Low-income individuals and families in New Jersey can’t participate in end-of-life planning because the state Medicaid program does not pay for this service. Thus, they can’t afford to consult with doctors and nurses to specify the medical treatment they want at life’s close.
Sen. Richard J. Codey (D-Essex and Morris) wants to change this by making New Jersey the third state in the country to have its Medicaid program reimburse providers for “advance care planning,” a term for consultations that determine such critical issues as when patients will be placed on life support or receive a feeding tube.
In addition to sponsoring a bill, S-2435, to do just that, Codey also introduced a resolution urging federal officials to reimburse this planning nationally through the Medicare program for seniors.
According to Donald L. Pendley, president of the New Jersey Hospice and Palliative Care Organization, advance directives and other documents that specify patient’s wishes are more common among wealthier residents. But Codey’s bill could help spur their use by a broader group.
The bill was released by the Senate Health, Human Services and Senior Citizens Committee last week.
“The best way to ensure that incapacitated patients are treated and cared for according to their wishes is to have medical directives prepared in advance,” Codey said in a statement.
He added that residents should have the ability to talk to healthcare providers, so they have the information they need to make these decisions.
The former governor noted that having government-sponsored programs adopt the change could lead to private insurers and doctors encouraging the practice. Colorado and Oregon are the only states that have adopted the change so far.
The issue has been politically charged since the debate over the 2010 Affordable Care Act, when former Republican vice presidential candidate Sarah Palin referred to the possibility of Medicare paying doctors to discuss end-of-life planning as creating “death panels.”
The New Jersey bill has drawn broad support from a variety of organizations representing healthcare providers.
Pendley believes that the state should do anything it can to encourage residents to talk more about their wishes at the end of life. “It’s always better that the family understands, or more importantly, that the patient gets what they want,” Pendley said.
“There are a million reasons why families and people don’t discuss end of life — I mean, we are a death-denying society,” Pendley said. “The more that we can do to orient the payment system for healthcare to reflect decision-making by the patient …” the better.
Another key supporter of the bill is Codey’s own sibling, Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey, a statewide coalition of Catholic providers.
“Catholic hospitals throughout New Jersey provide compassionate aid-in-dying to our patients each and every day in our hospitals and healthcare facilities,” she said in a statement, adding that her organization “respects both the sanctity of life and the healthcare mission of healing and caring.”
She said that ensuring that patients have the opportunity to discuss “their deeply personal end-of-life wishes with their doctors and caregivers” would ensure “dignity in the final stages of life.”
Chrissy Buteas, president and CEO of the Home Care Association of New Jersey, said the bill would expand the right of patients to make crucial decisions.
“Hospice providers are specifically trained to help patients and families achieve a measure of peace of mind in making end-of-life decisions,” she said. “We should be allowing them to provide that expertise to more patients. “
The New Jersey Hospital Association also supported the measure.
The bill was released on a party-line vote, with all five committee Democrats voting in favor and both Republicans present — Sen. Robert W. Singer (R-Monmouth and Ocean) and Sen. Dawn Marie Addiego (R-Atlantic, Burlington and Camden) –abstaining. Sen. Diane B. Allen (R-Burlington) was absent.
New Jersey Health Commissioner Mary E. O’Dowd has made end-of-life planning a priority, including by encouraging the development and use of practitioner’s orders for life-sustaining treatment (POLST), a form that carries the force of a doctor’s order in determining the type of care that patients receive.