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 [...]
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 now you know the story—or at least think you do: A nursing home nurse sees an 87-year-old resident in cardiac arrest and calls 9-11. Despite desperate pleas of the call center operator, the nurse refuses to do CPR and the resident dies. Except most of the story isn't true. Lorraine Bayless lived at a Bakersfield (CA) continuing care community called Glenwood [...]
More people over 65 are dying in hospice care and fewer are dying in hospitals. But this good news is tempered by a very different story. People are also being hospitalized more frequently in the last three months of their lives, are more likely to spend time in intensive care units, and are often receiving hospice care for just a [...]
Health policymakers love the idea of hospice. Yet Medicare seems to be learning exactly the wrong lessons from the success of the program, which provides well-integrated patient-centered comfort care to people with terminal illness. Instead of trying to understand why hospice is growing in popularity, Medicare is instead making it harder to enroll. As often happens in its regulation of [...]
Too many people make the dangerous roundtrip from hospital to nursing facility and back again. These transfers may increase risks of delirium, medication errors, falls, and infection. There is no doubt that some patients die as a result of these transfers. And, they cost payers—Medicare, Medicaid, and private insurance—hundreds of millions of dollars each year. The real tragedy: By some [...]
WBUR radio and Kaiser Health News report that the Massachusetts Senate has quietly approved a measure requiring doctors and nurses to discuss end of life options with patients who have a terminal illness. The Palliative Care Awareness bill was included as part of a sweeping health reform measure and, remarkably, was not controversial. It was supported by both Republicans and Democrats and [...]
I recently had the opportunity to participate in a panel on end-of-life care jointly sponsored the Charles E. Smith Life Communities in Rockville MD, Suburban Hospital in Bethesda, MD,, and Sibley Hospital in Washington, D.C. The session was part of a day-long program on care transitions and highlighted the special importance of caring for the dying. My fellow panelists and I brought a wide [...]
I am a huge fan of efforts to increase awareness of palliative care among physicians, health systems, patients and their families. And I wanted to pass on information about three major efforts to do that. The first is a landmark study by the prestigious Institute of Medicine on the importance of managing pain. The report, Relieving Pain in America: A Blueprint [...]
More than 8,000 general practitioners in the United Kingdom will soon begin displaying in their offices seven "end-of-life" promises to their patients. It is a great idea. According to an article in The Independent, every GP (much like primary care physicians in the U.S.) will post this end-of-life pledge on the wall of their waiting room. The Charter for End of [...]