The La Crosse Model Comes to the Bay Area

Inspired by La Crosse’s success, Kaiser Permanente worked with Gundersen and started its own Life Care Planning program in 2012.7 Among its goals is to increase the numbers of patients completing advance directives. Over 600 physicians, nurses, and social workers have now been trained as facilitators. Kaiser palliative care specialist Kumar says much of what Kaiser did was modeled after the Gundersen program. She said, “We’re hoping to do the same thing over the next eight to ten years, to get greater than ninety percent of our patients with planning done.”

But replicating the Gundersen model throughout the entire Bay Area presents huge challenges. Bringing together all the hospitals and the hundreds of churches, senior facilities, and social service agencies would be extremely difficult and expensive. In addition, the Bay Area has a much larger, diverse population with multiple languages and cultures. Without language-proficient facilitators, outreach to all sectors of the Bay Area would be nearly impossible.

Educational outreach efforts largely depend on volunteers organizations like the East Bay Conversation Project, a community-wide coalition working to help people plan their preferences for care at the end of life.8 At a recent gathering in Berkeley, Alison Rodman and two other volunteers talked to a group of seniors on how to complete an advance directive. She told them that forms are available on-line. “It’s a pretty simple document that’s legal and you don’t have to go through great expense by using a lawyer or having it notarized,” Rodman said.

Don’t Wait Until It’s Too Late

La Crosse resident Leah Brueggeman is glad her family didn’t wait. “And of course, we don’t like to think of death and dying but—it happens,” she said. Several years ago, Leah’s husband Jim made the decision to stop medical treatment for his ailing mother. But following her death, Jim had second thoughts. “I came home and my husband—he was just nearly sobbing. He was just distraught,” said Leah, “He said ‘I killed my mother.’ He said ‘We stopped her medication.’ I said ‘That’s what she wanted.’ ”

Unbeknownst to Jim, his mother had filled out an advance directive. Leah went to his mother’s assisted living facility and found a copy of it. “We got it out. Her wishes are right here: no medication blah blah blah,” said Leah, “I took that home and said ‘Honey, take a look at this. This is what your mother wanted. You’re not killing her.’ ”

Jim stopped agonizing over his mother’s death, now that he no longer had to guess at what she wanted. Thanks to her advance directive, Jim and Leah were able to avoid the guilt and conflict that had torn apart the family of Terry Schiavo over twenty years ago.

JoAnn Mar’s report is part of the End of Life Radio Project, supported by a grant from the Association of Health Care Journalists and The Commonwealth Fund.

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