Hospital and Hospice

Care trends shift as patients and hospitals learn

Wheaton Franciscan Healthcare-St. Joseph started a palliative care program in 2004 with the goal of improving care for patients near the end of their lives.

The result: More patients are receiving hospice care in their homes and similar settings, and fewer patients are spending the final days of their lives in the hospital.

From 2003 through 2007, the hospital more than doubled the number of days that chronically ill Medicare patients received hospice care in the last six months of their lives.

The use of hospice care increased even more - 141% by the same measure - at Aurora Sinai Medical Center.

Most people would rather die at home, surrounded by loved ones, than in a hospital, attached to tubes and monitors. And a new report by the Dartmouth Atlas Project shows that those Milwaukee hospitals are part of an emerging trend to heed patients' preferences for the care they receive in their last days.

The growth in popularity of hospice care in the Milwaukee area, described here in a quote from a Sentinel Journal article, mirrors that in the rest of the U.S., as has been proven in studies like the Dartmouth Atlas Project and it's kin. While originally largely resistant, many hospitals now are embracing and integrating hospice care, partnering with area hospice programs or creating their own programs when others are not present. This bodes well for patients, as hopefully all will have a variety of choices for their end-of-life care, whether it be hospice or traditional medicine.

Conversations

Talking about hospice care

Caring Connections has always pushed for the best in end-of-life care, and their latest project is no difference. Titled, "Private Conversations and Public Discource: The Importance of Consumer Engagement in End-of-Life care," the report seeks to make public a subject that many, even those in health care, still find difficult to discuss. A Fort Morgan Times article has more details:

Private Conversations and Public Discourse is a call to action that encourages - and provides a framework for - a national agenda for consumer engagement in end-of-life issues. The call to action details eight specific areas that must be addressed, including:

Individuals need to talk about and document their wishes for care at the end of life.

Health care providers need to initiate honest, timely and culturally-relevant discussions with those for whom they are caring.

Policy makers need to eliminate barriers that prevent timely access to hospice and palliative care.

Employers need to support staff who are living with a serious illness or are caregivers or grieving.

The media needs to explore ways to demystify dying and help normalize the experience for the general public.

The stories of Karen Ann Quinlan, Nancy Cruzan, and Terri Schiavo are shared to help paint a picture of public discourse involving death. Past efforts to advance care at the end of life conducted on the national level are also cited.

The report was written and published by NHPCO`s Caring Connections, the organization`s consumer engagement initiative that provides free information on care, caregiving and community engagement. Funding for the report was provided by the Robert Wood Johnson Foundation, Princeton, New Jersey.

"Far too many people don`t have the information they need to make informed decisions about end-of-life care, " said Kathy Brandt, a senior vice president at NHPCO who leads Caring Connections. "We must not allow fear of the subject to discourage Americans from learning more and engaging in thoughtful discussions with family, loved ones, and healthcare professionals. The consequences of not understanding available choices are far more serious than many people realize."

People deserve the right to make informed choices about their health care, and without an understanding of those choices it simply isn't possible. Thanks to organizations like Caring Connections, more people will be able to make the choice that's right for them.

Cutting Hospice Costs Money

Hospitals cost more, have less benefits for many patients

When it comes time to tighten our collective belts, government officials are quick to slash the budgets of services like hospice care, but, as the state of Florida recently found out, there is no way around the fact that traditional hospital care is much more expensive. The Sun News reports:

A few months ago, the state decided it would save money by ending coverage of hospice care. The outcry was huge. You're being shortsighted, the opponents said. It will cost you more in the long run, they said. Caring for patients in hospice means fewer visits to the emergency room, where costs are much higher.

The opponents were all right, and the new director of the state Department of Health and Human Services quickly reversed the decision upon taking office in January, a triumph of common sense in a process that often lacks it.

Similarly, areas that are considering introducing hospice care programs worry about the initial costs, when the investment is proven to pay off over time both financially and in benefits to patients and the community.

Palliative Care Saves

Cost-effective and pain-killing? Yes please.

 Palliative care, a service very much like hospice care but for those who are not terminally ill, is a growing field but still quite misunderstood. The average patient does not know the difference, and as a result are often worried when a palliative care team approaches them. The reality, though, is that palliative care simply does a better job of coping with the actual symptoms resulting from serious conditions than traditional medical care. Much like hospice, palliative care reduces treatment expenses as well, as this quote from a Washington Post article explains:

A study in the March edition of Health Affairs found that Medicaid patients at four New York state hospitals who received palliative care on average incurred nearly $7,000 less in hospital costs per admission than Medicaid patients who didn’t receive palliative care. This study supports the results of a 2008 Archives of Internal Medicine study of non-Medicaid patients at eight hospitals that showed average savings of about $1,700 for those who survived a hospital stay and $4,900 for those who did not.

With the ever-rising cost of hospital care taking a toll on many, saving thousands of dollars per person is nothing to scoff at, not to mention the incredible benefits to patient and family.

A Special Loss

Grief is inevitable in the death of a parent

 A parent's death is a difficult time, and often brings a particular type of grief. In an article for Caring.com, Senior Editor Paula Spencer created a list of reasons why this "a Special Kind of Loss":

1. Our parents are our "wisdom keepers." "We spend a lifetime looking to our parents for answers," says psychotherapist Sherry E. Showalter, author of Healing Heartaches: Stories of Loss and Life. They're the repositories of knowledge about our history, our upbringing, family traditions, the names of all those faces in old photos. With their passing so, too, goes the information and insight that hasn't already been transmitted or recorded.

2. Unresolved issues often follow the parent-child relationship into adulthood. The balance of the parent-child relationship shifts several times, first as we gain maturity and create our own families, and then as parents grow older and often need our support. These realities bring plenty of opportunities for misunderstanding or discord. And not all these bumps are smoothed out by the end. Differences that go unreconciled can leave a forlorn sense of unfinished business, Showalter says.

3. Parent death always feels sudden -- even when it's not. People often expect that the death of someone older or someone who's been ill for a long time will feel easier to endure because it's predictable. Yet the disappearance from your life of a figure you've known since birth is, when it finally happens, always a sudden change.

4. Decisions about rituals are up to you. "Suddenly you're the adult preparing the funeral, the viewing, the obituary, the eulogy -- there's nobody older to tell you how to manage, no one to correct you or say, 'No, that's not how you do it!'" says one woman in her 40s who lost both parents within two years. "I felt pushed to a different level of adulthood."

5. Your children lose grandparents. Many people who lose their parents talk about "grieving for what won't ever be" -- being unable to ask their parents for parenting advice, for example, or having their parents attend their children's birthday parties, graduations, and weddings. Parents may also need to help their children mourn, or they may feel a need to preserve the grandparents' legacy for their children.

6. Losing the "buffer generation" forces us to reexamine our own mortality. When a grandparent dies, there's still a whole generation between you and death. With a parent's death, your own eventual demise may feel uncomfortably nearer.

While sadness is inevitable, hospice care can help by both improving quality of life and counseling the family before and after death, lessening the burden so that families and friends can better celebrate the life of a loved one.