Health collaborative working to improve care, dignity for elderly Utahns

SALT LAKE CITY — It's not easy to discuss end-of-life care with parents, grandparents or patients, but encouraging those conversations and getting the decisions recorded properly is one of the goals of the One Utah Health Collaborative.

"None of us really want to talk about these hard things, wills, estate planning, advanced directives," Alan Ormsby said. "Remember that if incapacity happens, you're not able to do any of these things anymore."

Ormsby, the Utah director of AARP, is one of the people working on the initiative called "dignity in dying." He has worked on helping older Utahns for about 25 years, also serving as the director of the Division of Aging and Adult Services and of the Division of Services for People with Disabilities.

He encouraged people to have the courage to bring up that hard conversation while their loved ones are healthy.

Reducing waste through individualized care

Ormsby said the goal of the One Utah Health Collaborative was to make access to healthcare easier and more affordable to Utahns, which means identifying what is wasteful or too costly.

"Where medicine can be so fraught with challenges, it's just great to see really good people trying to make it better," Ormsby said.

He said this initiative focused on elderly Utahns is "low-hanging fruit" — everyone recognizes that healthcare costs go up. Half of all costs in the healthcare system are to care for 5% of the population using the system the most, and much of that 5% is older individuals.

"We all recognize that healthcare is too expensive; healthcare also has a lot of waste, a lot of things that people don't necessarily want," he said.

When Utah Gov. Spencer Cox announced the One Utah Health Collaborative in late 2021, he called it "one of the most transformative and visionary healthcare efforts" in the country. It is an effort to use collaboration and innovation among those involved in the healthcare sphere, rather than regulation, to fix problems.

The healthcare system is currently designed to give patients everything unless there are other instructions contradicting that, but Ormsby said most people say they would rather choose the care that matters to them, helping them keep their dignity. Through the dignity in dying initiative, healthcare leaders are considering which baseline services are offered, evaluating whether that is the best approach and asking how to help people get the care they want.

As its first step, the collaborative is creating a registry to help make the wishes of patients become more accessible to the physicians and emergency responders who may be caring for them.

Health documents to create

An advanced directive is the healthcare document Ormsby said everyone should consider creating — and it's easy. He suggests people fill out the documents while he's presenting on it, leaving them with a completed form immediately. The only requirement is a signature from the person it applies to and a witness. A free form is available online from the Utah Commission on Aging.

Ormsby said families may want to include a lawyer in the process of getting an advanced directive if there is a question about whether the person it would be for still legally has the capacity to make the decisions required. But, now, a lawyer is not typically needed.

People who are facing a specific condition with a higher possibility of needing to call 911 for help may want to also create an order for life-sustaining treatment, often called an OLST. In an emergency, first responders will not consider an advanced directive but instead are tasked with trying to keep someone alive and get them to a hospital for more care. They will, however, consider an order for life-sustaining treatment because it includes orders from a doctor who has considered the patient's health.

Orders for life-sustaining treatment need to be created with a physician.

Recent improvements

Over the last decade, Ormsby said he has seen moves to improve care for elderly Utahns — physicians are better at talking to people about end of life care, advanced directives are easier to obtain and there are more resources out there to help people make the decisions.

Now, when people are admitted into a hospital or other care facility, they are asked if they have an advanced directive, and if they don't, the facility also asks if they would like help creating one. In some situations, an order for life sustaining treatment is also brought up.

"I think Utah has done a lot of things right. … Not every state has an order for life sustaining treatment; we were one of the first. And it's been fine-tuned and I think better educated," Ormsby said.

He encouraged people to reach out to the area agencies on aging, something each county throughout the U.S. has, for specific advice, and said it is "the best kept secret in all of the aging process." People can be connected to the one closest to them by calling 1-800-677-1116.

Next steps

Already, people involved in the collaborative's dignity in dying initiative are looking for ways to help people know about the purpose of these documents and how to talk to their doctors about them.

Right now, he said the registry is waiting for funding to build the registry. Once they get it live, the next step will be making sure doctors and individuals are getting the orders for life sustaining treatment on the registry and available for emergency responders to look up. Emergency responders are not able to follow an order if they don't know about it or have access to it.

"I would say the ultimate goal is to reduce the waste that comes from not knowing what people's wishes are and in the process of that, enhance the dignity that a person has in their ability to say, 'This is what I want, and not what the system is going to push on me,'" Ormsby said.

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