[Congressional Record Volume 157, Number 56 (Friday, April 15, 2011)]
[Extensions of Remarks]
[Page E737]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         INTRODUCTION OF THE PERSONALIZE YOUR CARE ACT OF 2011

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                          HON. EARL BLUMENAUER

                               of oregon

                    in the house of representatives

                         Friday, April 15, 2011

  Mr. BLUMENAUER. Mr. Speaker, today I am proud to introduce the 
Personalize Your Care Act of 2011.
  Advances in healthcare have led to increasingly complex health care 
decisions and more treatment options than we have ever before had the 
benefit--or the burden--of choosing between. Both Democrats and 
Republicans agree that individuals should be fully involved in 
decisions related to their own health care and should be able to make 
informed decisions about that care reflecting their values and their 
needs. We also agree that when people have expressed their wishes, 
particularly in a formal and legally binding manner, those wishes 
should be known and respected.
  While there is widespread agreement regarding these principles, too 
often this is not the reality. Most adults have not completed an 
advance directive; if documents are completed, they are not regularly 
revisited and can be difficult to locate. Because these issues are 
difficult to discuss, surrogates often feel ill-prepared to interpret 
their loved ones' written wishes.
  These shortcomings can leave families and healthcare proxies faced 
with the burden of determining their loved ones' wishes in the midst of 
crisis, sometimes with little or no information about how best to 
direct care. This adds not only stress and anxiety to an already 
difficult situation, but studies show that lack of advance care 
planning actually prolongs the grieving process after losing a loved 
one.
  One of the greatest misconceptions about advance care planning is 
that it is a one-time event. Attempting to plan for all possibilities 
in a single document or within a single conversation is overwhelming 
and, quite likely, impossible. Where possible, this should be an 
ongoing conversation. Careful, early advance care planning is important 
because a person's ability to make decisions may diminish over time and 
he or she may suddenly lose the capability to participate in his or her 
health care decisions.
  Successful advance care planning is less about legal documentation 
and more about facilitating ongoing communication about future care 
wishes among individuals, their health care providers, and surrogates. 
This approach recognizes that advance care documents like advance 
directives are not the ``ends,'' but the ``means''--they are the tools 
for documenting care preferences based on informed decisions that 
incorporate an individual's values, personal goals, and current 
circumstances.
  This process not only provides higher quality care, but personalized 
care.
  The Personalize Your Care Act aims to support advance care planning 
by providing Medicare andMedicaid coverage for voluntary consultations 
about advance care planning every 5 years or in the event of a change 
in health status. This periodic revisiting of advance care documents 
and goals of care recognizes that an individual's preferences can 
change over time. It also recognizes that the advance care plan should 
be updated if an individual develops a serious or chronic illness, if 
additional curative and palliative treatment options become available, 
and to consistently reflect the individual's current circumstances and 
preferences.
  Honoring the expressed wishes of individuals must also be a priority. 
For this to occur, advance care planning documents must be accessible 
wherever care is provided. The legislation ensures that an individual's 
electronic health record is able to display his or her current advance 
directive and/or physician orders for life sustaining treatment 
(POLST), so that his or her wishes are easily accessible and respected. 
Furthermore, under the legislation, advance directives would be 
portable, ensuring that advance directives completed in one state are 
honored in another state, in the event care needed to be provided 
there.
  The legislation also provides grants to states to establish or expand 
physician orders for life sustaining treatment programs. These programs 
have a track record of promoting patient autonomy through documenting 
and coordinating a person's treatment preferences, clarifying treatment 
intentions and minimizing confusion, reducing repetitive activities in 
complying with the Patient Self Determination Act, and facilitating 
appropriate treatment by emergency personnel.
  These investments in advance care planning will reinforce patient-
centered care--engaging individuals in planning and decision-making 
about their future care and ensuring that those preferences are 
documented, accessible, and can be honored in any state and in any care 
setting.
  I am proud to introduce the Personalize Your Care Act with the 
support of patient advocates, physicians, nurses, and the faith 
community who see every day how advance care planning improves 
individuals' and families' peace of mind and the quality of their care.

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