Advance Care Planning: Past, Present and Future

Brian Hanson, APEX President and CEO, introduced the Advance Care Planning (ACP) guest panel from investor-members Essentia Health and St. Luke’s. The panel presented insights to investor-members on ACP and a vision for the future. The topic was of interest for many investor-members, both from a business planning perspective and from the viewpoint of taking care of aging parents.

The panel included:

• Sue Hamel, Vice President and Chief Nursing Officer at St. Luke’s;
• Patty Minogue, Emergency Department and Intensive Care Unit Case Manager at St. Luke’s;
• Sandee Carlson, Director of Hospice and Advance Care Planning Program Coordinator at East Region Essentia Health; and
• Dr. Jonathan R. Sande, Oncology and Advance Care Planning Director at East Region Essentia Health and Ethics Program Director at St. Mary’s Medical Center.

Dr. Sande led the panel’s presentation with an introduction of what ACP entails. He stated that he believes this topic to be one of the leading three issues in healthcare today. Dr. Sande has consulted with more than 300 very ill patients and in many cases, their families have not yet discussed end-of-life situations and options. It is ideal to have a neutral “agent” that can express the goals, morals and beliefs of the patient.

Generally, only 30% of the population has completed a Health Care Directive, putting both the patient and family members in difficult positions when making end-of-life choices. ACP is truly a continual process, often involving trained, third-party facilitators to aid in broaching difficult conversations. Ultimately, the goal is to help patients complete their directives, mapping out the patient’s desires before an illness.

At Essentia, the process of developing a directive follows the Respecting Choices® approach, which involves a series of five promises to a patient. As Sandee Carlson pointed out, Essentia has formalized processes and provides trained professionals to initiate conversations between patients and agents. The agents leave with an understanding of patient’s values and wishes. Essentia is working to develop a system to address the initiative of training staff to speak with patients.

Sue Hamel shared the process that St. Luke’s follows regarding ACP, partnering with Honoring Choices Minnesota to promote these conversations with the employees. The conversation with patients begins upon admittance. If a patient hasn’t already done so, St. Luke’s requests whether the patient would like more information regarding ACP, and whether they’d like to work with one of their patient consultants. St. Luke’s also encourages physicians to have conversations with their patients in the clinic setting. She reiterated the importance of discussing ACP with patients prior to a time of crisis.

Patty Minogue presented background to investor-members on what the community has been working on with respect to ACP. There has been a transformation in how the community is responding to the need. The first group, Educating Community on Healthcare Options (ECHO), was originally made up of healthcare providers. It has now transitioned to a larger regional entity, Advance Care Planning Northeast Minnesota, which includes providers as well as attorneys, long-term care providers, parishes, consumers and St. Louis County health and human services representation.

While conversations regarding ACP are difficult for individuals and families, the panel encouraged investor-members to consider the moral and financial responsibility of not having the conversation.

Minogue indicated the cost to employers with employees who are caregivers to family members at home is an estimated $17-33 billion each year. She shared the success of an initiative led by healthcare providers in La Crosse, WI. Providers began having the ACP conversation with patients in 1991 and now more than 95% of patients have partaken in the process. Today, La Crosse has significantly more control of their expenses associated with end-of-life. Patients receive best-practice care, providers respect patients’ values and goals, and the community is a national model for healthcare excellence. The panel believes if we work together, our region can experience the same benefits.

The presenters are forming a community wide ACP Steering Committee made up of various leaders in the community. The members of this committee will be ambassadors for ACP to stakeholders in their community. The panel extended an invitation to APEX investor-members to join this committee and initiative. If you are interested in this opportunity, please contact one of the speakers outlined in the presentation.