The word hospice originated from the Latin hospitium, which means “to host or offer a place of shelter.” In 2009, an estimated 1.56 million patients, more than 40 percent of deaths, received hospice services in the United States. But many others who might have benefited from hospice care did not seek services, perhaps due to misconceptions, fears and the lack of information of patients, caregivers and even physicians.
“Hospice is a collection of services that are designed to support the patient and family through the course of a serious or terminal illness,” said Donald Schumacher, Psy.D, president and CEO of the National Hospice and Palliative Care Organization (NHPCO). The aim of hospice is to provide physical and emotional care and comfort in the months, weeks and days before death.
It’s often hard for patients and their loved ones to acknowledge that the time to consider hospice care has come. People come to that realization differently and there are some that might never seem to face that the end of life is near. But through the ups and downs of emotions and physical status, hospice team members Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
Sending dementia patients to the hospital could overwhelm the health care system and not offer them any better care at the end of life, researchers noted.
The researchers obtained data on all hospitalizations involving a dementia diagnosis for the 85 years and older group between years 2000 and 2008 from the nationally representative Nationwide Inpatient Sample database, a part of the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project.
Annual hospitalization data came from the U.S. Census Bureau. They projected the future volume of hospitalizations involving a dementia diagnosis in the 85 years and older group two ways, Read more »
*This blog post was originally published at ACP Internist*
Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously dysfunctional either/or approach to palliative care and hospice we’re stuck with in this benighted country.
The problem is that in order to qualify for hospice, patients must not only have a certified life expectancy of less than six months, but they must also not be undergoing any active treatment for their malignancy. When you stop to think about it, though, this is actually quite discriminatory. We don’t require people on hospice with other diagnoses to discontinue their life sustaining medications. Patients with COPD are allowed to continue their bronchodilators; CHF patients don’t have to stop their ACE inhibitors and digoxin. But if a cancer patient wants to qualify for hospice, they have to forgo curative treatments like chemotherapy.
So what if the oncologists call it “palliative” chemo instead? Read more »
*This blog post was originally published at Musings of a Dinosaur*
We’ve reached the second half of our discussion on Bending the Cost Curve in Cancer Care. The authors of the NEJM paper, Drs. T. Smith and B. Hillner, go on to consider how doctors’ behavior influences costs in Changing Attitudes and Practice. Today’s point on the list: “Oncologists need to recognize that the costs of care are driven by what we do and what we do not do.”
In other words (theirs): “The first step is a frank acknowledgment that changes are needed.” A bit AA-ish, but fair enough -
The authors talk about needed, frank discussions between doctors and patients. They emphasize that oncologists/docs drive up costs and provide poorer care by failing to talk with patients about the possibility of death, end-of-life care, and transitions in the focus of care from curative intent to palliation.
They review published findings on the topic: Read more »
*This blog post was originally published at Medical Lessons*
One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea.
Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re good to go.
Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year. Read more »
*This blog post was originally published at Movin' Meat*