were competent.

The FHCDA now provides a framework for health care decisions to be made by surrogates. By doing so, it reduces the uncertainty and need for judicial determination in many situations in which current law did not provide a clear way for a health care decision to be made for an incompetent patient.

You can find a copy of (S.3164/A.7729), The Family Health Care Decisions Act at http://assembly.state.ny.us/leg/?default_fld=&bn=A07729%09%09&Summary=Y&Actions=Y&Votes=Y&Memo=Y&Text=Y