For decades, government and health care leaders have seen the United States’ expenditure on end-of-life care as a major problem. Often, the costs don’t translate into high quality care. Market dynamics are changing, and a rapidly aging population is forcing us to rethink these longstanding problems.

A term used to describe the support and medical care during the time surrounding death. Older adults with one or more chronic illness may need significant care for days, weeks, or even months before death.

Many of the same end-of-life care issues that were present in the past still exist today — there’s been relatively minor change over the past several decades. Most stakeholders would argue that the biggest issue is the spending on older adults near end-of-life. Other well-known, perennial problems include:

1. Confusion around hospice and palliative care

Many patients, families, and even clinicians, confuse hospice and palliative care. Palliative care is an umbrella term used to describe care that improves the quality of life and can be delivered across a lifespan. Hospice care is a type of palliative care that is provided at a specific time in life and is uniquely tied to a payment system. Confusion around end-of-life care options contributes to patients not receiving the care they need at the right time, and in the right place — increasing their chances of hospitalization.

2. Hesitance or resistance to hospice and palliative care

Clinicians, patients, and family members often postpone palliative care and hospice due to confusion around services and the stigma around death. For hospice specifically, there is hesitancy due to the innate desire to extend life and exhaust all treatment options. This reluctance to transition away from potentially curative treatments contributes to a lack of conversations between older adults and their providers about end-of-life care preferences. Avoiding conversations with providers about end-of-life care leads to under-utilization of hospice and palliative care services.

3. Difficulty generating revenue for palliative care under fee-for-service (FFS) payment models

Revenues generated by billing for palliative services are often insufficient to offset the costs of a program, and therefore palliative care has often been looked at as a loss leader for hospice volumes. The inability to generate revenue has also limited the use and access to palliative care services.