1. 1 Life Planning /CHCF Philip Lisagor, MD, FACS www.TheROYL.com

2. 2 Where Are We? 10,000 Americans turn 65 every day and this will continue until 2031 This encompasses 78 million Americans born between 1946 and 1964/ aka Baby Boomers Baby Boomers are currently taking care of their parents and often of their children in today’s economy One in 5 Americans have advanced directives, and 1 in 5 of them have it available for 1/25

3. 3 Where Did We Come From? Egyptians, at least the wealthy, planned for their deaths in advance

4. 4 Ancient Hebrew Patriarchs So did the Hebrew Patriarchs: Abraham, Isaac and Jacob

5. 5 Greek Thoughts Greeks had Hades, abode of the dead Charon, ferryman, for the River Styx Coin placed in mouth of the dead to pay Charon

6. 6 How Did We Get to Today? Dissolution of extended family Belief in science and medicine Evolving complexities of everything!

7. 7 How Did I Get Involved? MD 72, University of Chicago Career in surgery/ general, thoracic, cardiac including thoracic oncology That means lung cancer! Long trip to actually talking with patients, their families and loved ones

8. 8 Why Don’t Doctors Talk to Patients? Not trained Had seminar with Elizabeth Kubler-Ross in Medical School, “Of Death and Dying” 5 steps of Grief Uncomfortable Dealing with failure Dealing with their own mortality Feeling they have nothing to offer Takes time and isn’t included in government or insurance billing codes

9. 9 Ostrich Effect

10. 10 Development of ROYL Rest of Your Life planning Toolkit for Doctors Aimed an End of Life Planning Expansion to Stakeholders Expansion to Rest of Your Life planning

11. 11 What is ROYL 1. comprehensive and integrated web app to facilitate Rest of Your Life planning 2. built in logic and knowledge to allow two year community college grad to assist 3. focused on HOME a. advanced care planning b. home modification c.home health monitoring and pharma compliance d. earlier home hospice as indicated 11

12. 12 How Does ROYL work? 1. increase patient engagement and autonomy a. ROYL family conference http://www.theroyl.com/planning-rest-of- life/medical/family-conference/ http://www.theroyl.com/planning-rest-of- life/medical/family-conference/ b. open dialogs and facilitate advanced care planning 2. Develop cadre of ROYL health assistants at each SNF, will interact upon admission for advanced care planning and at discharge to promote home modification, home health monitoring and pharma compliance and educate about real benefits of home hospice a. increased patient satisfaction b. decreased cost c. survival benefit of hospice over aggressive medical 12

13. 13 ROYL and Cultural Change and Paradigm Shifts 1. Cultural shift is possible, US birth experience a. needs health care and economic engines b. both currently exist in US Health Care 2. Paradigm Shift-needn’t have doctors, nurses and social workers do the patient, family, loved one interactions about ACP 3. ROYL is totally PATIENT CENTERED!! 13

14. 14 Benefits of ROYL Improved quality Improved patient/family/loved ones satisfaction Reduced cost of health care US #1 in cost US #7 in benefits Growth not sustainable (16% GDP currently Decrease hospital admissions and readmissions

15. 15 Risks of Failure to do ROYL Decreased quality Decreased satisfaction Increased costs-50 billion/year Someone will do planning for you, loss of patient autonomy Patient Fears Death panels argument Why? Who? Unnecessary Medical Treatments

16. 16 ROYL Legal documents Personalized information sheets Personalized process action check list Cultural Change-possible with current economic imperative of the graying of the boomers!

17. 17 WWW.TheROYL.com