By Craig Dresang, CEO, Yolo Hospice
Originally published in The Davis Enterprise
One of the great challenges for those of us who work in the field of hospice is that many healthcare providers don’t have end-of-life discussions with their patients and families. Sometimes, and too often, those important conversations happen when the patient is just hours or days away from death. There is a significant cost of not having these conversations – doing things that are not aligned with patient goals and wishes that can result in unwanted medical procedures or treatments.
A 2012 survey conducted by the California HealthCare Foundation, revealed that 80 percent of Californians say that if seriously ill, they would want to talk to their doctor about end-of-life care. However, only seven percent of patients in our state have had an end-of-life conversation with their physician.
In July of this year, the Federal program that insures 55 million older and disabled Americans released a piece of news that is music to the ears of hospice organizations. The Centers for Medicare and Medicaid took the bold and compassionate step of announcing its plans to recognize end-of-life-counseling as a medical expense. That means Medicare intends to pay doctors, nurse practitioners, and physician assistants to have face-to-face conversations with patients about end-of-life care.
It also means that more patients will have the opportunity to choose whether and how they want to be kept alive if they become too sick to speak for themselves. This plan comes as many patients, families and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by artificial means.
There are many reasons why these conversations don’t happen. Many healthcare professionals are not properly equipped or trained to have them. They require more time and preparation. Some providers don’t fully understand the benefits of hospice care. And, according to an Institute of Medicine report called “Dying in America” and a committee of medical and bioethics experts, the U.S. needs to overhaul its system of end-of-life care because it is currently flawed. Among other things, it can reward healthcare providers for delaying hospice admissions and performing unnecessary procedures.
For patients this means too many deaths marked by unwanted breathing machines, feeding tubes, toxic drugs, and other treatments that may not extend or improve quality of life. The end result is often prolonged pain and suffering for patients and their families.
Patients should decide for themselves where they want to die and under what circumstances they want life-sustaining treatment. These conversations, which can be documented and kept in medical records and with family members, are an important part of high quality and patient/family-centered care. Documents such as a Physician Orders for Life-Sustaining Treatment (POLST) and Five Wishes will reduce confusion at end-of-life, giving patients more control and freeing families from tortuous decisions.
When healthcare providers feel that there is nothing more they can do for their terminal patients, there is, in fact, more they should do. They can have these important conversations, and when appropriate, help guide their patients into the compassionate, dignified circle of care we know as hospice. It’s time to take seriously the overwhelming research that demonstrates how patients live longer and experience a higher quality of life when they receive hospice care earlier in their terminal diagnosis. A study conducted by the National Hospice and Palliative Care Organization has shown that patients who receive hospice care actually live an average of a month longer than those with a similar diagnosis who do not access hospice.
Medicare’s new and welcome policy change, slated to take effect on January 1, 2016, should help foster a different level of quality in the fabric of our healthcare system.