End of Life Care- A Consumer Issue We Need To Talk About

Americans don’t like to talk about death.

When the Affordable Care Act was created we had a heated discussion about the provision that provided doctors with compensation for discussing the end-of-life care for their patients. Those opposing the law (and everything else about it) introduced “death panels” and “pushing grandma off the cliff” into the discourse. The public fell for it, and the section was eliminated from the law. We didn’t want to talk about it anymore.

Well, the Institute of Medicine has resurrected the discussion with its release of the 500 page report “Dying in America.” In it, the IOM attempts to highlight how our existing health care system is woefully unprepared to address the influx of deaths we should expect with an aging population and why it’s only going to add unnecessary costs to an already bloated health care system.

Here’s some facts to think about:

·         In 2011 we spent over $550 billion on Medicare. Of that amount, approximately 28% was spent during the last 6 months of life and 32% was spent during the last two years of life.

·         A study of patient inpatient hospital costs during the last two years of life found huge variations in costs between hospitals. At Mayo Clinic the inpatient costs were $53,000 while UCLA spent $93,000 and New York University spent $105,000. There was no difference in quality of life or outcome (all patients ultimately died.)

·         According to research at Dartmouth, while most patients would prefer to die at home, nearly 55% ended up dying in the hospital.

·         While most Americans believe it is important to talk to their families about their end-of-life preferences, only 30% have written instructions (Advanced Directives) on what they are.

Bottom-line: Health care costs are greatest at the end of our lives (which is no surprise). While we know it is important to document our end-of-life preferences, very few have actually followed-through and outlined what we want. While most would prefer to die at home (or a setting other than a hospital), the majority of us will end-up dying in the hospital- and the costs to Medicare or our families will be dependent upon which hospital we go to.

Even though we may not want to talk about it- death is a reality. Our health care system is not equipped to predict our preferences when we are no longer able to communicate what they are. Health care will throw all its resources to prolonging a life no matter what we would have wanted. This only adds to the emotional and financial costs associated with the event.

Talking with family and executing an Advanced Directive is part of the role the new health care consumer will need to play. It’s about accountability and direction for ourselves and for our family members who will be making difficult decisions on our behalf.

This isn’t “pushing grandma off the cliff.”  This is making easier for those we care about. We need to talk about it.