Keynote speaker Susan LeGrand, MD, of the Cleveland Clinic Foundation presented a talk, Barriers to Palliative Care from a Clinical Perspective. She offered a clinical viewpoint on the definition of "palliative care," the function of hospice, and the need for effective medical training. Dr. LeGrand emphasized that the term "palliative care" is often interpreted as meaning non-curative, but she added that such total care also often includes aggressive, life-prolonging treatment. This care encompasses spiritual and emotional care, in addition to the standard medical aspects of end-of-life health care.
Dr. LeGrand also spoke to the systemic shortcomings of the Medicare hospice benefit, which she suggests desperately needs revision. The methodology for determining who qualifies for hospice is out of synch with the disease course and treatment modalities. The current benefit restricts hospice eligibility to patients who have a six-month life-expectancy, and to those who agree to the hospice approach to care, which can preclude some treatments. Dr. LeGrand said that under these regulations, many seriously ill patients fall between the gaps of not qualifying for home care or hospice, despite the need many have for such care.
Richard Doerflinger, Associate Director of Policy Development at the United States Catholic Conference, expanded on an issue he had introduced at the November forum—a legislative mandate that would require the Department of Health and Human Services to establish an office of Pain Management and Palliative Care. The office would have three primary duties: collection and distribution of best practices; initiation of a grant program in palliative care; and consultation to the the Secretary of Health and Human Services to make recommendations to the Department of Justice.
ABCD is grateful not only to our featured presenters for their very helpful insights, but also to those organizations that have co-hosted lunches, and who have expressed interest in doing so. Future meetings will address decision-making at the end of life, and end-of-life issues in long-term care facilities.
Katie McGoldrick, an undergraduate at George Washington University, is an intern in the ABCD Office of Policy and Development.
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