End of life

Medicare May Be Spending Far Less on End-Of-Life Patients Than We Think

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 [...]

By |2018-10-11T09:32:44-04:00October 11th, 2018|End of life, Medicare|0 Comments

How The Battle Against Opiods Could Put Some Older Adults At Risk

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 [...]

By |2016-11-02T15:13:16-04:00November 2nd, 2016|Health Care|0 Comments

Are Seniors Getting Too Much Medical Treatment?

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 [...]

By |2015-11-02T10:04:54-05:00November 2nd, 2015|Health Care, long term care reform, Medicare|0 Comments

Americans Want Docs to Talk About End-of-Life.

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 [...]

By |2015-09-30T15:50:43-04:00September 30th, 2015|End of life|0 Comments

A New Way To Get Hospice Services Without Giving Up Aggressive Treatment

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, [...]

By |2015-07-21T17:46:44-04:00July 21st, 2015|End of life|0 Comments

The Death With Dignity Debate Misses The Point

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 [...]

By |2015-03-11T10:32:07-04:00March 11th, 2015|Aging, End of life|0 Comments

Hospice Is Becoming a Chain Business

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 [...]

By |2015-01-14T18:06:48-05:00January 14th, 2015|End of life|3 Comments

Should We Take Zeke Emanuel’s Advice And Be Ready To Die At 75?

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 [...]

By |2014-09-24T16:03:56-04:00September 24th, 2014|Aging, End of life|3 Comments

The Real Story Behind The Latest Hospice Controversy

The Washington Post published an extensive investigative story on hospice the other day. The take away: Hospices (mostly for-profits) are making big bucks by manipulating their case loads to maximize Medicare payments. In short, they are taking on many patients who are frail but not dying and thus staying on hospice care for a very long time. But the Post [...]

By |2014-01-03T14:40:23-05:00January 3rd, 2014|Care Coordination, End of life, Medicare|1 Comment

Almost one-in-five intensive care patients may be getting futile treatment

Almost one of every five patients in the intensive care units of a major teaching hospital got treatment that was futile  or “probably” futile, according to the doctors who treated them.  And older patients—especially those admitted from a nursing facility—were most likely to get care that does nothing to improve their quality of life, or even keep them alive for [...]

By |2013-09-11T17:38:02-04:00September 11th, 2013|End of life, Hospitals|2 Comments