Honoring Choices Napa Valley A community coalition actively supporting improved advance care planning for Napa residents Robert Moore, MD MPH Family Physician Chief Medical Officer, Partnership HealthPlan of California

You Never Know When...

It’s always too early until it’s too late...

Advance Care Planning (ACP)– Why?  Prevent Unwanted Pain  Prevent Unwanted Intervention  Reduce Stress and Depression for Families  We never know when an unexpected catastrophe will occur  We need to have ACP discussions about treatment options/decisions needed before we become sick or injured

A community-wide problem  A community-wide solution

Honoring Choices Napa Valley  Vision: o All adults in Napa County will receive health care based on previously expressed personal and cultural values and preferences regarding aging, illness, and end of life care.  Advance Care Planning as a Prevention Strategy o How do we know this is possible?

Respecting Choices La Crosse Wisconsin, Model: Gundersen-Lutheran Health System

Honoring Choices Minnesota  Four key strategic Components 1. Community engagement 2. High Quality Training 3. Continuous Quality Improvement 4. Build infrastructure

What is happening locally?  California POLST (Physician Order etc.) form  Hospital Palliative Care Programs  Kaiser promoting ACP  Other programs to promote ACP in physician offices  Cancer case management and other case management  Latino elder coalition/Legal aid providing ACP counseling to Latino population Community-level Gaps o High risk of not dying the way they want to

Community Engagement Community Partners Include: o Businesses o Civic leaders o Education Community o Faith-Based Community o Attorneys o Service organizations o Healthcare providers/organizations

Community Engagement Core Goals of Community Engagement Strategy o To Demystify... Taboo issues related to death and dying processes in the twenty-first century o To Inspire... Napa Residents to become more involved in the end-of-life care decision-making process o To Model... Ways in which families can discuss and embrace end-of-life care planning o To Support... Families with an on-line “tool kit” of video and text tools o To Prepare... Providers, caregivers and families alike to make certain that individual choices are always honored

1. Community Engagement  HCNV goal o By 2020, we seek a significant shift in the knowledge, behaviors and attitudes of Napa County residents regarding Advance Care Planning, advanced illness, and the end of life.  Community Kickoff event o September, 2013

What will success look like?  Regular conversations among families and friends about options in health care at different stages of life  Most Napa County adults have completed Advance Directives  Regular review and discussion of Advance Directives with clinicians, families, and decision-making agents  Consistent honoring of end-of-life wishes

What will it take for us to succeed?  Build an effective coalition with participation by dedicated leaders  Cooperate with each other (especially health care providers)  Build project management capacity to coordinate efforts  Implement local trainings for First Steps facilitators  Secure funding or sponsorship for facilitators

Coalition organizations  Napa Valley Hospice and Adult Day Services  St. Helena Hospital  Queen of the Valley Hospital  Community Health Clinic Ole  Kaiser Permanente  Legal Aid of Napa Valley  Veterans Home of California, Yountville  Partnership HealthPlan of California  Napa County Health and Human services

Individual coalition members  Leon Garcia, mayor American Canyon  Mary O’Leary, RN

2. High Quality Training o Partner: Coalition for Compassionate Care of California o Train the Trainer, October, 2014

3. Continuous Quality Improvement Strategic Planning process identified three initial focus areas: 1. Residents of the Veterans Home 2. Senior Center/Retirement Facilities 3. Clients of estate planning attorneys Reviewed Advance Directive options

Different Versions of Advanced Directive  Easy to Read Version  5 Wishes  California Medical Association  MyDirective.com  Kaiser  American Bar Association Durable Power of attorney for Health Care  Legal Aid of Napa

What is missing from Advance Health Care Directives?  Setting the stage: who am I?  Additional detailed wishes around end of life care  Special messages “My Comfort Care Wishes and Preferences—Supplementary Information for Healthcare Agents and Care Providers”

4. Building Infrastructure HCNV:  Guiding Principles  Financial support  Project Management

Guiding Principles Hospitals, Health Care Organizations and Providers may compete on other levels, but we must agree not to compete on ACP, but to work together. Collective Promises: 1. We will initiate the conversation. 2. We will provide assistance with advance care planning 3. We will make sure plans are clear 4. We will maintain and retrieve plans 5. We will appropriately follow plans

Financial support  In-kind support of all coalition members  Napa Valley & Adult Day Services  Napa Valley Vintners  Other coalition partners o St. Helena Hospital o Queen of the Valley Hospital o Partnership Healthplan of California

Project Management  Coalition members  Coordinator: Kathie East

Mobilizing a Community A Call to Action Community-wide convening o Engage emotionally and passionately o Give a Vision of what the future can look like o Include all sectors of the community Key role of leadership o Strategy o Relationships o Focus energy

Changing Values by Having a Conversation: “Why don't we die the way we say we want to die? In part because we say we want good deaths but act as if we won't die at all.” – Katy Butler, Wall Street Journal, 9/7/13

Honoring Choices Napa Valley Questions?