Health Care Reform: U.S. Needs More Options for Seniors

WASHINGTON All of us can agree that our current health care system is in need of fundamental reforms that will expand access, improve quality, and increase value. As Congress prepares to spend a long, hot summer working to find bipartisan agreement on many proposed reforms, it is important that we also have a discussion about one area of health care reform that makes many of us uncomfortable: the care that we provide to our seniors and others with life-limiting illnesses.

Too often, we fail to provide patients, their families, and caregivers with the necessary tools, information, and support to age well, and with dignity, in a setting that they prefer.

I know firsthand how tough this can be on patients and their families: My mother suffers with late-stage Alzheimer's disease. When she was first diagnosed with this cruel disease almost a decade ago, my family missed the opportunity to talk frankly and honestly with my mother and her health care providers about her care options. We did not discuss living wills, or advanced care directives.

If my family had better access to good information, informed counseling, and other key resources a decade ago, we might have held important family discussions with my mother and worked with her doctors and pastor to craft a care plan that truly reflected my mother's wishes.

NOW MY FAMILY certainly is not alone in having difficulty discussing these sensitive end-of-life issues. But it's clear that an honest discussion about care options, treatment settings, and end-stage care planning would give many patients and their families the opportunity to make more informed decisions that could dramatically improve the quality of life of patients and their family caregivers.

That's why I have introduced the Senior Navigation and Planning Act of 2009 (S.1263). At its heart, this bill helps Medicare beneficiaries, their families, and caregivers to plan for their transition into senior life in non-crisis moments. Essentially, we are trying to help seniors, their families, and caregivers navigate through a complex health care system.

My legislation -- which has been endorsed by groups such as AARP, the National Hospice and Palliative Care Organization, and the Duke University Divinity School -- provides access to hospice expertise and other care planning services to those who have been diagnosed with a life expectancy of 18 months or less, while also allowing patients to continue to pursue curative treatments. This will allow more seniors to have access to palliative care, advance care planning that is patient-centered, and counseling, respite, and care training for family members.

Most important, my proposal gives both patients and their families wider access to more tools -- sooner -- so they can make more informed choices about all of their options.

Let me be clear: This legislation does not in any way deny or limit health care services.

However, it does recognize that overall health reform should include a thoughtful process that informs patients, their families, and caregivers on how to navigate and think through many difficult decisions about when, and how long, to pursue treatments near the end of life.

By enacting these reforms, we will begin to develop a culture in which all of us will have the ability to age well, with dignity, in the setting of our choosing.

MY LEGISLATION also includes incentives for doctors, hospitals, and nursing homes to incorporate accredited programs in palliative care into their discharge planning. It promotes a broad-based effort to educate the public on the importance of end-of-life planning, and it sets up a thoughtful structure that incorporates the expertise of religious leaders, medical ethicists, and others in this long-overdue national discussion.

Besides providing emotional relief and peace of mind for patients and their families, this improved advanced care planning may have an economic benefit as well.

Currently, we leave it to families to resolve these extraordinarily difficult decisions, often in moments of crisis, with little guidance. Is it any wonder then that, by some estimates, up to a third of Medicare costs occur in the final 12 months of life?

In fact, programs that have offered these expanded services have found increased satisfaction from patients, families, and caregivers, and maintained or improved quality, in addition to decreasing costs. My legislation could reduce Medicare spending by an estimated $18 billion over 10 years, even as we work to provide more structured information and planning services that better support the patient's wishes and improve overall quality of life.

I recently met with almost 50 leaders of the faith community in Hampton Roads to discuss this proposal, and I was struck by their unanimous support for including this discussion in our national debate over health care reform. These leaders of all faiths agreed that it is not an easy conversation to have, and these issues make many people uncomfortable.

But this is a discussion we need to have if we're truly serious about improving our nation's complicated -- and broken -- health care system.

Mark Warner represents Virginia in the U.S. Senate. Contact him at 202-224-1915, or through the Web site http://www.warner.senate.gov.