By Rhea Go-Coloma, LMSW
Elisabeth, 89, who has a history of heart failure and spinal stenosis, lives at home with her elderly husband. Over the past few months, she’s been admitted twice to the hospital with symptoms of heart failure. Her Medicare Advantage plan used a predictive algorithm to identify Elisabeth as a candidate for home-based palliative care. When seen at home on the first visit, the palliative nurse discussed with her specific goals of care.
Elisabeth’s preference was to avoid aggressive care and hospitalization, and to disable her implantable cardioverter defibrillator — decisions that were documented in an advance directive (AD), a legal document that spelled out Elisabeth’s end-of-life (EOL) care ahead of time. Typically, ADs specify wishes surrounding the use of dialysis and breathing machines, resuscitation if breathing or heartbeat stops, tube feeding and organ or tissue donation.
ADs were developed as a result of widespread concerns over patients undergoing unwanted medical treatments and procedures in an effort to preserve life at any cost. They are essential for patients who wish to remain at home during EOL care — the majority of Americans. [Read more…]