By Robin Stawasz
Anyone who was been working in healthcare, especially those caring for the seriously ill in any capacity, knows that we face a dilemma at the end of life. How do we balance the desire to keep someone alive with the desire to find comfort when the efforts to extend life cause discomfort? Most importantly, this conflict can cause undue suffering for patients when treatment options are unrealistic. But it also causes moral conflict for family members and providers, as well as takes up resources that could do a greater good somewhere else.
We have tried to address this conundrum through policy and education efforts. This includes the hospice benefit itself as well and advance directive promotion, payment model innovation, and palliative care expansion. However, the issue persists. According to the recent JAMA article, the Case Western Study found 58% of people in the community – and 64% of people in nursing homes – received aggressive treatment in the last 30 days of their lives. 25% of people in the community and 40% of people in nursing homes died in the hospital. Instead of trying more of the same – which has been shown to be not as effective as we need it to be – what else can be done?
Concurrent care could make a big difference. When the choice for a family is either treatment or palliation, most will choose treatment for many reasons. We need make the choice unnecessary. Allowing treatment to co-exist with hospice or increasing the reimbursement for non-hospice palliative care to make it more powerful will allow families to transition from different focuses across time, not at a single point, which reflects how this priority transition actually occurs. It also allows a care team to continue to care for their patients, not turn them over to someone else when they need them the most. We can make a difference, but we need to be allowed to do the work the right way.
If you would like to talk more about End-of-Life Care, Acclivity is here for you – please contact us.
Source Material: “Aggressive Medical Care Remains Common at Life’s End” by Paula Span posted by The New York Times on March 14, 2023 (https://www.nytimes.com/2023/03/14/health/end-of-life-care-hospice.html)