In an article that has received a good amount of advanced press, today’s Journal of the American Medical Association publishes research findings on end of life care, or more particularly, utilization of hospice care. The article, entitled, Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009, shares the findings of research seeking to determine changes in site of death, place of care and care transitions for Medicare decedents between 2000, 2005, and 2009.
Research results indicated that while more individuals aged 65 and older are dying at home, their utilization of intensive care services (i.e., hospital ICU) during the last month of life increased (29.2% of decedents utilized ICU in 2009). In addition, 11.5% of decedents in 2009 had three or greater hospitalizations during the last 90 days of their lives. And while hospice use increased, upwards of 28% used hospice services for three days or less in 2009.
A key finding of the research is that increased use of hospice may not lead to a reduction in resource utilization. The authors believe their findings could, “raise concerns that hospice is an ‘add-on’ to a growing pattern of more utilization of intensive services at the end of life.” Hospice providers hoping to avoid the sequestration axe take note: while your inherent value proposition of improving the quality of life, while easing the individual pain and family burden associated with end of life care is invaluable, getting paid for your efforts in this environment also requires demonstrable cost savings.
As I have written here before, the Death Panels moniker given to us courtesy of Sarah Palin has been a tremendous disservice to encouraging open and candid discussion on the personal, social and economic challenges of dealing with end of life care. But I see a huge opportunity here for hospice providers – and the trade associations that represent them – to seize this important initiative back from politicians and elected officials.
They should use this opportunity to take a leadership role in creating a national framework for encouraging candid dialogue, open sharing of concerns, fears and ideas – and for advancing policy initiatives that encourage knowledge and education regarding the alternatives available to individuals and their families facing end of life decisions.
Oscar Wilde wrote that, “life is too important to be taken seriously.” Well, I posit that death is too scary to run in fear from.
Cheers,
Sparky
Sparky's Policy Pub 
It has been my experience that many people having honest and frank discussions and making decisions for all of us about death and end of life care, are people who are not facing death or end of life. Since my husband was diagnosed, several years ago, we knew this kidney disease would kill him, because it is so rare, there is no information on how long it will progress, however the time (for which I am grateful and blessed to have) has afforded a unique opportunity, for both of us, to accept death as a part of life. At first it we worried ourselves silly over it, then we ignored it for awhile, then as my husband started to accept that things were not going to be the same for him ever again, he started to do some research. Since then we have been able to make some valuable decisions about what is acceptable to him when the time comes, what sort of treatments he will pursue and what he expects his quality of life to be. Why do I tell you this long story? Because I think everyone should have these discussions with their loved ones, parents, children, partners… without fear and in complete honesty. I have friends who say things like “don’t talk about that, ” or “that’s silly, he has a long life ahead,” or my favorite “he’s too young to be that sick.” They are in denial of their own mortality, and when their time comes, it is going to hit them like a freight train. I believe if regular folks could start a grass roots discussion of death and end of life care, it may filter up to policy makers and decision makers. It seems to me that only in America do people look at death as something to fear, which is why the majority of people could not accept Dr. Kevorkian and the European model of end of life self determination. On a small scale we have start chipping away at that stigma of death, so that people can start making their own decisions about the end of their lives and the kind of care they would like to receive, or not receive. Organizations like Hospice, which incidentally was a beautiful blessing to my family when my grandma was dying, would be able to do more to keep folks at home with their loved ones at the end if people were more mentally prepared. People get scared and go to hospital, because they think that is the place to be for the best care, even though Hospice can help you at home. Recently a friend of my husband’s lost her battle with cancer, Hospice was there for her, so she could stay at home, but she was person who refused to accept the inevitable, and last minute left home to go to the hospital, where she died surrounded by doctors, instead of family. Sometimes fighting to the end isn’t bravery, it is an exercise in futility, once we can change our perception as individuals of death, then a change in policy on end of life care can be effected. This is a huge leadership opportunity for a paradigm shift on this topic, I look forward to some changes in our society as we evolve.