TUESDAY, SEPTEMBER 7, 2010


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INSURING YOUR HEALTH Michelle Andrews


Rather than creating ‘death panels,’ new law adds to options for people at the end of life


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bout this time last year, voters and politicians were consumed by the rumor, fanned by health-care overhaul opponents, that the legislation would include “death panels” of government bureaucrats who could “pull the plug on Grandma” if she needed costly care. The outcry led legislators to


MARVIN JOSEPH/THE WASHINGTON POST


CVS pharmacist Jeslie Cuaresma prepares to administer the flu vaccine to Linwood Taylor last week, well in advance of the November-to-May period when authorities say most influenza occurs.


Vaccination isn’t the only way to ward off the flu


flu continued from E1


with heart, lung or kidney dis- ease, can get much sicker. Flu can cause high fever and pneu- monia. It can cause diarrhea and seizures in infants. The nasal spray to prevent the flu, which contains weak- ened live virus, is approved for use only in healthy people ages 2 to 49 who are not pregnant. The shot, which contains killed virus, should not be given to people who have severe aller- gies to eggs or to a previous flu shot, nor to people with a his- tory of Guillain-Barre syn- drome. Officials recommend that children younger than 9 be- ing vaccinated for the first time should receive two doses — ei- ther mist or injection — spaced at least four weeks apart. Locally, officials are not plan- ning the type of mass clinics for the general public that were in place last year, but some juris- dictions will be giving free flu shots and sprays at school- based clinics. Parents should see information coming home in backpacks over the next few weeks. “At this point, we do not have


a novel flu virus creating the kinds of situations that we were dealing with last summer and into the fall,” said Pierre Vigi- lance, the District’s health di- rector. Just as important in flu prevention, he said, are simple steps, such as washing hands, covering your mouth when you cough and staying home when sick, he said. In Montgomery County, health and school officials are planning to have clinics this fall at some high schools and el- ementary schools, where chil- dren will be able to receive free vaccinations. Parents will get details later in the school year. Prince George’s County will


offer free sprays at each of its 65 elementary schools between Oc- tober and early December, said Donald Shell, the county’s health officer. The vaccine will be given during the school day to students who present the re- quired consent form, which means parents will not need to accompany their children. Prince George’s schools had lower than expected vaccina- tion rates for the H1N1 flu virus last year among African Amer- ican and Hispanic populations, reflecting a national trend for those groups, and officials are hoping to improve on that this year. (That rate ranged from 3 to 4 percent at some schools last year to 51 to 52 percent at oth- ers, Shell said.) “We had some distrust of the vaccine and of the whole process last year,” he said.


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The county has been working with pastors and other commu- nity leaders to overcome mis- perceptions about the vaccine. Using information gathered from a survey sent to 1,500 county residents this summer, officials are tailoring a media campaign that focuses on flu facts: Three of every 10 children get sick with flu every season, and when children miss school, their parents miss work. Some Northern Virginia ju-


risdictions, such as Fairfax County, traditionally do not of-


fer vaccinations in schools. Last year’s pandemic was the excep- tion. In Arlington County, the school-based clinics were so suc- cessful — with more than 50 per- cent vaccinated, the highest rate in the state — that health offi- cials are trying to convince pri- vate-sector providers to hold clinics at convenient locations in some neighborhoods as part of a pilot program to reach a wider population, according to Reu- ben Varghese, Arlington’s health officer.


sunl@washpost.com


scrap a provision of the House bill that would have paid for voluntary consultations between physicians and Medicare beneficiaries about end-of-life care: living wills, hospice benefits and the like. Since the furor died down, end-of-life care has been mostly out of the spotlight. But misperceptions remain. A July poll by the Kaiser Family Foundation found that 36 percent of seniors still believe that the overhaul creates “death panels.” Another 17 percent said they didn’t know one way or the other. Many people may not realize


that, in some ways, the new law will expand options for patients at the end of life. One of these involves hospice care, in which a team of specially trained providers treats dying patients’ pain and other symptoms but don’t try to cure the underlying disease. The team also helps the patients’ families, instructing them in caring techniques and providing bereavement counseling after death. Under current Medicare rules, beneficiaries whose doctors determine that they have less than six months to live can choose hospice care — but only if they forgo any further life-prolonging treatment.


The new law establishes a three-year “concurrent care” demonstration program at 15 sites nationwide, in which Medicare would cover both kinds of treatment simultaneously. Although the vast majority of


patients seeking hospice benefits are over 65, starting in 2013, the new law also allows children who are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) to receive both hospice and curative care. Some private insurers, such as Aetna and UnitedHealthcare, have been offering concurrent care to their private-market clients for years. Experts agree that hospice


benefits can provide crucial support for both patients and families during a very difficult time, and some research indicates they may extend the patient’s life. Yet fewer than 40 percent of patients are in hospice care when they die, according to the National Hospice and Palliative Care Organization. Many terminally ill patients wait until death is imminent to choose hospice care. The median length of time in hospice was just more than 20 days in 2008; more than a third of people died or were discharged from hospice in seven days or less. “We think it’s far too short a period for patients and their families to adjust to the realities of impending death,” says Jon Keyserling, vice president of public policy and counsel for the NHPCO. Judith Caravan’s story


supports that. After going through chemotherapy and many radiation treatments for his lung cancer, her husband, Crune Caravan, finally decided he’d had enough. Somewhat


reluctantly, his wife called a hospice center near their home in Columbus, Ohio. “I was skeptical,” she says. She quickly changed her mind.


Three hospice nurses came to the home, evaluated her husband and adjusted his medications, making sure he wasn’t in any pain. They ordered a hospital bed and got it set up that same day. Over the course of the next week, a nurse visited several times to help calm him when he felt anxious. They also talked with her about what to expect and gave her a small book that described the changes she might see in him. He died seven days after their first visit. “I kind of do wish they’d come in earlier,” Judith Caravan says. Hospice professionals say


patients and family members are better served if they use hospice benefits for about two months. Experts agree that the requirement that they forgo curative treatment stops some Medicare patients from choosing hospice. Even when aggressive therapy may provide little therapeutic benefit while severely diminishing the patient’s quality of life, it’s not easy to say “no more.” Once the 15 demonstration sites are up and running, expected sometime in 2012, participants won’t have to make that choice.


This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.


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