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June 30, 2009

The Honorable Mark R. Warner

United States Senate
459A Russell Senate Office Building
Washington, D.C. 20510

Dear Senator Warner:

AARP is pleased to endorse the Senior Navigation and Planning Act of 2009 (S.
1263). This bill would help individuals and families better plan for their end-of-life
care needs before they are in a crisis and ensure that their wishes for care are

Most individuals and their families do not want to think about long-term care, let
alone the care and support they may need in the final stage of their lives. Yet we
need to have our families come together to have end-of-life conversations before
there is an emergency. Planning is simply essential to ensure that an individual’s
wishes for care are understood and respected at the end-of-life. It is also easier
for family members to have these conversations earlier and know their loved
one’s wishes when a time comes and they have to make decisions about care for
their loved ones who may not be able to speak for themselves.

This legislation would help educate the public about advance care planning, the
various legal documents and other end-of-life planning tools that individuals can
use to make their wishes known, and the availability of services such as hospice
and palliative care through a national education campaign, toll-free telephone
line, and other tools.

The bill also takes important steps to help train health professionals in palliative
care so they can give patients with advanced illnesses all of the information they
want and need about their treatment and care options. The bill also focuses on
enhancing advance care planning opportunities for Medicare beneficiaries such
as advanced illness care management that includes counseling, palliative care
consultation services, respite services and caregiver training; and requirements
for physicians to provide certain individuals with information on advance
directives and other end-of-life planning tools.

We are also pleased that the bill includes an Office of Medicare/Medicaid

Integration in the Centers for Medicare and Medicaid Services (CMS) that would
help improve care coordination and quality and reduce costs for individuals
The Honorable Mark R. Warner
June 30, 2009
Page 2

who get the care they need through both Medicare and Medicaid. These
individuals are often in poor health and have very high health care costs.

AARP supports the bill’s provisions to increase the use of physician’s orders for
life-sustaining treatment that translate the wishes of individuals with advanced
chronic progressive illness into medical orders that health care systems

Portability of advance directives is another important provision that

will help individuals receiving care in multiple states ensure that advance
directives executed in one state are honored in another state in which the
individual needs care. Honoring individuals’ expressed wishes must be a priority
regardless of where the care is provided.

Your bill recognizes the need to help ensure quality end-of-life care, informed
decision making by individuals and their families, and respect for individuals’
wishes. We look forward to working with you, as well as your colleagues on both
sides of the aisle, to advance these important issues. If you have any further
questions, please feel free to contact me, or have your staff contact Rhonda
Richards of our Government Relations staff at 202-434-3770.


David P. Sloane
Senior Vice President
Government Relations and Advocacy