Grant will help get end-of-life wishes online
By GINNY MERRIAM of the Missoulian
The worry that family and friends would have to make tough decisions under pressure in the case of accident or illness has spurred about 25 percent of Americans to draw up papers describing what they want.
But what good are those documents if they can't be found when you pull up to the emergency room doors?
It happens all too often, say collaborators in a new project to create an electronic repository for health-care advance directives. That would mean that doctors and other health-care providers could call up the patient's wishes on a secure Web site, even if the patient can't speak.
Toward that end, the Missoula Demonstration Project and nine partners have won a $461,180 grant to set up the Web site, called the Missoula Choices Bank. By the end of a three-year development phase, the public will be able to deposit advance directives through 26 "portals" around western Montana. Entries will be set up at each of the nine partners' offices and other locations, with staff available to help. In three years, they will serve about 25 percent of Montana's population.
The approach is a "home-grown, Missoula, local solution" that's unique among cities, Ira Byock, a founder and the principal investigator of the Demonstration Project, said at a press conference Monday at the Boone and Crockett Club.
"This is a national problem," he told a lunch gathering of those associated with the project. "It's a problem that affects every community and health system in the country."
"This is a unique approach," he said. "We're doing something important here, and I'm proud to be a part of it.
The immediate need for a copy of an advance directive comes up all too often, said the Rev. Dan Dixson, director of pastoral services at Community Medical Center. Dixson told of an 89-year-old man who was brought to the Community emergency room last spring after being found by a friend collapsed at home. He was given maximum life-saving procedures - CPR, breathing tube, intensive care - before hospital personnel finally reached his son in another city.
"What?" his son said. "But he had a living will."
The last the son had seen it, Dixson said, was in a pile of papers at his father's house.
"What a sad thing that Bob had to go through that," Dixson said. "And just because the advance directive was not available."
"Sometimes they're just not where you need them," he said.
Advance directives are documents that detail what a person wants at the end of life and designate someone to make decisions for them if they are too sick or injured to decide for themselves. The most common forms are a living will and the health-care power of attorney. They also can indicate organ donation and spiritual preferences. The Demonstration Project has a "My Choices" packet to help people develop their papers.
People avoid doing so, Byock said, because the subject is uncomfortable. However, 60 percent of people die in hospitals, and at least one-third have a stay in an intensive care unit in the month before death.
"We don't want to be a burden to our families," he said. "But we are a burden. That's OK. That's what families are for."
Money for the project came from a competitive application to the Technology Opportunities Program of the Department of Commerce National Telecommunications and Information Administration. The Demonstration Project and its partners pledged matching money and in-kind services of $462,340. The Demonstration Project's partners in the Choices Bank Project are Christ the King Church Parish Nurse Program, Community Medical Center, Hospice Care Foundation, Missoula Aging Services, Nightingale Nursing Services, Partners in Home Care, St. Patrick Hospital and Health Sciences Center and Western Montana Clinic.
The project director is Linda Tracy of the Demonstration Project. She will continue to convene its task force, which began as the Advance Care Planning Task Force two years ago and developed the "My Choices" packet.
After the three-year grant, the in-kind and money donations indicate that the Choices Bank can stand alone as a community-owned nonprofit entity.
"This is a remarkable demonstration of how collaboration can work," said Mark Hanson, Demonstration Project executive director.