Key Problems in End of Life Care

Quality and Cost Considerations for Healthcare Providers:

• Administration of effective advance directives that are understood by all family members, communicated to key family stakeholders and PCP and then followed when implemented
• Disease management programs that track diminishing returns as the disease progresses, and recognizes how to manage “next steps” in an open and frank manner that is coordinated with the primary care physicians
• Transparency in providing various treatment options to patients and how the simple to complex options can be weighed from a quality of care, cost and quality of life perspective
• Communication with the patient and family so that treatment options are understood clearly
• Communication and collaboration within the palliative care treatment team so that decisions are made and there is compliance with the treatment plan
• The need to achieve market differentiation based on a sense of humanistic and family-centered balance between caring and treatment considerations as perceived by patients, families and community

Financial Considerations for Healthcare Providers at Risk:

• In any given health insurance risk population, approximately 1% of individuals are at end of life and these beneficiaries account for nearly one-third of all health care expenditures.
• Nearly 30% of the Medicare budget is spent in the final year of life and this trend is expected to increase as the baby-boomer population ages.
• For those patients who wish to die with in-home hospice or in a hospice facility, reduced use of hospital at end of life has dramatic financial implications for the patient, their families and the healthcare system.
• Most people over 65 years of age are diagnosed with some form of chronic disease and the approaches to disease management can be improved from what is in place today.

Well-being Considerations for Patients, Their Families and Care Givers:

• Dealing with serious illnesses and end of life is fraught with emotional, physical and psychological problems that often prevent clear decision making to occur within traditional healthcare settings.
• Patients and their families want comfort and dignity, as well as appropriate care, and they want to be involved in what that means from both treatment and quality of life perspectives. Most people would prefer to be treated in advanced stages of illness and die at home or in a supportive hospice setting rather than in a hospital or on life support.
• As baby-boomers face issues coping with parents’ illnesses and frailty, often from a distance, as well as confront their own morbidity and mortality issues, the call for more support in considering options and resources is evident.
• Healthcare providers are not resourced for taking the considerable time and research involved in considering and supporting the patient and family in making timely and informed end of life decisions in line with their values, as well as religious and cultural beliefs.
• At advanced stages of chronic disease and terminal illness patients are often subjected to drastic and repeated medical interventions that are both painful and expensive and, while often well meaning, frequently inappropriate for someone who is at the end of treatment options and  close to death.
• Protracted treatment for serious illnesses and end of life can deplete family financial assets and compromise the physical, emotional and spiritual well-being of the family unit and caregivers.
• Navigating serious illness and end of life decisions and the psycho-social support that is provided have significant implications for both the quality of life for the patient during the final episodes of illness and for the burden of care – the longer-term emotional, psychological and physical health and stability of the family unit.