Todays Message… We must provide end-of-life care - not doing so is not an option We must provide end-of-life care - not doing so is not an option Options

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    26-Mar-2015

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Todays Message We must provide end-of-life care - not doing so is not an option We must provide end-of-life care - not doing so is not an option Options are.. Options are.. Where its provided, its quality and associated costs Where its provided, its quality and associated costs Significant disparities exist among VISNs and facilities in their provision of this care Significant disparities exist among VISNs and facilities in their provision of this care Evidence suggests that the provision of palliative care results in cost savings relative to acute care alternatives Evidence suggests that the provision of palliative care results in cost savings relative to acute care alternatives Slide 2 What is Palliative Care in VA? Care focused on enhancing quality of life for patients with life-limiting and terminal illnesses Care focused on enhancing quality of life for patients with life-limiting and terminal illnesses Utilizing Utilizing Dedicated nursing home beds Dedicated nursing home beds Consult teams Consult teams Coordination of home hospices and management in HBPCs Coordination of home hospices and management in HBPCs Slide 3 Assumptions and Possibilities Assumption: Instituting or expanding a palliative care program would just be an additional expense we cannot afford Assumption: Instituting or expanding a palliative care program would just be an additional expense we cannot afford Possibility: Maybe a palliative care program would more than pay for itself through shifting workload, resulting in net cost savings Possibility: Maybe a palliative care program would more than pay for itself through shifting workload, resulting in net cost savings Slide 4 Assumptions and a Certainty Assumption: We have no choice where people die (or how much it costs) because Assumption: We have no choice where people die (or how much it costs) because Deaths are unpredictable Deaths are unpredictable Patients want aggressive care Patients want aggressive care Deaths in acute care are fundamentally different from those on a hospice ward Deaths in acute care are fundamentally different from those on a hospice ward Certainty: If veterans who cannot die at home have no alternative to acute care, that is where they will die Certainty: If veterans who cannot die at home have no alternative to acute care, that is where they will die And its going to be Expensive And its going to be Expensive Slide 5 Where to die? Veteran choice or the default mode ICU and Acute Care? Very few people want to die in acute care or the ICU Very few people want to die in acute care or the ICU Veteran choice is most affected by having no choice Veteran choice is most affected by having no choice If veterans cannot die at home and only acute care is available, they will die in acute care by default If veterans cannot die at home and only acute care is available, they will die in acute care by default Where would YOU want to die, if unable to die at home? Slide 6 Demographics of Dying in VA the Need Serving an older, sicker population because of WWII generation Serving an older, sicker population because of WWII generation 674,461 estimated veteran deaths in 2001 (28% total national deaths) 1,800 per day* 674,461 estimated veteran deaths in 2001 (28% total national deaths) 1,800 per day* Veteran deaths peak in 2005 at 687,273 Veteran deaths peak in 2005 at 687,273 *Office of the Actuary, Vet Pop2000 Slide 7 TAPC Survey Highlights 80/107 facilities had some palliative care in nursing homes 80/107 facilities had some palliative care in nursing homes 41 dedicated bed programs for 403 beds total 41 dedicated bed programs for 403 beds total 45//109 facilities had palliative care/hospice consult teams 45//109 facilities had palliative care/hospice consult teams 30 HBPC programs included some palliative care 30 HBPC programs included some palliative care Slide 8 TAPC Worrisome Findings 29 respondents reported never using community hospice resources 29 respondents reported never using community hospice resources 63 facilities reported never using fee basis for home hospice care 63 facilities reported never using fee basis for home hospice care 64% of facilities reported serving