Transforming End-of-Life Care

SUMMARY

Health care near the end of life should be based on each patient’s wishes rather the assumption that patients want aggressive, costly care.

The last year of a person’s life is often physically painful, emotionally lonely, and shockingly expensive. Most Americans would prefer to die in the familiar surroundings of their home, surrounded by friends and family, rather than in a hospital or nursing home.

The reality is that millions of Americans don’t have their wishes honored. Instead, they receive costly and aggressive medical treatment at the end of their life that only marginally, at best, increases their life expectancy – often at the expense of their quality of life. But in some areas of the country, end of life is managed much more in accordance with patients’ wishes through a coordinated system of patient-first advance directives and advanced illness care planning that appropriately directs medical personnel.

The result is far less hospitalization, far fewer ineffective treatments, and as a by-product, far less expense. These areas can serve as a model for how to reform a piece of our health care system in a way that protects patients and significantly drives down costs for Medicare and the rest of health care.

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