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Six Things You Need to Know About End of Life Care
As healthcare in the U.S. advances, our medical model pushes to extend life, even if it comes at a high cost and sacrifices the quality of the patient’s remainder of life. However, with leading researchers and physicians speaking out about living life well until the very end, the conversation is changing. Medicare has even expanded its coverage to include advance care planning and launched a new care model to better serve its beneficiaries who are nearing death. The following observations focus on the latest developments surrounding care at the end of life:
- “End-of-Life Care” Can be Curative or Palliative or Both.
In defining “end-of-life care,” The Kaiser Family Foundation states that it includes “all health care provided to someone in the days or years before death, whether the cause of death is sudden or a result of a terminal illness that runs a much longer course.” The services provided as one nears the end of life may be delivered in hospitals, nursing homes, hospice centers, long-term care facilities, or a patient’s home. It is left to the patient and his/her loved ones to decide whether to pursue curative treatment or palliative care and when and if to change that course. It is common for patients and their loved ones to often revisit and adjust their treatment decisions during this journey, and studies among Medicare beneficiaries show that nearly one-half of all decedents experienced a healthcare transition in the last two weeks of life. - There is an Increase in Healthcare Usage in the Last Year of Life.
Estimates by the Centers for Medicare & Medicaid Services (CMS) show that healthcare spending on the elderly population in the U.S. is consistently rising. As medicine advances, new options are available to treat diseases more efficiently, aggressively, and intensely. In hopes of extending life, a large portion of the older generations pursues the medicalization of aging and disability. Over one-fourth of all Medicare expenditures for the elderly are comprised of end-of-life care services. A longitudinal study of adults age 65 and older showed that 51% of decedents visited the emergency department during their last month of life, with 77% of this group ultimately being admitted to the hospital and 68% of those who were admitted dying there. Medicare reports that an average of $33,500 was spent in 2011 on beneficiaries who died, which is almost four times higher than that spent on beneficiaries who did not die. - An Increase in the Aging Population Will Increase the Demand for Healthcare.
The oldest members of the “Baby Boom” generation have now passed age 65. With life expectancies at age 65 and age 85 increasing, the people who survive to those ages can now expect to live more subsequent years. As nearly 75 million Americans turn 65 by 2029, those needing access to healthcare will dramatically increase. Additionally, studies show that U.S. baby boomers have increased rates of hypertension, diabetes, obesity, and hypercholesterolemia. For hospitals, there will be many challenges of caring for an increased amount of elderly patients, particularly as a large amount of the same population retires from their jobs in the healthcare field, leaving a void. - End-of-Life Care Services Are Expanding and Reaching More People.
Nearing the end of life, many people find themselves spending their final days in a hospital rather than in their own homes as they may have wanted. The data from the CDC’s latest National Hospital Discharge Survey of 2.5 million deaths reveals that approximately one-third of deaths occurred in general hospitals. Among Medicare beneficiaries aged 65 and older, one-third of almost 2 million deaths occurred in the hospital, despite the fact that over 80% of these decedents reported that they wished to die at home. - There is Mixed Evidence that Hospice Use Reduces Costs.
Conventional thought about end-of-life care is that hospice care can help reduce high healthcare costs in the last year of life. However, it appears that the evidence supporting this thought is mixed. Recent studies show that while there may be a financial benefit for cancer patients to use hospice services, patients who die of other conditions may not experience reduced costs from hospice use. Typically, hospice decedents do spend less money in healthcare during their final month of life than non-hospice decedents. However, it appears that these final months’ savings are not reflective of the entire year—it appears that the majority of hospice decedents’ spending occurs prior to hospice enrollment during the last year of life. So, hospice users may spend less in their final days, but not necessarily in their final year. In fact, in many cases it appears that end-of-life costs were slightly elevated with hospice use. - Planning for the End of Life Leads to a Better Quality of Life near Death.
Most people do not reach the end of life suddenly; it is often a drawn-out result of one or more diseases that have been managed and endured for months or years. Openly addressing all of the patients’ options for curative and/or palliative care is vital for providing the patient with the best quality of life as they draw near to death. There is growing evidence that supports the effectiveness of palliative care for life limited patients and its contribution to improved quality of life. The IOM’s latest book about death in America cites several studies that suggest that palliative care has the capacity to do the following:
- “Improve information and communication, access to home care services, emotional and spiritual support, wellbeing and dignity, and care around the time of death
- Reduce depression, enhance quality of life, and increase survival
- Reduce critical care unit mortality
- Prevent emergency department visits, hospitalizations, and deaths away from home”