Category Archives: End of Life Care

The Cow Skull, Airport Security, and Lessons Learned from My 13 Years at The John A. Hartford Foundation

Rachael Watman shows off her prized cow skull, as a passing plane causes dog Rebel to wonder how the skull ever got through airport security.

Rachael Watman shows off her prized cow skull, as a passing plane causes dog Rebel to wonder how the skull ever got through airport security.

In May, I will leave The John A. Hartford Foundation to become the Vice President of Programs at the Rita & Alex Hillman Foundation. Naturally, I’ve spent time reflecting on my 13 years here. I’ve learned many lessons, gathered best practices, and worked with some of the smartest people in the nation.

The memory that stands out, however, involves a cow skull.

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Talking with Patients about End-of-Life Care:
New Poll Reveals How Physicians Really Feel

advance_care_talk_shutterstock_280364744_400pWe are excited to announce a new national poll released today that shows physicians clearly understand the importance of talking with older adults about end-of-life care, and that they overwhelmingly support a new Medicare benefit that reimburses them for holding advance care planning discussions with patients.

Very importantly, the poll also provides valuable insights into some of the barriers that keep physicians from having advance care planning conversations. The survey of primary care and specialist physicians in 50 states was supported by The John A. Hartford Foundation and our wonderful partners at the California Health Care Foundation and Cambia Health Foundation. We will delve even further into the barriers we uncovered, as well as strategies for overcoming them, with a series of interprofessional focus groups of health care providers later this year.

CHCF Logo_300pThe survey released today—Conversation Stopper: What’s Preventing Physicians from Talking with Patients about End-of-Life and Advance Care Planning?—opens a window to the personal views, feelings, and even fears of physicians concerning some of the most sensitive and important interactions they have with patients.

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Three New Grants Totaling $6.7 Million Represent Powerful Opportunities to Improve Care of Older Adults

From right, Amy Berman, John A. Hartford Foundation President Terry Fulmer, Jon Broyles of C-TAC, and Bud Hammes of Respecting Choices engage in a convening held in June 2015 by JAHF on “End of Life and Serious Illness.”

The John A. Hartford Foundation’s dedicated staff is constantly monitoring the dynamic health care landscape to identify powerful opportunities for large-scale change that will result in better care and better lives for all older adults. I am very pleased to announce that our Trustees last week approved three new grants totaling $6.7 million that leverage these opportunities.

One of the keys to effective grantmaking is to partner with innovative leaders at the very top of their fields. That is certainly true of the Foundation’s new grants.

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End of Life and Serious Illness:
A John A. Hartford Foundation Change AGEnts Issue Brief

This is the third in a series of seven issue briefs.

This is the third in a series of seven issue briefs.

The John A. Hartford Foundation Change AGEnts Initiative accelerates sustained practice change that improves the care of older adults. It does this by harnessing the collective power of The John A. Hartford Foundation’s interprofessional community of scholars, clinicians, and health system leaders.

In December 2015, nearly 100 John A. Hartford Foundation Change AGEnts gathered in Philadelphia, PA to identify challenges and opportunities for improving care of older adults in several care settings and issue areas. Each group worked toward identifying actionable areas for John A. Hartford Foundation Change AGEnts, the Foundation, and colleagues in the field to pursue. The brief below represents the summary of the End of Life and Serious Illness group’s proceedings and should inform future work to create widespread and systemic changes in the care of older adults.The other issue briefs will be published on Health AGEnda over the following weeks. 

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Medicare’s Advance Care Planning Payment
Is a Game-Changer

Amy Berman, on a recent trip to Hawaii. "I have done so much more than survive. I have thrived."

Amy Berman, on a recent trip to Hawaii. “I have done so much more than survive. I have thrived.”

The end of October marked five years since I was diagnosed with stage IV inflammatory breast cancer, a life-limiting disease. A small fraction of people (11-20 percent) in my situation survive to five years.

