Honoring Choices
Napa Valley
A community coalition actively supporting
improved advance care planning for
Napa residents
Robert Moore, MD MPH
Family Physician
Chief Medical Officer, Partnership HealthPlan of California
You Never Know When . . .
You Never
Know
When . . .
It’s always too early until it’s too late . . .
Advance Care Planning (ACP)– Why?
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
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Prevent Unwanted Pain
Prevent Unwanted Intervention
Reduce Stress and Depression for Families
We never know when an unexpected
catastrophe will occur
We need to have ACP discussions about
treatment options/decisions needed before we
become sick or injured
A community-wide problem

A community-wide solution
Honoring Choices Napa Valley

Vision:
o All adults in Napa County will receive health
care based on previously expressed personal
and cultural values and preferences regarding
aging, illness, and end of life care.
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Advance Care Planning as a Prevention Strategy
o How do we know this is possible?
Respecting Choices
La Crosse Wisconsin, Model:
Gundersen-Lutheran Health System
Honoring Choices Minnesota
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Four key strategic Components
1. Community engagement
2. High Quality Training
3. Continuous Quality Improvement
4. Build infrastructure
What is happening locally?
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California POLST (Physician Order etc.) form
Hospital Palliative Care Programs
Kaiser promoting ACP
Other programs to promote ACP in physician
offices
 Cancer case management and other case
management
 Latino elder coalition/Legal aid providing ACP
counseling to Latino population
Community-level Gaps
o High risk of not dying the way they want to
Community Engagement
Community Partners Include:
o Businesses
o Civic leaders
o Education Community
o Faith-Based Community
o Attorneys
o Service organizations
o Healthcare providers/organizations
Community Engagement
Core Goals of Community Engagement Strategy
o To Demystify . . . Taboo issues related to death and dying
processes in the twenty-first century
o To Inspire . . . Napa Residents to become more involved in the
end-of-life care decision-making process
o To Model . . . Ways in which families can discuss and embrace
end-of-life care planning
o To Support . . . Families with an on-line “tool kit” of video and
text tools
o To Prepare . . . Providers, caregivers and families alike to
make certain that individual choices are always honored
1.
Community Engagement
 HCNV
goal
o By 2020, we seek a significant shift in
the knowledge, behaviors and
attitudes of Napa County residents
regarding Advance Care Planning,
advanced illness, and the end of life.
 Community
Kickoff event
o September, 2013
What will success look like?

Regular conversations among families and
friends about options in health care at
different stages of life
 Most Napa County adults have completed
Advance Directives
 Regular review and discussion of Advance
Directives with clinicians, families, and
decision-making agents
 Consistent honoring of end-of-life wishes
What will it take for us to succeed?
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Build an effective coalition with
participation by dedicated leaders
Cooperate with each other (especially
health care providers)
Build project management capacity to
coordinate efforts
Implement local trainings for First Steps
facilitators
Secure funding or sponsorship for
facilitators
Coalition organizations

Napa Valley Hospice and Adult Day Services
 St. Helena Hospital
 Queen of the Valley Hospital
 Community Health Clinic Ole
 Kaiser Permanente
 Legal Aid of Napa Valley
 Veterans Home of California, Yountville
 Partnership HealthPlan of California
 Napa County Health and Human services
Individual coalition members

Leon Garcia, mayor American Canyon
 Mary O’Leary, RN
2. High Quality Training
o Partner: Coalition for Compassionate
Care of California
o Train the Trainer, October, 2014
3. Continuous Quality Improvement
Strategic Planning process identified
three initial focus areas:
1.
2.
3.
Residents of the Veterans Home
Senior Center/Retirement Facilities
Clients of estate planning attorneys
Reviewed Advance Directive options
Different Versions of Advanced Directive
 Easy to Read Version
 5 Wishes
 California Medical Association
 MyDirective.com
 Kaiser
 American Bar Association Durable
Power of attorney for Health Care
 Legal Aid of Napa
What is missing from Advance
Health Care Directives?
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Setting the stage: who am I?
Additional detailed wishes around end of life care
Special messages
“My Comfort Care Wishes and
Preferences—Supplementary
Information for Healthcare Agents and
Care Providers”
4. Building Infrastructure HCNV:
 Guiding
Principles
 Financial support
 Project Management
Guiding Principles
Hospitals, Health Care Organizations and
Providers may compete on other levels, but
we must agree not to compete on ACP, but to
work together.
Collective Promises:
1.
2.
3.
4.
5.
We will initiate the conversation.
We will provide assistance with advance care planning
We will make sure plans are clear
We will maintain and retrieve plans
We will appropriately follow plans
Financial support

In-kind support of all coalition members
 Napa Valley & Adult Day Services
 Napa Valley Vintners
 Other coalition partners
o St. Helena Hospital
o Queen of the Valley Hospital
o Partnership Healthplan of California
Project Management

Coalition members
 Coordinator: Kathie East
Mobilizing a Community
A Call to Action
Community-wide convening
o Engage emotionally and passionately
o Give a Vision of what the future can look like
o Include all sectors of the community
Key role of leadership
o Strategy
o Relationships
o Focus energy
Changing Values by Having a
Conversation:
“Why don't we die the way we say we
want to die? In part because we say
we want good deaths but act as if we
won't die at all.”
–Katy Butler, Wall Street Journal, 9/7/13
Honoring Choices
Napa Valley
www.HCNV.org
Questions?