How and where Americans die has drastically changed over time. Until the 20th century sudden death was the most common way to die, and home the most common place. After being superseded by hospitals for decades, home has reemerged as the most common place for Americans dying of natural causes.
Historically, stakeholders have been hesitant to address death and dying, but we cannot ignore these topics. The changes in means and location of death, along with our rapidly aging population, require better discussions about end-of-life care to reduce confusion around care options and enable the health care industry to meet patients’ needs, reduce costs, and improve quality. Here are three conversations providers, patients, and caregivers should be having about end-of-life care:
Better understanding of options can improve quality of care. When everyone involved understands what is possible, a person approaching death can have better relief of suffering—there is more respect for the individual’s dying wishes. Additionally, understanding the options and having better conversations around end-of-life care can lead to fewer ICU stays, fewer hospitalizations, and reduced utilization of treatments such as chemotherapy. However, societal fears about death and dying have kept stakeholders from realizing the benefits of end-of-life care.
Confusion around hospice and palliative care is a perennial problem—one that has kept many patients from receiving the right care in the right location. Both focus on the care, comfort, and quality of life of a person with a serious illness, but hospice is administered only when a patient has a prognosis of six months or less. Most patients in hospice care must also forgo curative treatments. A doctor or palliative care team will usually manage a patient over the course of treatment, transferring the patient to hospice care when appropriate.
The ability to continue receiving curative treatment during hospice care—known as concurrent hospice—is not a widely accepted. However, unlike the Medicare hospice benefit, the Veterans Administration (VA) does not require patients to end curative treatment in order to enroll in hospice (Sources: VITAS and NIH, Tricare).
Demographic and industry changes have pushed doctors to rethink how they consult with patients about end-of-life preferences. Some experts argue that today’s prevalent approach to advance care planning has fallen short, since patient preference often changes when faced with death. So, there is a push to not only start conversations with patients earlier, but also equip patients with the necessary tools to help make tough decisions in the moment. (Source: NYT)
Although advance care planning isn’t a perfect solution, it is the best current way to understand patient decisions before a health event occurs. Common components to advanced care planning include:
For more senior care resources—including our glossary on common terms related to senior care—go to advisory.com/seniors.
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