Clearly, I have survived. But I have done so much more than survive. I have thrived. I still work and enjoy a great life. I feel good. And unlike most people with my medical condition, I’ve never been hospitalized—no surgery and none of the combination infusions. I take medication to hold back the cancer but, with my team, I choose treatments with the least burden and side effects. And this has helped me thrive!

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An Open Letter to CMS: Medicare Rule Covering
End-of-Life Conversations Would Be Lifesaving

Amy Berman prepares for her single, larger dose of image-guided radiation therapy.

Amy Berman prepares for her single, larger dose of image-guided radiation therapy.

Editor’s Note: The following open letter to the Centers for Medicare & Medicaid Services, written by Senior Program Officer Amy Berman, was originally published by the Washington Post on Sept. 28, 2015. To read the article on their site, please visit A nurse with fatal breast cancer says end-of-life discussions saved her life. 

To: Centers for Medicare & Medicaid Services:

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Honoring the Wishes of Nursing Home Residents

This is the third in a series of six Health AGEnda posts on the 2014 Annual Report.

This is the third in a series of six Health AGEnda posts on the 2014 Annual Report.

Editor’s Note: The John A. Hartford Foundation’s 2014 Annual Report features five profiles of Hartford Change AGEnts whose work is representative of the kinds of practice and policy change the initiative is making. Read Harnessing the Power of Hartford Change AGEnts for more on the Change AGEnts Initiative. In the coming weeks, the Health AGEnda blog will spotlight the stories and videos of the other Hartford Change AGEnts profiled in the Annual Report. Today, we meet Mercedes Bern-Klug, PhD, MSW, who received a Hartford Change AGEnts Action Award for an interdisciplinary approach to working with two Iowa nursing homes to ensure that older adults’ wishes regarding life-sustaining treatments are followed under the state’s IPOST law.

Making sure that the wishes of nursing home residents are respected regarding health decisions has been a focus of Dr. Mercedes Bern-Klug’s career, especially as it relates to end-of-life decisions.

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Focusing on the Health Goals of Older Adults

Missed_Target_400pThis week we offer a poignant story of one physician’s struggle to understand what he could do to help his aging and ailing new patient. Written by Dr. Mitch Kaminski, and originally posted on Pulse, a leading narrative medicine website, this true tale makes the point that if we don’t understand a person’s own personal health goal, we are unlikely to achieve it.

We are unlikely to help them.

The John A. Hartford Foundation is deeply committed to aligning care by all health care providers to address the goals of older patients. As people age and become much more medically complex and frail, well-intended treatments may not help with pain or function. The treatment may create new problems and burdens.

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Grappling with the Tough Questions of How We Live—and Die

SeniorsRoses_400pI think it would be safe to say that most of us have trouble facing our own mortality. The idea that tomorrow isn’t promised fails to get many of us to actually live that way (I know I’m guilty).

Longer term and more connected to the John A. Hartford Foundation’s  work, we don’t like to think of ourselves as “old”—let alone dying—and we don’t plan well for futures that will likely include the need for long-term care or services later in life.

Our health care system and policies reflect this short sightedness, as well. That’s why it’s been refreshing to see some provocative writing about these issues over the past few weeks that might help us all think and do more to live our final years in old age the way we would want.

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Dying in America: There Must Be a Better Way

DyingInAmericaCover400pLast week, the Institute of Medicine released a new report titled Dying in America.

The committee that worked on the report included some long-time grantees and friends of the John A. Hartford Foundation,  such as June Simmons  of the Partners in Care Foundation, Jean Kutner, a Beeson Scholar  and faculty member at the University of Colorado, Diane Meier, leader of the Center to Advance Palliative Care, Patricia Bomba  of Rochester, NY’s Excellus Blue Cross/Blue Shield, and Joan Teno of the Center of Excellence in Geriatric Medicine at Brown University.

As always, we are proud to be associated with leaders who give their time to explore such urgent issues.

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