Laurie Leonard LMSW Executive Director End of Life Choices New York End of Life Choices New York Education we educate the public and health care professionals on end of life issues Counseling ID: 630144
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Slide1
What Social Workers Should Know About End of Life Care
Laurie Leonard, LMSW
Executive Director, End of Life Choices New York Slide2
End of Life Choices New York
Education
- we educate
the public and health care professionals on end of life
issues
Counseling
- we provide
free counseling to people who are approaching the end of life and their families.
Advocacy
- we pursue
legal and legislative reform to ensure a
patient’s
right to a peaceful death, including implementation and enforcement of advance directives, pain and symptom management and legalization of aid in dying
.Slide3
Dying has changed in the past 100 yearsSlide4
Pain Management
Three reasons why pain is undertreated:
Many
doctors are not fully trained in pain
management
Some
doctors are afraid they will be investigated by law enforcement agencies or disciplined by state medical
boards
A lack
of communication between patient and
doctor
Doctors
sometimes don’t ask the right questions to properly assess
pain
. Patients sometimes are reluctant to tell the doctor how much pain they are
in.Slide5
To improve pain management:
Speak up
Don’t under-report
Don’t
wait too long
Report ineffectivenessAsk for referral to a pain specialistSlide6
Hospice and Palliative CareSlide7
Hospice and Palliative Care
Palliative care provides treatment to prevent or relieve pain and suffering and to improve the patient's quality of life, both physically and
emotionally
All
hospices provide palliative care, but not all palliative care programs are in hospices.
Hospices enable you to stay at home
If
you are age 65 or older home hospice care is covered by Medicare; if you are younger than that it is covered by Medicaid and many regular health insurance
plans.
Two requirements for hospice:
A
life expectancy of six months or less.
The patient can
not receive treatments intended primarily to
cure (i.e. chemotherapy), unless the primary
purpose of the treatment is to make
the patient
more comfortable. Slide8
Mount Sinai Palliative Care
Symptom management
24-hour availability
Mount Sinai Visiting Doctor home care and referral
Inpatient palliative care services
Social services supportPhysical, psychosocial, spiritual, and emotional supportIn-depth discussion with patients about their condition and their treatment optionsSlide9
hpcanys.org
Their directory shows:
Palliative care programs in hospitals
Hospices (all do palliative care)
It includes non-members of organization as well as membersSlide10
New York State Legislation
These laws are relatively
new;
many health care professionals don’t even know about them and are not providing their patients with the required information and counseling.
Palliative Care Information Act
- requires
doctors and nurse practitioners to offer to provide terminally ill patients with information about their palliative care and end-of-life options, including hospice.
Palliative Care Access Act
- requires
that hospitals, nursing homes, and other institutions provide terminally ill patients with information about their palliative care options, and they also must facilitate access to those options
.Slide11
Advance Directives
https://
www.youtube.com/watch?v=igZvuCJv4VQSlide12
Advance Directives
Health
Care Proxy:
If
you are suddenly injured or become ill and are unable to communicate, someone else will have to make health
care decisions for you. Without a health care proxy form family and friends do not have the legal right in all circumstances to make medical decisions on your behalf.
A health care proxy identifies your health care agent.
The doctor is legally required to follow the instructions of your health care agent. They will tell
the
doctor what types of treatment you want and what you don’t want.
The form is 2 pages long and easy to complete, no lawyer or notary required.Slide13
Family Health Care Decisions Act
Establishes
the authority of a patient’s family member or close friend to make health care decisions for the patient in cases where a patient lacks decisional capacity and did not leave prior instructions or appoint a health care agent. Person with authority must be chosen in this order:
Court-appointed guardian (if there is one)
Spouse or domestic partner
Adult child
Parent
Brother or sister
Close friendSlide14
Advance Directives
Selecting your health
care agent
:
Select someone you trust to
follow your instructions. A person most likely
to do exactly what you asked them to do.
Sharing the treatment you want:
After
choosing your health care agent, the next step is to tell him or her what treatments you want.
This can be general (ex. “I
want everything possible done to keep me alive
”) or very specific indicating treatment you do not want (ex. feeding
tubes, ventilators, or
antibiotics).Slide15
Living Will
This document outlines the treatments you would or would not want.
It’s very hard to enforce in New York State.
The living will can be stapled to the health care proxy form to specify your wishes, but a living will
without
a health care proxy does not fully protect you. Slide16
“My health care agent knows my wishes regarding artificial nutrition and hydration”Slide17
Do Not Resuscitate Order (DNR)
A
DNR instructs medical personnel not to revive you if your heart stops beating or you stop breathing, but it
only
covers those circumstances, not other situations.
A
DNR order must be signed by a doctor. It also should be easily located. If EMT’s come to your home and do not see a DNR, they will resuscitate you, no matter what your family members tell them.
Sometimes
DNR’s
are not honored. There’s
only one way to
guarantee
a DNR will be honored…and that is to
not
call 911. If you are under hospice care, the hospice should be called instead.Slide18
MOLST Form
Must be signed by both patient and doctor
Must be shocking pink color
Normal usage: “
If your
doctor would not be surprised if you died with a year”Slide19
Palliative Sedation
A last resort when symptoms can not be controlled any other way
Legal if intention is to relieve suffering rather than to cause death
Usage varies among different hospitals and hospicesSlide20
VSED
Voluntarily Stopping Eating and Drinking
To
refuse all food and liquids, including those taken through a feeding tube, with the understanding that doing so will hasten
death.
Usually a peaceful way to die
Usually 10-14 days until deathSlide21
Medical Aid in Dying
When at the request of a terminally ill, mentally competent patient, a doctor prescribes a life ending medication for the patient which the patient must self-administer, if he or she chooses to do so.
Aid-in-dying is currently legal in six states: Oregon, Washington, Montana, California, Colorado and Vermont. It was also legalized for all of Canada in a unanimous ruling by the Canadian Supreme Court.Slide22
Questions?