Commission on End of Life Care Presents Report to Engler

The Michigan Commission on End of Life Care today presented Governor John Engler with a comprehensive report and recommendations on how to improve humane and dignified treatment at the end of life. The report examined state policies to remove barriers to effective pain management and improve access for citizens to end of life care. The 12-member Commission, appointed by the Governor, also recommended ways to evaluate and improve training and curricula for health care professionals on end of life care.

"When I appointed this Commission, I charged them with the responsibility of tackling an issue that is extremely complex, emotional and spiritual," said Engler. "This reports reflects the very thoughtful and thorough approach taken by the Commission as Michigan seeks to lead the nation in providing support and quality care to those at the end of life."

"This report represents a significant step toward improving end of life care for all citizens in our state," said Commission Chair Rev. Clayton L. Thomason, J.D., M.Div. "By working together, we can make the last phase of life better for Michigan's patients, families and communities."

The Commission on End of Life Care held public meetings across the state as they gathered input on issues relating to end of life care. "The input from caregivers, families and health care providers who spoke to the Commission on this issue helped us build on our extensive efforts in Michigan to provide quality care and compassion when it is needed most," said Michigan Department of Community Health Director James K. Haveman, Jr.

Included in the Commission's 46 policy recommendations are:
Education and outreach.
-- The Department of Community Health and the Department of Consumer and Industry Services should implement a public information campaign on end of life issues throughout Michigan for families and health care professionals. Families should be encouraged to engage in caring conversations with loved ones concerning their expectations and wishes for end of life care and to plan for their financial, emotional, legal and spiritual needs at the end of life.

Professional education. Access to effective end of life care requires health care professionals who are expertly trained to deliver it.
-- Health professional schools and educational programs should include in their core curricula content on end of life care appropriate to each discipline, including knowledge, skills and approaches to patient care.
-- The Departments of Community Health and Consumer and Industry Services, and health professional licensing boards should promote and advance the art and science of end of life care in the education of health professionals at all levels and should promote palliative care as a defined area of practice, education and research.

Pain and symptom management. Michigan citizens deserve the very best pain management that professionals can deliver. Experts agree and data confirm that early and aggressive pain treatment lengthens life and improves its quality. Vigilant attention to physical and emotional symptoms is the core of high quality end of life care.
-- The Legislature should repeal the Official Prescription Program (OPP) because in its current form it impairs patient access to effective pain management without a corresponding benefit in the control of prescription drug diversion.
-- The Legislature should replace the current Official Prescription Program with a system that prevents drug diversion and promotes high-quality pain care. It should support electronic monitoring of the prescribing of prescription medications and should be developed with the advice of pain management experts and law enforcement. It should require no additional prescription forms; should be efficient and invisible to the patient and practitioner; and provide accurate and useful information to all who need it.
-- The Departments of Community Health and Consumer and Industry Services should explore ways to provide for the transfer of unused pain medications to other patients through a central control point such as a hospice, hospital or other appropriate organization. This will make these important and costly pharmaceuticals available to the uninsured or underinsured persons in need.

Reimbursement.
-- The Department of Community Health should assess and validate existing Michigan data to determine how to optimize care at the end of life by redistributing resources and redesigning incentives to provide more options concerning the types and settings of care.

Long-term care. Several populations need long-term care including the elderly, persons with severe disabilities, persons with dementia, and persons at the end of life. Michigan residents of long-term care facilities living with advanced illness or dying deserve quality end of life care.
-- The Michigan Departments of Community Health, Consumer and Industry Services and the Long Term Care Work Group should create incentives for instruction in palliative care for physicians, pharmacists, nurses, social workers and nursing assistants who provide services to residents of long-term care facilities.
-- Long-term care providers should develop initiatives for improving end of life care in their facilities and palliative care to reduce pain and physical discomfort.

Decision making for end of life care. Citizens need to know the best way to make their wishes for end of life care known and must be confident that those wishes will be carried out.
-- Information clearly denoting that a person has a do-not-resuscitate and/or an advanced directive should be added to the back of Michigan driver licenses or identification cards.

Family issues. Effective, compassionate end of life care must go beyond medical care for the patient to include social, psychosocial and spiritual support for the patient, family and caregivers.
-- Respite care is an important part of the care plan for most families and health care payers should be encouraged to provide adequate reimbursement for respite services.

The results of the Commission survey on the availability and cost of public and private insurance coverage for hospice services, pain management and palliative care found that federal Medicare benefits set the pattern for private insurance coverage of end of life care services. In addition, even though Medicare covers hospice care, less than one in five Medicare beneficiaries utilized hospice care at the end of life.

In the near future, the Commission will distribute a Resource Guide for end of life care, which will be an easy-to-use inventory of resources available to Michigan citizens for end of life planning.