Advance Directives and Advance Care Planning
Are We at a “Tipping” Point?
How is it that 24 years after the Patient Self-Determination Act went into effect we have not made significant progress in increasing the percentage of people who have Advance Directives? Death has been hidden behind hospital doors for almost a century, new funeral and memorial technology has advanced, and people still seem to think that death is optional and prefer to avoid the end of life discussion.
Current research shows that only about 25% of the population has completed Advance Directives, yet 80% of the population states that they wish to die at home. Many of us have talked till we are blue in the face, much money has been spent, and many different initiatives have been started but the number hasn’t budged.
All of this may seem discouraging but there are several different moves afoot that may open the subject up and bring it into the mainstream. Things like:
- Respecting Choices – an advance care planning model that has been inculcated into the fabric of the community in La Crosse, WI and has been around long enough to demonstrate significant community, personal, and financial impacts that are being noticed and shared.
- Institutes of higher learning have started and/or increased their emphasis on end of life care and Advance Directives in their medical and nursing school curriculums planting the seed for better communications with patients in the future.
- Accountable Care Organizations and Medical Home models are being encouraged by Health and Human Services to collect and report data on the advance care planning, that they are providing to seniors, which will eventually impact their reimbursements.
- Ever increasing numbers of people, bothered by the lack of discussion and emphasis placed on the needs of people at the end of life, have taken the initiative to develop electronic tools on the internet to guide and help people address these issues before the need arises.
- And, as I referred to in last month’s newsletter, Death and Dying Cafes and Dinner Parties are becoming increasingly popular in the U.S. as the underlying need to talk about death and our beliefs about it are being met through this informal yet growing medium.
Making advance care planning and Advance Directives a part of the mainstream of American life, where it is considered inappropriate not to discuss our thoughts and feelings on these issues, will go a long way towards increasing percentages in the future. With the pace of change upon us we may just be at the beginning of that tipping point. More people will be willing to have “the conversation” and give “the gift”.
Contributed by M Jane Markley LLC, www.mjmarkley.com