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Preparing for Life’s ‘What-Ifs’

Kaiser Permanente grows its Life Care Planning service with a goal of putting patients at the center of their care decisions.

Kaiser Permanente members Tony and Guadalupe Perez have been through a lot together. Married for 40 years, they’ve faced Tony’s life-threatening leukemia, complications from an ensuing bone marrow transplant, and his struggles with diabetes, kidney failure, and heart disease.

After Tony was hospitalized at the Kaiser Permanente Medical Center in San Jose in February, he completed the stage of Kaiser Permanente’s Life Care Planning program that is designed for people with chronic illness who are experiencing a decline in health. Kaiser Permanente Northern California offers the Life Care Planning service to help members think about, discuss, and document their wishes around future health care decisions with a goal of receiving care that aligns with their values and beliefs.

The Life Care Planning conversation the Perezes had with Kaiser Permanente staff included a discussion of the progression of Tony’s illnesses, potential complications, and specific life-sustaining treatments that could be offered.

“I have a point a view about life,” Tony said. “If I can no longer eat, and I can no longer move, I think at that point I would rather have them let me go. I don’t want to be in a life-support situation.”

Achieving Peace of Mind

Tony Perez is one of more than 23,000 Northern California members who have documented their wishes using an advance health care directive through Kaiser Permanente’s Life Care Planning process. The program was implemented across Northern California last August. More than 600 Kaiser Permanente nurses, social workers, health educators, physicians, and volunteers have been trained as facilitators to help members complete the process.

With National Health Care Decisions Day coming up on April 16, Kaiser Permanente’s Regional Life Care Planning Managing Director Melissa Stern said she hopes adults of all ages, healthy or ailing, will take the first step in the process. It begins with choosing a loved one or trusted friend to serve as a health care agent — someone who can speak for you if you’re unable to do so because of illness or injury.

“Almost 50 percent of people who approach death are not able to speak for themselves in those last weeks or days. Too often other people make the decisions to guide their care often not knowing what their loved one would want,” Stern said. “We’re trying to help our members and families achieve some peace of mind about these incredibly important decisions.”

San Jose Program Shines

Some Kaiser Permanente medical centers, such as the one in San Jose, have made Life Care Planning part of regular appointments for end-stage kidney disease and heart failure patients. Kaiser Permanente San Jose received a regional Vohs Award for Quality for its Life Care Planning work.

Assistant Physician in Chief Ruma Kumar, MD, said the medical center’s study of patients who completed Life Care Planning found they opted for less procedural interventions and had fewer complications than end-stage kidney disease and heart failure patients who had not had the Life Care Planning conversations.

“Helping patients understand their disease more fully enables them to make decisions that are in line with their values. With Life Care Planning, the health care team knows what’s important to each of our patients, so we can honor their wishes.”

She added that research shows that the planning also reduces anxiety and stress for patient families.

“I see this as one of the greatest gifts that patients can give their loved ones.”

Kaiser Permanente members and the general public can go to the Life Care Planning site to learn more about the process, start the process, or download an advance health care directive.