Excellence in Care at the End of Life

As part of the debate on health care reform, there have been a few articles focused on places providing excellent end-of-life care around the United States. One community is LaCrosse, WI, where the biggest hospital there, Gundersen Lutheran, has been at the forefront of ensuring patients plan for the end of their life while they are healthy. From The Washington Post:

The hospital began urging families to plan while people are healthy. For those who want help writing a directive, a physician will discuss the powers and limits of medicine and explain to family members what it means if they agree to serve as the "health-care agent." They will also help people define the conditions under which they would no longer want treatment. Hammes said people often define this as "when I've reached a point where I don't know who I am or who I'm with, and don't have any hope of recovery."

The directives are power-of-attorney forms that protect physicians and family members against liability, and the hospital makes clear to its doctors that they are expected to follow them. Today, more than 90 percent of people in town have directives when they die, double the national average.

The Post also conducted on online interview with Dr. Bernard "Bud" Hammes (Director of Medical Humanities) and Joan Curran (Chief Government Relations & External Affairs Officer) of Gundersen Lutheran where they discuss the efforts there in more detail.

The Chicago Tribune also recently ran an article focused on an effort to improve end-of-life conversations in Chicago that is modeled on the initiative started at Gundersen Lutheran.

. . . in Chicago, end-of-life care experts have launched a citywide effort to encourage such talks -- and not just for terminally ill people, but as a routine element of good health care.

The Someone to Trust initiative, begun in 2006, has trained more than 150 facilitators to lead advance care planning conversations. The program runs pilot sites at major medical centers throughout the city and is collaborating with government and medical policy bodies including the Illinois Department of Public Health, the Illinois Attorney General, the Illinois State Medical Society and Metropolitan Chicago Health Care Council.