I just read the part of the Obama Health Bill about "Advance Care Planning Consultations". Doctors are required to talk to their medicare patients about the benefits of an "order" which may limit "life sustaining treatment" which includes artificial feeding, antibiotics, etc. I'm trying to visualize that conversation between my 81 year-old mother with Alzheimer's and her Dr. (who loses patience with us now) and it's not pretty. If I think of that conversation between a Dr. and an AD patient that doesn't have any family, I am really disturbed. Any thoughts?

Hi, kmtina, and welcome to the forum.

I haven't seen the part of the bill you're talking about, but I assume this is in reference to getting an "Advance Health Care Directive" in place. And it would be a very good thing to get drawn up if a person doesn't already have one.

Many caregivers (for any type of patient, not just dementia) have been put in a terrible position by having to make decisions for a loved one about what sorts of treatments should be given, without having the input from that loved one about what they want. The doctors may end up in a bad position, too.

And the patient may end up receiving treatment s/he does not want, without an AHCD in place.

The AHCD stipulates whether the person wants every last type of treatment possible, or prefers a less aggressive approach that places value on quality of life. The person can put in as much detail as s/he wants about the treatments that are or are not acceptable. There's a standard form that can be downloaded from the internet.

It's best if we all get those in place while we're still fully functional, and able to understand the implications the different treatments that might be proposed to prolong life.

It's a legally binding document, so anyone who executes one has to be mentally capable of understanding what s/he is doing. You'll often see recommendations on these boards to bring the subject up as soon as a loved one is diagnosed, if the ADLO hasn't taken care of this important planning process. If the AD has progressed too far, the ADLO wouldn't be able to execute such a document, so it would be pointless for the doctor to discuss it -- other than asking the caregivers if there is one.

Thanks for your reply. It's section 1233 in HR 3200.

I think we basically agree. These are very important documents and it would be wonderful if everyone had them but they are a private family matter. As a health insurer, the government's goal is now to cut costs on health care. It may seem pointless to us for the Dr to discuss these things with an AD patient but the proposed law requires him to do just that and it evidently makes sense to the government. Remember...the law doesn't require him to talk about the benefits of the documents; it requires him to talk about the benefits of no antibiotics. There's no qualification on the mental capacity of the patient. What does this say about the government's attitude toward seniors? Can you imagine public reaction if a private insurer did this?

Where do I find this document and how do I download it?


Help!

I just put HR 3200 in google and it came from a Library of Congress site. I think if you download it, it may be about 1000 pages but it's easy to find the relevant section in the index in the front.

I hate to bring this up but another thing occurred to me last night when I was watching Obama's press conference.

Someone asked him about the sacrifices the American people would be asked to make in regard to their care with the cuts in medicare and with government control over what treatment they will pay for. Should the government decide what care really "works" for AD patients or the family? What about general anesthesia? How would they assess that?

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For anyone who is interested in reading the text of HR 3200: America's Affordable Health Choices Act of 2009 below is a link that gives 3 options for viewing the text: Download...View it in PDF...or... Read it on 'Thomas'.

http://www.govtrack.us/congres...t.xpd?bill=h111-3200

kmtina--- Because of the escalating cost of health insurance many Americans are unable to afford coverage. They often put off care until the situation is critical and the resulting unpaid bills cost every one of us money in the form of increased charges.

I'm not a fan of insurance companie. When my COBRA ran out in June, I joined the ranks of the uninsured because I was unwilling to pop for a monthly premium in excess of $1700. So far...I'm way ahead of the game...I have not had to go to the doctor and my 1 prescription costs $17.

As far as I am concerned allowing Medicare Part D to be run by insurance companies was a mistake. That oversight costs Social Security money. Each insurance company has the right to negotiate a per drug payment rate with each pharmacy instead of there being a fixed national or state rate. In this age of doughnut holes...It pays to shop around. Strange as it may seem there are cases where one of the largest pharmacy chains is reimbursed substantially more for a prescription than a 'mom and pop' pharmacy.

