A Call for End of Life Care Reform

According to a recent report, Dying in America, issued by the Institute of Medicine, the US health care system needs to overhaul its treatment of end-of-life care to focus less on acute care and more on palliative care.

Usually received in hospitals, acute care is the active but short-term treatment of severe injuries or episodes of illness. Palliative care focuses on improving the quality of life for patients with serious illnesses by relieving symptoms, discomfort and stress, either at home or in a health care setting. A 2010 study in New England Journal of Medicine demonstrations that terminally ill patients who receive palliative care live longer (in the case of this study two and a half months longer) than those who don’t.

Hospitals are currently motivated to provide acute care which often turn out to be costly and poorly suited to the needs and preferences of patients. Many elderly patients nearing the end of life would like to receive care at home, but as in this case of a daughter trying to bring her hospitalized father home, sometimes power-of-attorney and your loved one’s lucid wishes aren’t enough to achieve home-based palliative care.

In order to improve access to palliative care, the report committee recommends that the federal government and health care policy makers provide health care facilities with financial incentives to 1) use medical and social services that decrease the need for emergency room and acute care, 2) coordinate care across multiple care settings (e.g. patient’s home, hospice, nursing home), and 3) use advance care planning and shared decision making practices.

The report committee posits that improving access to palliative care will connect patients nearing the end of life and their families with medical services that are more in line with their needs, care goals, and values as well as reduce their health care spending.

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