PALTC23 Conference Recordings SA11 Interdisciplinary Ethics Panel Approach to End-of-Life Decision-Making for Unbefriended Nursing Home Residents

Interdisciplinary Ethics Panel Approach to End-of-Life Decision-Making for Unbefriended Nursing Home Residents

This session, based on our recent Journal of Clinical Ethics article, presents an Interdisciplinary Ethics Panel approach to end of life (EOL) decision-making for unbefriended nursing home (NH) residents, lacking decisional capacity, via a 9-step algorithm, developed for this purpose. It reviews outcomes of 3 quality-of-care (QOC) initiatives conducted in our facility, a public NH home in NYC with a large unbefriended population, which indicates this approach promotes advance-care planning in this subpopulation. It also reviews another QOC initiative when this approach was successfully applied to EOL decision-making for NH residents with surrogates during the COVID-19 pandemic. Upon completion of this session, participants will be able to apply this approach in situations as described.

Learning Objectives:

At the completion of this session, learners will be able to:

  • Make a determination of decisional capacity based upon the evidence-based Appelbaum model for decisional capacity.
  • Explain the psychosocial determinants of health prevalent among the unbefriended in this large public nursing home and how these factors influence the end-of-life decision-making process.
  • Apply this novel interdisciplinary ethics panel approach to the end-of-life decision-making for unbefriended nursing home residents without decisional capacity, as well as to nursing home residents who lack decisional capacity but have surrogates.
  • Describe the major approaches to the end-of-life decision-making for the unbefriended without decisional-capacity in our country and to explain why the framers of the Algorithm for the Unbefriended selected an interdisciplinary team approach.

Ravindra Amin, MD

Ravindra Amin, MD, is the chief of psychiatry at Coler Rehabilitation and Nursing Care Center, which is part of New York City Health + Hospitals, the largest public health care system in the US. He has championed the practice of Psychiatry in the PA/LTC setting for over 20 years. He teaches Geriatric Psychiatry fellows of NYU School of Medicine. His team received the Howard Gutterman Award for the best poster at AMDA 2014 for their quality improvement work to reduce unnecessary antipsychotic medications.

Howard Finger, DO

Howard Finger, DO, is attending physician and clinical ethics consultant at Coler Rehabilitation and Nursing Care Center and at Henry J. Carter Specialty Hospital and Nursing Facility. He was co-chairperson of the NYC Health + Hospitals Bioethics Council from 2019 to 2022, and currently, he serves on the board of direction of the Empire State Bioethics Consortium (ESBC) and is a member of the AMDA Ethics Subcommittee.  In conjunction with the Bioethics Council, he developed an Algorithm for the Unbefriended to assist care teams in making end-of-life treatment decisions when patients lack both decisional capacity and surrogates, which he applied at Coler. He was lead author of three articles on the subject, the latest of which, “An Interdisciplinary Ethics Panel Approach to End-of-life Decision-Making for Unbefriended Nursing Home Residents,” was published in the 2022 summer issue of The Journal of Clinical Ethics.  For his work, Dr. Finger received the 2020 Foundation for Post-Acute & Long-Term Care Medicine’s Quality Improvement & Health Outcome (QIHO) Award for improving the quality-of-life for persons living in nursing homes.

Rani Rao, MD, CMD

Rani Rao, MD, CMD, is Medical Director of Primary care service line for New York Presbyterian Queens Medical Group. Her previous role was Chief Medical Officer for Coler/NYC Health+Hospitals. She is a board certified internist and geriatrician who is fellowship trained in medical ethics at U Chicago McLean Center for Clinical medical Ethics. She has been a speaker in various national forums including annual PALTC meetings and Corser symposium for bio-ethics. She was awarded Medical Director of the Year 2023 by PALTC. She is a member of the PALTC Ethics committee.

  • 1.0 CME
  • 1.0 CMD Management 
  • 1.0 MOC

Release Date: 03/29/2023   |   Expiration: 03/01/2026

Credit Statements:

Accreditation: Post-Acute and Long-Term Care Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

CME Designation: Post-Acute and Long-Term Care Medical Association designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CMD Credit Hours: This CME activity has been pre-approved by the American Board of Post-Acute and Long-Term Care Medicine (ABPLM) for up to 1.0 management hours toward certification or recertification as a Certified Medical Director (CMD) in post-acute and long-term care medicine. Each physician should claim only those hours of credit actually spent on the activity.

The CMD Program is administered by the ABPLM. Each physician should claim only those credit hours that he/she actually spent in the activity. For further information, contact ABPLM at 410-992-3117 or at cmd@paltmed.org.

ABIM Maintenance of Certification (MOC): Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 Medical Knowledge MOC points and patient safety credit in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.

Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Financial Disclosure Statement:

The Association requires the disclosure of all speaker/faculty/planner’s relevant financial relationships; presence of off-label use of a device or medication; and discussion of any experimental, new or evolving topic prior to each accredited education activity.

If the learner perceives any bias toward a commercial product or service, advocation of unscientific approaches to diagnosis or therapy, or recommendation, treatment, or manners of practicing healthcare that are determined to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients please report this to the Association's staff.

The following speaker(s) disclosed relevant financial relationship(s): 

  • Julie Gammack, MD, CMD (Planner & Speaker): Stockholder: Amarin
  • Kenya Rivas Velasquez, MD, CMD, FAAFP (Planner & Speaker): OptumRx: Stockholder
  • All other planners, speakers, and AMDA staff have no relationships with ineligible companies.

All relevant financial relationships have been identified and mitigated.

Components visible upon registration.