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Thanks for the link. The whole idea of passing a bill "quickly" without reading it bothers me. I think we need some changes in health care, but I hope our lawmakers don't go overboard. I think to pass a bill without reading it would be like a doctor prescribing meds without checking test results. From what I have heard, there have been so many calls and emails from constituents that hopefully, the "powers that be" will consider carefully what they will do.

kmtina, I've read the section of the bill you're worried about. (Thank you for the link, Cheri.) I see nothing that emphasizes *limiting* life sustaining treatment, and nothing that requires the doctor to emphasize the benefits of no antibiotics. And as far as I can see, it *does* require the doctor to talk about the benefits of the documents. This measure requires the doctor to provide a thorough and objective explanation of AHCDs, including providing the person with adequate resources to help the person decide what he might or might not want to be included in his AHCD. (I wish I'd had someone do that when I wanted to draw one up for myself -- the forms are very simple, and one is expected to figure out what details to include. I didn't have a clue until I found "Hard Choices for Loving People".)

It does not make a special exception for having such a consultation with dementia patients who are too far advanced to be able to execute such a document -- you're right about that. Nor does it make a special exception for persons with any other disability that makes them unable to execute such a document.

But it does not say that the doctor has to force the patient to execute an AHCD, and it does not say that a person has to have an AHCD, it just says the doctor has to explain what one is. And I don't see any provision for an oversight body who will monitor the doctor and make sure that he gives a wildly detailed consultation to every patient who crosses his path. I imagine that, at most, he'll just have to put a checkmark in a box in the patient's file.

If you're concerned that the special exceptions are really needed, contact your representatives. People who draft such sweeping legislation don't always think of every nitpicking little detail for the first drafts. I doubt very much that anyone would object to making that kind of change to the measure.

I attended a healthcare roundtable with one of my representatives who happens to be on the ways and means committee. Someone brought up the question about whether healthcare for the elderly (and mainly the elderly have AD, though there are some with EOAD) would be rationed. The representative said (this isn't a direct quote, but the gist of it) "well, there's a limited amount of funds, blah, blah.." " hard choices, blah, blah........" and ended up with "I hope that not too many elderly will want heroic measures, knee replacements..." Though this isn't exactly what is being discussed in this thread, I do think that Obamacare isn't going to be elderly friendly with respect to spending money.

There's a vast amount of money spent in America on dying patients. Many of us don't know how to welcome death in a loved one, no matter how big a relief it would be to our loved ones.

It's totally rational to look at the end of life expenses, and trim those down. I for one do not want my life prolonged, when my best outcome still means a painful few more weeks or months of life. There is nothing loving in prolonging anyone's suffering.

Yet, I know that some people can't handle the thought of letting go, even if it means tens of thousands of dollars to keep someone on a machine and/or massively drugged, when Nature has said it's time to go. For any insurer to step in and say "No" to further end-of-life care, well, good luck to them. I don't know how it could be done, without tremendous emotional pain.

It is an interesting read, to be sure. Very hard to decipher most of the language. I have been searching the internet for interpretations of the bill, and find may interesting things in it, that you just don't get by simply reading through it. As it is, within 5 years, ALL plans, Gov. and private will HAVE to be identical. So, which one are we going to choose to pay for?? Uh huh.

Just to make this more clear, I took the relevant section and deleted excess verbage. That leaves the language I object to below:

‘advance care planning consultation'…shall include…an explanation of orders regarding life sustaining treatment …which shall include ….the reasons why the development of such an order is beneficial to the individual and the individual's family

(B) A(n) consultation …may be conducted if there is a change in health condition, including diagnosis of a chronic, progressive, life-limiting disease …or upon admission to a skilled nursing facility, a long-term care facility…

`(4) A consultation …may include the formulation of an order regarding life sustaining treatment.

`(5)(A) …the term `order regarding life sustaining treatment' means an actionable medical order that—

`(i) is signed and dated by a physician …communicates the individual's preferences including an indication of the treatment desired by the individual;

`(B) The level of treatment indicated may limit some or all specified interventions. Such indicated levels of treatment may include among other items—

`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;

`(iii) the use of antibiotics; and

`(iv) the use of artificially administered nutrition and hydration.'.

Here's something I find most curious. There's language about the patient's wishes but the patient doesn't need to sign anything; just the doctor (or a nurse). Isn't that a way of getting around the mental capacity issue? (particularly in my mother's case who is moving from mild to moderate AD) Why isn't the family notified of these orders? I agree changes need to be made to this provision and this organization and AARP should be the ones pushing for it. Let's see if anyone objects.

