After a half-century as a Medicare benefit, hospice care still has had only limited success in improving the quality of patients’ lives as they approach their deaths. While more people are enrolling in hospice (about 1.7 million in 2020), they often do so only days before dying. Thus, they fail to benefit from the best of what hospice has to [...]
I’ve recently spent more time as a hospital visitor than at any time since the pandemic began. A lot has changed since Covid-19, but my experiences confirm some good advice for older patients, their families, and the medical staff that cares for them. Here are a few ideas for patients and staff. While they focus on hospitals, many apply to [...]
You probably have heard the statistic: One-quarter of Medicare spending is for patients in the last year of life. It is cited as a major reason for excessive medical spending in the US and leads to a widely-accepted conclusion: If only we would stop “wasting” dollars on futile care for those who soon will die anyway, we could significantly slow [...]
There is no doubt that the widespread over-use of opiods has become a serious public health problem in the US. But I worry that older adults with palliative care needs may become unintended casualties of efforts to reduce the use and accessibility of these powerful drugs. The opiod problem is real. Nearly 30,000 Americans died from use of these drugs [...]
Older adults are getting too much medical treatment. No, I am not suggesting we ration treatment for seniors or empower the mythical death panels. Rather, the health system should replace aggressive but ultimately useless medical interventions with more care. This means rethinking the way we care for older adults with chronic disease. We should organize care around the goal of improving their quality of life rather than on [...]
The public overwhelmingly thinks doctors should have end-of-life conversations with older patients. It even thinks Medicare ought to pay for those talks. It just doesn’t want to have them, at least not yet. Those are results of a new Kaiser Family Foundation poll, which found that 89 percent of respondents felt physicians should discuss end-of-life choices with them. But only [...]
A new Medicare pilot program will make it easier for patients to access some hospice benefits without giving up standard medical treatment for a terminal disease. It is an important step towards building a health system that fully integrates social, spiritual, and palliative care such as pain management with health care. But it doesn’t get all the way there. Today, [...]
Ever since the death of Brittany Maynard--the 30-year old with terminal brain cancer who ended her own life last November-- the issue of physician-assisted suicide has received an enormous amount of attention. Now it is back in the headlines as many states consider laws permitting the practice. It is an important and passionate debate, but for the vast majority of people, it misses [...]
Large multi-agency, multi-state hospices are fast become the primary source of end-of-life care in the U.S. According to a new study, chains cared for nearly half of all hospice patients in 2011, a dramatic increase from a decade before when small organizations (mostly non-profits) provided three-quarters of all care. And my own review of their financial reports suggests the biggest chains [...]
In a recent article in The Atlantic, entitled “Why I Hope to Die at 75,” Ezekiel Emmanuel makes the following provocative argument: I am not interested in living beyond age 75 since I am likely to suffer from functional limitations and will no longer be able to contribute much to society. I will not accept curative medical treatment, only comfort [...]