Connecticut Leads the Way in the

Physician Assisted Living Initiative

CONGRESSWOMAN ROSA L. DeLAURO

     As the "baby boom" generation draws closer to retirement age, our nation faces an explosion in health-care costs. We will need to explore innovative strategies to hold costs down, while at the same time maintaining the highest quality of care to people with incurable illnesses, and while at the same time holding down the costs that come with the extensive medical care of a terminal illness. Connecticut's hospice program is an excellent model for the country as a whole to follow.
Connecticut led the way for the nation when America's first hospice care unit opened in the early 1970s. In 1978, the Connecticut Hospice created the research and teaching component for hospice care with the opening of the Hospice Institute for Education, Training, and Research. The Institute fostered ground-breaking research in issues surrounding care for the terminally ill.

     The Thompson Institute and the Connecticut Hospice program have thrived and expanded since that time. Based on the success of these models, hospice units have moved from Connecticut to hospitals and nursing homes throughout the nation. Countless numbers of terminally ill patients across the nation depend on the care they receive through hospice. In this, along with so many other health-care issues, Connecticut has provided an example to the nation in promoting a health-care climate in which the needs of the patients and their families come first.

     Hospice is a blessing for the patients and families who depend on these services. As a cancer survivor and a strong hospice supporter, I understand how hospice can

Congresswoman ROSA L. DeLAURO, Connecticut's Third District, was first elected to Congress in 1990 and was reelected in 1992, 1994, and 1996. At the beginning of the 105th Congress, was renamed to the Appropriations Committee, where she had served during the 103rd Congress. She sits on the Labor/ HHS and the Agriculture Subcommittees. During the 104th Congress she served on the National Security Committee.

truly become a second family for patients grappling with a serious and terminal illness—with a talented and caring staff who are always ready to help when they are needed, and patients who spend time together, reaching out to offer loving support. A hospice inpatient unit is more than just a hospital ward—it is a true community.

     Connecticut, a pioneer in the hospice movement, and is again blazing a trail in the area of heath care with the Physician Assisted Living (PAL) Partners initiative, announced in September by Attorney General Richard Blumenthal. This program is geared to inform people about hospice care and to give them the opportunity to consider their options at a time when they are healthy and not immediately facing a terminal illness.

     Once a diagnosis has been made, it often becomes difficult to make an educated and informed decision as to medical treatment. Conflicting emotions rage out of control—anger, fear, denial, deep depression are all too common, not just for the patients, but for their families as well. When patients are trying to come to grips with their own mortality, it is difficult to focus and make educated decisions on issues as to what medical treatment they want and what measures should be taken (or avoided) to prolong life.

     Hospice care can help ease the pain and suffering that comes with a terminal illness. Hospice allows patients to spend their final days in a caring atmosphere where pain is controlled and where suffering—both physical and emotional—can be minimized.

     Working with doctors, religious organizations, hospice, and other medical groups, PAL will help to educate Connecticut citizens regarding the range of their options before they come face-to-face with that most devastating of news.

     The initiative is aimed at increasing doctor-patient collaboration. Doctors are educated as to available hospice programs and encouraged to sit down with patients to discuss the possibility.
The program includes a directive to be signed by the patient indicating her desire to receive hospice care should she ever be faced with a terminal illness. Although this document is not legally binding, it affords an excellent opportunity for patients to play a role in their medical care.

     Patient choice in health care is an issue at the top of our nation's agenda. Choice of doctor, specialist, treatment, and even length of hospital stay is increasingly being made by insurance companies rather than by the doctors and patients who should be making these important medical decisions.

     And that is exactly what PAL is designed to foster— conversations and decisions made between doctors, patients, and family. The 10 principles incorporated in the program are common sense and flexible, and acknowledge the fact that every case is different. But the key standards remain the same, among them: addressing the needs of the patient and his family; allowing the physician to coordinate medical services; controlling symptoms through physical, sociological, spiritual, and psychological care; and coordinating home care and inpatient care.

     When faced with a serious illness, understanding the implications and making decisions regarding the course of

medical treatment is often one of the few things patients can do to maintain a measure of control in their lives. Critical illnesses too often take decisions from you; the idea that you are no longer in control of your body is difficult to fathom; it can be unimaginably more frustrating when an insurance company takes away that control from you.

     Hospice care, and the PAL program, helps to put that power of control and decision making back in the hands of patients and their doctors. Patients can stand up and say what type of care they want and what care they do not want. Hospice home care allows patients to retain their independence and spend time with their families while receiving care to control pain and monitor their illness .

     Hospice home care also helps to control costs; home care is far more cost-effective than treating a patient in a hospital for along period of time. As we move into the next century and attempt to find strategies to prolong the life of the Medicare Trust Fund, home care is an option we must explore in greater detail.

     I am proud that Connecticut has again put itself out in front in the evolution of our heath-care system. From the start of the hospice movement, to ensuring that all patients have knowledge of and access to the options available, Connecticut has led the way. As we see the PAL initiative move into action, I hope that Connecticut will once again prove itself to be a model for the nation.