As for me, my mother and I have private health insurance (yes, I pay a lot and it's a high deductable) and I don't think I'll be able to keep it under this bill. My insurer will not be allowed to write new business after this bill passes so how long to you think they'll be in business? Another nail in the coffin: employers can pay a small fine for not offering health insurance and then dump their employees in the govt. plan. If anyone doubts this bill is about getting to a single payer socialized medicine plan, you need to wake up and smell the coffee.

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Just had an email from a friend who attended a meeting at her representative's office. Someone asked the rep about the government "getting access to your bank account" and said it was on page 26 of the bill. The rep said he had no knowledge of this. I tried to pull up the bill using the link that was here, but its unavailable Does anyone know anything about this? I'd never heard of this before. My friend was fairly (?) certain that it was page 26.

Viscious hoaxes are rife on the internet recently. I just got an email titled "Senior Citizens Death Warrant." These kind of fear campaigns are inexcusable, and that fact that people pass them along without checking independent sources is shameful.

Every word in that legislation is there for a reason.

Organizations like AARP and respected investigative groups like FactCheck.org have thoroughly debunked these horror stories.

There is a lot of room for debate on all sides of this issue, and I for one would welcome a well-reasoned discussion of what this legislation will and will not do for Alzheimers patients and the elderly.

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My question involved a friend who attended a meeting where the question was asked and the rep didn't know. At least one thing was established....according to her he couldn't answer quite a few of the questions put to him. He either hadn't read or didn't understand.

As Elizabeth said, I'm sure every word in the legislation is there for a reason....now if we can find out the reason....

I was under the impression that AARP backed the Obama plan but I was told by someone at AARP when I called and asked, that this was simply not true. The young man that I spoke with said AARP backed health care reform but had never backed Obama's plan specifically. That was the answer I was given....it may be a different answer today!

Has anyone seen page 26? That's what is being questioned by my friend.

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Kmtina---

Below are 2 links that specifically deal with the section that you repeatedly have referred to.

http://www.aarp.org/aarp/press...ughey_statement.html
http://www.factcheck.org/

Whitney---Your friend may be upset about ‘‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS” – It starts on page 57. Here is a link that explains part of it.

http://www.politifact.com/trut...h-bill-needs-check-/

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skericheri, thanks for those links. That's exactly how I read that section of the bill ... the intact bill, that is.

quote:

Originally posted by skericheri:
Kmtina---
Below are 2 links that specifically deal with the section that you repeatedly have referred to.

http://www.aarp.org/aarp/press...ughey_statement.html
http://www.factcheck.org/

Whitney---Your friend may be upset about ‘‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE TRANSACTIONS” – It starts on page 57. Here is a link that explains part of it.

http://www.politifact.com/trut...h-bill-needs-check-/

Thanks, skericheri. I'll pass that link along to her although she was fairly certain is was page 26.

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I'll give this a try:

Living wills and advance directives have certain legal protections. The patient must sign them and the signature must be notarized or have two witnesses. Because an individual is usually designated to carry out the wishes of the patient, families often have the time to discuss these issues. An order regarding life sustaining measures is signed by a doctor and states the patients wishes...the protections of patient signature and family notification are gone. Obviously, there is a huge potential for abuse in the case of a patient with mild Alzheimer's.

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Kmtina---I believe in the information contained in the following links:

http://www.aarp.org/aarp/press...ughey_statement.html
http://www.factcheck.org/


Actually...I was a registered Republican until recently.

You are more than welcome to continue posting or to move on.

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Please, keep political urges on the web's numerous political sites. This forum is for and about people with dementia and those who love us. Goodness knows I like to argue, but this is not the place.

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** This message has also been posted in the thread 'Healthcare in America'

We appreciate and value the discussions our members bring to this community. We would like to caution these discussions as politic debates often become heated, and can lead down a path not focused on the community’s purpose. The community’s purpose is to offer a safe and supportive environment so that all those affected by Alzheimer’s and other dementias can find the resources and support.

If you are interested in becoming an Alzheimer's Association advocate Join the Cause at www.alz.org/advocacy/ This is a great way to become directly involved with these important issues.