Compassion and Support
MARCH 2017
Know Your Choices. Share Your Wishes.

If sudden illness or injury prevents you from making your own medical decisions, would your loved ones feel comfortable making them for you? Would your family or loved ones know enough about what you value and believe to feel comfortable making decisions about your care? Have you chosen someone to serve as your spokesperson?

April 16 is National Healthcare Decisions Day, a day when people are encouraged to have these conversations with their loved ones. The advance care planning process helps individuals in preparing for sudden illness or injury, from which recovery is expected, as well as the dying process and ultimately death.

Health care professionals must lead by example. Start by discussing your values, beliefs and what is important to you with loved ones. Choose the person who supports your wishes and could handle potential conflicts between your family and friends. Empower them by putting it in writing and completing a Health Care Proxy form, the legal document that names them as your spokesperson or health care agent. Although not a legal form, the Living Will form clearly states your preferences for future care. These documents are called advance directives and are activated only when a person is unable to make their own decisions.

While NHDD is just one day, in New York State, the NHDD NYS Coalition works year-round to promote the value of advance care planning, health care proxies, MOLST and eMOLST. The coalition’s goals aim to:
• Increase conversations that lead to completion of health care proxies
• Increase awareness of MOLST/eMOLST programs in the community
• Support statewide implementation of MOLST & FHCDA, PCIA and PCAA , and appropriate legislative changes

The goals of the NHDD NYS Coalition align with the Delivery System Reform Incentive Payment (DSRIP) Program's goal to “promote community-level collaborations and focus on system reform, specifically a goal to achieve a 25% reduction in avoidable hospital use over 5 years." If you are working on advance care planning and palliative care projects through DSRIP, share how you are incorporating public education with members of the NHDD NYS Coalition. For more information on DSRIP, visit the NYSDOH webiste.

For more information on the NHDD NYS Coalition and resources, visit the NHDD page on CompassionAndSupport.org. If you have any questions or wish to join the coalition, please email Meg Greco. Thank you for your continued support of ACP, MOLST and eMOLST.

Featured Resource:
JoAnn's Story and PSA

JoAnn's Story and PSA highlight the importance of having a discussion with loved ones and completing an advance directive. Her story also aligns with the NHDD National Theme, "It Always Seems too Early, Until It's too Late".

CompassionAndSupport's YouTube channel contains these clips and a number of other video resources that can easily be used to support community education.

MOLST FAQ:
Why is NHDD on April 16th?

Since first uttered by Benjamin Franklin, two things are inevitable in life: Death and Taxes. Ten years ago, April 16th was chosen as National Healthcare Decisions Day, linking awareness of the importance of advance care planning and the typical last day to submit tax returns. NHDD exists to inspire, educate and empower the public and providers about the importance of advance care planning. Initiating the process early is critical in preparing patients and families to enter the MOLST program.


eMOLST Champion:
South Point Plaza Nursing & Rehabilitation Center

South Point Plaza Nursing & Rehabilitation Center is a skilled nursing facility located in Island Park, NY. With 185 beds, the facility offers short term rehabilitation, post-surgical care, long term care and hospice services. South Point Plaza is part of the SentosaCare network of nursing facilities. South Point Plaza has been using MOLST for several years and in 2016 they began implementing eMOLST.

Joe Benden, South Point Plaza’s administrator and Vicky Shaw, assistant administrator, have championed the project with the support of several key staff including Dr. Polina Khanina, medical director, Nicole Berg, director of social work and Raywattie Persaud, director of nursing. The facility prepared staff for eMOLST adoption through MOLST education and training and eMOLST hands-on training, provided by Dr. Bomba and Katie Orem as part of IPRO’s “Transforming EOL Care Initiative.” For more information, please contact Carolyn Kazdan.

The facility began using eMOLST in November 2016 and were able to quickly convert existing paper MOLST forms into eMOLST. Resident demographics were imported via template to ensure data entry and monitoring were simplified. This paper conversion effort was also viewed as a quality improvement project.

South Point Plaza’s administrator, Joe Benden, supports the eMOLST project stating, “the eMOLST system simplifies the process of having end-of-life discussions and ensuring all documentation is completed correctly. eMOLST is a valuable new tool for our residents and their families, as well as our staff and physicians.”

South Point Plaza anticipates implementing Single Sign on with the assistance of their EMR vendor, SigmaCare, so that staff will not have to remember a separate username and password.

Study Confirms Positive Impact of Thoughtful End-of-Life Conversations

Improving the quality of care for patients with advanced serious illness and those near the end of life is one of the most serious challenges of today’s health care system. Residents in a nursing home are among the most vulnerable in society and deserve high quality, resident-centered palliative care and end-of-life care.

A recent study at The New Jewish Home in New York City was undertaken to understand the current status of end-of-life care in the nursing home as documented in existing medical records, and to set the stage for developing more effective processes, mechanisms and reporting tools aimed at improving care. The study used retrospective data (six months before death) of long-stay nursing home decedents (N=300) taken from electronic health records to capture the end-of-life experience.

Study findings were published in End-of-life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home in the Journal of Social Work in End-of-life and Palliative Care. Almost all decedents had Do Not Resuscitate and Do Not Intubate orders in place; just over half had Do Not Hospitalize and No Artificial Feeding in place. Overall there was congruence between the medical orders and the treatment received.

The study affirms thoughtful advance care planning discussions, using the 8- Step MOLST Protocol, that result in completion of the Medical Orders for Life-Sustaining Treatment (MOLST) help ensure seriously ill patients’ care goals and treatment preferences are honored. The discussions take time and often require more than one session. Study results support the need for review and renewal of MOLST, as decisions change over time as health status, prognosis and goals change in the last year of life.

Documented discussions regarding different types of treatment available were infrequent and few family members participated in care plan meetings. However, discussions that were documented were largely between physicians and adult children for residents without decisional capacity. The study underscores the value of engaging other members of the health care team to participate within scope of practice and encourages adoption of eMOLST.

Serving New Yorkers of all faiths and ethnicities for 168 years, The New Jewish Home is one of the nation’s largest and most diversified not‐for‐profit geriatric health and rehabilitation systems. Jewish Home serves 12,000 older adults each year, in their homes and on campuses in Manhattan and Westchester, through short-term rehabilitation, long‐term skilled nursing, low-income housing, and a wide range of home health programs.

Funding was provided by the Donaghue Foundation.

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