Better Care at the End of Life: What Can We Do?

On January 3, 2013 Dr. Ezekiel J. Emanuel published an opinion piece in the New York Times titled “Better, if Not Cheaper, Care”. His article addressed long held beliefs about end of life (EOL) costs and care and what we can do. Dr. Emauel put some holes in my view and attitude toward EOL and those of others. At the same time he supported a film I want to produce on palliative management and hospice care.

First, he pointed out that people do not spend more on healthcare in their last year of life than they do in the entire rest of their lives. Fact, 6% of Medicare patients who die each year do make up the majority of costs in the range of 27 to 30%. This figure has not changed in decades.

Recent studies show hospice may reduce costs in the last year of life for cancer patients by 10 to 20%. But they find no savings from hospice care for patients who die of other causes such as emphysema or heart failure. This may be because patients are entered into hospice care too late or the cost of labor intensive care.

Dr. Emanuel points to the need to change end of life care. Many Americans die in hospitals when the choice is to die at home. The ICU still accounts for 20% of deaths or post discharge with many patients experiencing symptoms such as pain that is controllable with appropriate palliative care.

 Four points are presented that will improve end of life care.

  1.  Train HCP how to talk to patients and families about EOL care.
  2. Pay physicians for a one time talk about EOL care.
  3. Every hospital should be required to have palliative care services. He notes that over 40% hospitals with greater than 50 beds do NOT have palliative care services.
  4. Revise eligibility for hospice care. The decision to enter palliative care is made on 6 months to live basis. It should be changed to need for specialized care such as pain management.

 First, this article opened my eyes to the reality and complexity of end of life care. I need to adjust my thinking about how we approach EOL and what we can achieve.

Secondly, the four points made to improve care can be achieved and will make a difference. These points support a new project I am producing. I want to make a short documentary film about my experience with palliation and hospice care and those who have not received it. My goal simply put, is to create a platform that opens a dialog between the following groups to improve decision-making during serious illness.  

  • ·      Patients and family
  • ·      Healthcare professionals
  • ·      Patients and healthcare professionals

I believe a film like this will aid this discussion—without tension—and in a way that evokes a positive response. We want to make it easy and productive to discuss palliative care, end of life, and hospice. We want to improve care and optimize time and quality of life

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