Every senior, every parent of a child with a disability, every advocate for seniors and every elder law attorney should stop today and say a prayer of gratitude for the life and advocacy of the man I’ve been proud to call my senator. He was the author of over 300 bills and the critical sponsor of countless others, whose topics included but are not limited to:

  • Medicare
  • S-Chip — expanding health insurance coverage for children of the working poor
  • Medicaid
  • Meals on Wheels
  • The Ryan White AIDS Act
  • The Americans with Disabilities Act
  • Funding for research on cancer, mental health, developmental disabilities, stem cell research, Alzheimer’s,
  • The Family and Medical Leave Act
  • The Older Americans Act

not to mention the countless number of actions he has taken on behalf of seniors and people with disabilities in Massachusetts. His constituent service work was legendary, and every advocate in Massachusetts knew that calling his office would result in action.

Teddy… you will be deeply missed.

Does your assisted living facility have an evacuation plan?

Now here’s good thinking — the head of a retirement community where I practice has started up a mutual assistance program for assisted living facilities and nursing homes. 170 Massachusetts facilities have signed on to help each other take in residents and share resources in the event of fire, prolonged energy outage, flood, etc., etc. This idea can keep a lot of frail elders out of emergency rooms and Red Cross shelters during crises.

So, when you are looking for a facility for yourself or a loved one, ask the admissions director whether it belongs to the Massachusetts Long-Term Care Mutual Assistance Association — and if they don’t, whether the facility plans on doing so by the time your loved one moves in. If the answer to both questions is “no,” consider going elsewhere.

On Social Security? No raise for you!

Ouch…. For the first time in over 30 years, Social Security will NOT be giving retirees a cost-of-living increase (COLA) for 2010. Most beneficiaries will not see a change in their Medicare Part B premiums; however, for about one-quarter of all beneficiaries, Medicare Part B premiums — normally automatically deducted from your Social Security check — will increase from the present $96.40 per month to an estimated $119 per month. It is also highly likely that Medicare D premiums for prescription drug coverage will go up for everyone.

Well, the scare tactics work in the short term (updated!).

The same folks who rammed the Schiavo legislation through in 2005 have tanked the proposal to have Medicare pay for a voluntary conversation about end-of-life options, now claiming that government shouldn’t be involved in end-of-life decision making. Chuck Grassley, the ranking member of the Senate Finance Committee said yesterday

“I think the best thing to do is if you want people to think about the end of life, number one, Jesus Christ is the place to start, and after that, in the physical life, as opposed to your eternal life, it ought to be done within the family and considered a religious and ethical issue and not something that politicians deal with,” he said.

This afternoon, the Senate Finance Committee has announced that Medicare funding to discuss advance directives will not be included in any package. However, the sharp-eyed Amy Sullivan notes at Time’s Swampland blog that

Remember the 2003 Medicare prescription drug bill, the one that passed with the votes of 204 GOP House members and 42 GOP Senators? Anyone want to guess what it provided funding for? Did you say counseling for end-of-life issues and care? Ding ding ding!!

Let’s go to the bill text, shall we? “The covered services are: evaluating the beneficiary’s need for pain and symptom management, including the individual’s need for hospice care; counseling the beneficiary with respect to end-of-life issues and care options, and advising the beneficiary regarding advanced care planning.” The only difference between the 2003 provision and the infamous Section 1233 that threatens the very future and moral sanctity of the Republic is that the first applied only to terminally ill patients. Section 1233 would expand funding so that people could voluntarily receive counseling before they become terminally ill.

And guess who voted for this measure? Yup — Senator Grassley.

Setting aside my feelings about this truly magnificent degree of hypocrisy for the moment, I will try to look on the bright side — seldom in my fifteen years of practice have I heard so much conversation at the national level about living wills, health care proxies and advanced directives. If the shouting encourages more people to contact attorneys to make sure that they have legally appropriate documents in place, perhaps something good will come out of it. I hope some people have learned that if they don’t have advance directives and a health care proxy in place, the default position for doctors is to do everything to keep someone alive, no matter what. And perhaps if the issue has become so politically toxic that it must be removed, some good things will be enacted into law.

Maybe this issue will be revisited in the next legislative session, when the flame-throwing has died down.

Text of the advance directives section of the health care reform act

The text of H.R. 3200, section 1233 can be found here.

We need to take the issue back from those who have hijacked it in order to torpedo health care reform. Many elder law attorneys have advanced directives tailored for Catholics, Christian Scientists, Orthodox Jews, etc., etc., which reflect a given faith’s particular teachings. The bill simply encourages these voluntary discussions by ensuring that Medicare will pay for them every five years.

When the truth doesn’t serve your goals, scare them to death.

Section 1233 of the House health care reform bill provides Medicare funding so doctors can be paid for a voluntary conversation with elders, who can be given “an explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.”

Now, you may not agree with the health care reform bills. You may not even agree that it’s needed or desirable. But are the national Republicans and their pals in talk radio so intellectually and morally bankrupt that they’ve resorting to this reprehensible garbage in an effort to kill health care reform?

But on right-leaning radio programs, religious e-mail lists and Internet blogs, the proposal has been described as “guiding you in how to die,” “an ORDER from the Government to end your life,” promoting “death care” and, in the words of antiabortion leader Randall Terry, an attempt to “kill Granny.”

People need facts to make informed choices. Doctors and nurses are trained to present information about options for treatment in a manner which encourages patient autonomy. Whether the medical provider personally agrees or disagrees with your decision is not legally or ethically relevant. What is relevant is that the patient receives the data needed which in combination with one’s own religious or moral viewpoint, will lead to an informed choice; and then have well-drafted advance directives which communicates that choice with treatment providers and loved ones included with your estate plan. Not only will you get the care that you want to have, but you make sure that your loved ones aren’t forced to go to court to seek guardianship in order to authorize such care.

But then, what we’re seeing is the opposite of intellectual honesty.

The attacks on talk radio began when Betsy McCaughey, who helped defeat President Bill Clinton’s health-care overhaul 16 years ago, told former senator Fred D. Thompson (R-Tenn.) that mandatory counseling sessions with Medicare beneficiaries would “tell them how to end their life sooner” and would teach the elderly how to “decline nutrition . . . and cut your life short.”

House Minority Leader John A. Boehner (R-Ohio) and Republican Policy Committee Chairman Thaddeus McCotter (Mich.) said they object to the idea because it “may start us down a treacherous path toward government-encouraged euthanasia.”

Remember, these are many of the same people who rammed a measure through Congress endorsing the State of Florida’s effort to keep Terri Schiavo alive, arguing that the legislature should interfere with the acts of her legal guardian and the courts because she didn’t have a living will. So, by this shameless logic, paying doctors to have voluntary discussions with their patients about medical options and advance directives leads to earlier, state-sponsored deaths, but it’s perfectly all right for legislators to interfere with the most painful discussion a family can have because there was nothing in writing to tell a doctor what to do.