New Rules for End-of-Life Planning and Palliative Care in NJ

Ron Marsico | January 30, 2020 | Health Care
The laws are designed to ensure that patients ‘get the care they need and no less, and the care they want and no more’
Credit: NJTV News
End-of-life and palliative care issues have gained more attention, as increasing numbers of baby boomers reach their senior years.

New Jersey continues to push its aging population and care providers to have one of life’s most difficult conversations: considering end-of-life and related palliative care options.

Legislation recently signed by Gov. Phil Murphy, building on goals of the New Jersey Governor’s Advisory Council on End-of-Life Care, means that medical facilities must implement plans to discuss end-of-life issues with patients and provide staff training (S-3116).

And emergency-room personnel are required to address palliative care options with seriously ill patients (S-3117).

Advocates of these efforts point to a Dartmouth Atlas of Health Care 2018 finding that patients nearing death in New Jersey undergo the nation’s most aggressive medical treatments, often at odds with the individual’s personal desires and high financial costs.

Lori Feldstein, CEO & executive director of Goals of Care Coalition of New Jersey, praised state officials for making the bills law, along with another one in December to further promote public awareness of these issues.

“These new laws requiring education and training about palliative and hospice care, and the importance of advanced care planning, are a critical step toward ensuring that patients get the care they need and no less, and the care they want and no more,’’ said Feldstein.

Information for patients and families

Taking effect in July, S-3116 specifically requires administrative and professional staff at hospitals, assisted living, long-term care facilities and nursing homes to receive yearly training on advanced and end-of-life care planning. They must provide patients and/or their families such information, including about Physician Orders for Life-Sustaining Treatment policies such as resuscitation and feeding tube decisions.

End-of-life and palliative care issues have gained more attention in New Jersey and across the country in recent years, as increasing numbers of America’s baby boom generation — those born between 1946 and 1964 — reach their senior years. Given the often awkward reticence among patients, their families and medical staff to discuss end-of-life care, state officials are intensifying efforts to promote conversations to increase awareness and help improve individuals’ quality of life in their waning days.

New Jersey ranked 9th nationally in 2018 among states with  seniors age 65 or older, with that category anticipated to grow nearly two-thirds by 2030, according to the Advisory Council on End-of-Life Care. Those 65 or older in the United States totaled 46 million in 2018, a figure expected to balloon to nearly 100 million in just the next 40 years, the council noted.

“People have to know there are options for them during their end-of-life planning,’’ said state Sen. Teresa Ruiz (D-Essex), a prime sponsor of both measures.

“When you’re faced with a challenge like that,’’ continued Ruiz, “it’s best to have medical professionals offering you everything that’s available.’’

Bipartisan support

Murphy signed both bills — which had overwhelming bipartisan support — into law last week amid a flurry of activity at the end of the prior legislative session. The state Department of Health is charged with adopting rules and regulations for medical facilities to implement plans to discuss end-of-life issues with patients.

Dawn Thomas, a DOH spokeswoman, said that while it is premature to discuss specifics, state health officials “will be talking with stakeholders to inform the drafting of rules to implement this legislation.’’

“We still have much work to do to ensure that people get the care that they want at the end of their lives,’’ said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute.

Schwimmer explained the institute is leading an initiative in 14 counties, titled “Conversation of Your Life,’’ to “educate residents and give them the necessary resources to create advance directives and discuss their care plans and wishes with their providers and family.”

Palliative care involves treating chronically, seriously ill patients to help reduce their pain and suffering, not the cause of their sickness.

Taking effect in August, S-3117 requires hospital emergency departments to provide information on palliative care to patients who would benefit from the option. Last summer, another law was enacted to have DOH set up a program to promote awareness and participation by improving access to New Jersey’s existing palliative and hospice care programs.

“Sometimes people turn to emergency rooms to receive medical relief from a serious illness that could be better managed through palliative care,’’ said state Sen. Nancy Munoz (R-Union), another sponsor of both bills.

Assessing the options

Treatments to counteract the underlying cause of a patient’s illness can be given in conjunction with palliative care, which would be used to help reduce side effects, but not with end-of-life care.

End-of-life options can include hospice care at home or at a facility, usually where life-saving treatments have ceased and the goal is to improve patients’ comfort — typically within the final six months of terminal illness cases.

In its November 2018 findings, the Advisory Council on End-of-Life Care declared: “The need to improve the current state of end-of-life care delivery in New Jersey by establishing patient priorities and defining goals of care both through effective communication and better utilization of palliative care is urgent.’’

The council added, “Changes are needed to reorient care for those with advanced serious illnesses to be aligned with the real wishes and preferences of patients and families.’’

Feldstein, the head of Goals of Care Coalition, added, “Our state is not very different from many other parts of the country, where our population is aging.’’