Death panels?

You may recall that during the recent prolonged health reform debate, opponents of the then proposals cited the inclusion of "death panels" as Federally mandated authorities who could deny Grandpa necessary care and instead, send him off to die in a, perish the thought, hospice.  Unfortunately, a debate that focused on governmental empowerment cast an unfavorable light on hospice care.  That was most definitely unfortunate.

Yesterday's Boston Globe included a piece regarding the significant (and concerning) finding that where you live makes a material difference to where you'll die.  And despite the fact that 80% of us would prefer to die with dignity, with the ones we love, and at home... in some locations that's less likely.  According to the article:

Researchers at the Dartmouth Atlas Project in Lebanon, N.H., analyzed the records of 235,821 Medicare patients ages 65 and older who died between 2003 and 2007. Overall, the researchers found that one-third of patients spent their last days in hospitals and intensive-care units. But there was a big range. At one end was Manhattan, where 46.7 percent died in the hospital. In contrast, 7 percent of cancer patients died in the hospital in Mason City, Iowa.

While chemotherapy and other aggressive procedures can prolong life and enable some cancer patients to return home and to work, studies have shown that these treatments have little or no value for frail elderly patients and those with advanced cancer. But 6 percent of patients received chemotherapy in their last two weeks of life, and the rate was much higher — more than 10 percent — in some places, the researchers found.

Similarly, more than 18 percent of cancer patients were placed on a feeding tube or received cardiopulmonary resuscitation in their last two weeks of life in Manhattan, compared with less than 4 percent in Minneapolis.

Use of hospice care also varied a lot. In at least 50 academic medical centers, less than half of patients with a poor prognosis receive hospice services, the researchers found. And in some hospitals, patients were referred to hospice care so close to the day they died that it was unlikely to have provided much comfort.

Some of these findings are understandable.  Hospitals and the physicians who work there are driven to heal and to save lives.  In the distant past, most of us expected that we'd someday die in a hospital.  Today, we'd rather not.  In the not so distant past, referrals to hospice were greeted by patients and their families as admissions of failure and generated disbelief and denial.  Fortunately, that is changing as a growing proportion of the public has positive hospice experiences with loved ones.

To learn more about hospice care, click here or call 781-569-2888.