Moore first notes that Medicare will spend $17 billion on a losing battle: preventing death. Other statistics include that 30% of Medicare's costs are spent in the last year of life, 50% of people die in the hospital, 20% of which are in ICU beds which cost 10 times as much as the daily rate for hospice. It might be easy to blame this on the government or other societal giants. But Moore notes, "we ask to be checked in. We are the problem."
Moore's view of hospice is a bit simplified. We've all experienced patients that do not want to sign a DNR, that do not want to discuss their wishes with their families (or vice versa), and that will never admit that they are going to die. For the sake of the article though, Moore makes her point. Hospice allows patients and families to have a say. Hospitals often do not. That again is a large generalization as there are MDs, God bless them, that are willing to have the tough conversations with families.
"Asking doesn't happen often enough, say medical experts who specialize in care for the dying. Terminally ill patients and their families need to make end-of-life choices, but they're often not asked to make them in a hospital setting. When no one asks, and no one answers, guess what? Hospitals provide aggressive, life-extending care."
I have to address one sentence in which she writes that "If you spend your last days in hospice care, your family can come and go." As I stressed to a family on the phone today, hospice does not provide custodial care. Neither will Medicare. Hospice can do continuous care or in-patient hospital stay for symptom management and respite to give the family a break. True, there are hospices that abuse continuous care, whom shall remain nameless, but when it comes down to it, families or a family hired caregiver are the ones on the frontline. There are no hospice homes in my area but it appears that most of them have guidelines about who can come to stay, either they are financially destitute or they are in the active dying stage. Someday hope my organization will have a hospice home. I think it can be a vital piece of the puzzle.
The article looks a lot at the financial cost of end of life care. And that's something we should be aware of given our health care crisis. I really think the larger issue is our attitude toward death itself. The saying goes that the only things we can be sure of in this life are death and taxes. I would say most Americans fear both. This article can hopefully be the start of a greater conversation. We need to tell our loved ones what our wishes are concerning our health, no matter how young or old we are now. We need to examine the life we live now. And if we are given a terminal diagnosis, we need to compare quality of life versus quantity of life.