Macro Level Social Work Practice and Advance Care Planning

Macro Level Social Work
Practice and Advance Care
Planning
Mia Morrisette
CSW, MBA
Advance Care Planning
Coordinator
Topics
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For the Love of Social Work
Review of the Patient Self Determination Act
Wisconsin Advance Directives
Blending Advance Care Planning with Social
Work Competencies
• A New Way of Doing Things (video)
• Questions and Conversation
1. Service
to provide help, resources, and benefits to help
people achieve maximum potential
2. Social Justice
to uphold equal rights, protection, opportunity, social
benefits to everyone
3. Dignity and worth of the person
every person is unique and worthwhile
4. Importance of human relationships
Social workers recognize the central importance of
human relationships
5. Integrity
maintain trustworthiness
6. Competence
practice within the scope of known skills and
abilities
A Brief History Lesson…
Karen Ann Quinlan 1976
Nancy Cruzan Dies, Outlived by a Debate
About the Right to Die
December 27, 1990 New York Times
Terri Schiavo
Schiavo Dies, Ending Bitter Case Over
Feeding Tube
By ABBY GOODNOUGH New York times Published: April 1, 2005
INELLAS PARK, Fla., March 31 - The long,
sorrowful struggle over Terri Schiavo's life
ended Thursday morning when she died in
her hospice bed almost two weeks after the
removal of her feeding tube, her parents and
siblings absent, the husband they reviled at
her side.
Patient Self-Determination Act of 1991
Patient Rights
• To facilitate a person’s own health care
decisions
• To accept or refuse medical treatment
• To make an advance directive
Patient Self Determination Act
We Must:
• Provide patients with written information about
Advance Directives (AD)
• Ask patients if they have an AD, and document
in medical record
• Educate staff and community about AD
• Never discriminate against patients based on
whether or not they have an AD
• Never require patients to have, or not have, an
AD
Wisconsin Advance Directives
Living Will or Declaration to Physicians
Power of Attorney for Health Care (POA)
Honoring Choices Wisconsin Advance Directive
Terminology is EVERYTHING
Honoring Choices Wisconsin Glossary and Style Guide
What is Advance Care Planning? It’s About the
Conversation~
•Organized process of communication
•Helps an individual understand, reflect upon and discuss
goals, values, and beliefs for future healthcare decisions
•Has the power to produce a written plan (Advance
Directive) that accurately represents the individual’s
preferences
•Prepares others to make healthcare decisions consistent
with these preferences
How Does it Work?
• A trained ACP Facilitator meets with a
patient and their chosen Health Care
Agent individually or in a group setting
– Leads the patient in discussion of values
– Role of the Health Care Agent
– Explore goals for treatment
– Complete an Advance Directive
Systematic Approach to Advance Care Planning
1. Initiate ACP before a medical crisis occurs
2. Skillfully assist patient with an individualized plan
3. Assure plans are complete and clear
4. Plans need to be available to all who participate in
decision making
5. Follow plans appropriately, and respect the values and
preferences of the patient
Matching Advance Care Planning with
Social Work Competencies
*Demonstrate Ethical and Professional
Behavior
*Engage in Diversity and Difference in
Practice
Dimensions of diversity are understood as the intersection of multiple factors including but not limited to age, class, color, culture, disability, ethnicity, gender, gender identity, immigration status, political idealogy, race, religion/spirituality, sex, sexual orientation and tribal sovereign status. Social workers also understand the forms and mechanisms of oppression and discrimination and recognize the extent to which a culture’s structures and values including social, economic, political and cultural exclusions, may oppress, marginalize, alienate , or create privilege and power.
Matching Advance Care Planning with
Social Work Competencies
*Advance Human Rights and Social and
Economic Justice
Matching Advance Care Planning with
Social Work Competencies
*Engage with
*Assess
*Intervene
*Evaluate Practice
With Individuals, Families, Groups and
Organizations and Communities
Why is Advance Care Planning
Important
News Flash
World Death Rate Holding Steady At
100 Percent
News • survival • ISSUE 31•02 • Jan 22, 1997
GENEVA, SWITZERLAND—World Health Organization
officials expressed disappointment Monday at the group's
finding that, despite the enormous efforts of doctors, rescue
workers and other medical professionals worldwide, the
global death rate remains constant at 100 percent. . . .
Be Honest!
A comedy break brought to you by...
21
The Facts
• 60% of people say that making sure their family is not burdened by tough decisions is “extremely important.”
• 56% have not communicated their end‐of‐
life wishes.
Survey of Californians by the California HealthCare Foundation (2012)
The Facts
• 70% of people say they prefer to die at
home.
• 70% die in a hospital, nursing home, or
long-term-care facility.
Center for Disease Control (2005)
The Facts
• 80% of people say that if seriously ill,
they would want to talk to their doctor
about end-of-life care.
• 7% report having had an end-of-life
conversation with their doctor.
Survey of Californians by the California HealthCare Foundation (2012)
The Facts
• 75% of physicians whose patient had
an advance directive were not aware
that it existed.
Critical Care Journal (2007)
The Town Where Everyone Loves to Talk about Death
Advance Care Planning
A new way of doing things
• http://Gundersen Lutheran
More Wisconsin Impact
On the National Scene
Institute of Medicine Report 2014
• Delivery of Person-Centered,
Family-Oriented Care
• Clinician–Patient
Communication and Advance
Care Planning
• Professional Education and
Development
• Policies and Payment Systems
•
http://iom.nationalacademies.org/~/media/Files/
Report%20Files/2014/EOL/Report%20Brief.pdf
New UW Health Data
UW Health Patients 60+ with an identified PCP,
WI address and Advance Directive on File
System wide
2013
2014
2015
25%
28%
30%
New UW Health Data
UW Hospital Deaths of Wisconsin
Residents 18 and older with an Advance
Directive on File
• FY 2013
887 Deaths ?
• FY 2014
958 Deaths ?
• FY 2015
894 Deaths ?
Gundersen Lutheran
96%
ACP at UW Health
Geriatrics
Northeast Family Medicine
UWMF Patient Resources/ CCM
2/2015 Conversation with patient and Health Care Agent
Verona Family Medicine
Pulmonary
Bone Marrow Transplant
Expansion plans for 2015
Increase number of UW Health Facilitators to 60
Pilot ACP in Group Settings
ACP Services to West Internal Medicine
ACP Services to East Internal Medicine Begin Collaboration with Oncology Clinics
Reaching UW Health Employees Favorite Resources
Facebook Pages
Pallimed
Columbus Death Café
Slow Medicine
YouTube
Ask a Mortician
Talking to Your Parents About Death
A Call to Action
Engage in
*Policy Practice
Practice Informed Research and Research
Informed Practice
Conversation and Questions