As the nation’s 75 million baby boomers continue to flood the U.S. healthcare system, requiring greater levels of treatment in the process, some medical professionals believe that one area of specialty is underexplored by doctors and patients: end-of-life care.
A 2015 study by the National Hospice and Palliative Care Organization (NHPCO) found that about 1.6 million patients received hospice care in 2014, including patients who had been under hospice care during the previous year. According to the Centers for Disease Control and Prevention, there were nearly 2.6 million deaths in the United States in 2014.
And while the CDC figure includes accidental deaths, suicides and infant deaths, many patients who could have benefited from end-of-life care and planning didn’t receive it, a Mid-South healthcare expert said. Cultural views on mortality often play a role – for physicians and patients – in this disconnect.
“A lot of people don’t like to think about this topic because they view it as planning for death, but in actuality dying only takes about five seconds,” said Jeri Ashley, system director of life planning and palliative medicine services at Baptist Memorial Health Care. “Before that is all living, so we want to help people plan to live well until those five seconds come. But the truth is, those five seconds can come at any time.”
For Ashley, end-of-life planning, which includes creating a living will and making decisions about future hospice or palliative care, should be initiated early. In fact, she recommends this type of planning for all patients, regardless of health condition, beginning at age 18.
“The simple truth is that we’re all going to die at some point and you never know when an accident or a debilitating illness will intervene and hasten that process,” Ashley said. “We want to take the fear out of death through life planning and encouraging patients, at whatever stage of life and at whatever health level, to make those plans known to their families and doctors. In the United States, 50 percent of those approaching the end of life are unable to make medical decisions on their own, and pre-planning would help with that.”
However, despite the fact that hundreds of thousands of patients who could benefit from hospice and palliative care do not utilize those services, hospice care is trending upward, according to the NHPCO report.
For example, Medicare claims from 2001 showed that 18.8 percent of end-of-life patients accessed hospice care for three or more days, but by 2007 that figure had grown to 30.1 percent. Of those Medicare patients with a cancer diagnosis, 36.6 percent used hospice services in 2001, and by 2007 the figure was 43.3 percent.
A more significant increase in hospice care was reported for patients diagnosed with advanced cognitive impairment and dementia. In 2001, only 14.4 percent of Medicare patients with such diagnoses received hospice care for three or more days, but that figure swelled to 33.6 percent by 2007.
But hospice care is not limited to geriatric patients, and it does not always result in time spent in treatment facilities, said Rod Robinson, assistant administrator and director of home care and hospice at Baptist.
Numerous factors affect how long patients use hospice services, including disease course and access to care, but the average length of service in 2014 was 71.3 days. Locally, the average stay is a bit shorter.
“Hospice can take place in homes, which is where most patients want to die, or in hospice beds in hospitals or in hospice residential facilities,” Robinson said. “Our average stay in a facility is 22 days, but in-home programs average 65 days. We love to have them as long as possible to help them prepare.”
Helping patients cope with end-of-life issues is gaining greater traction in the Mid-South, said Dr. Clay Jackson, medical director at Methodist Hospice and Palliative Care. And that’s an encouraging trend for patients and healthcare systems.
“Over the last decade I’ve noticed a robust increase in both inpatient and outpatient palliative care in our area,” Jackson said. “This is important because palliative care can increase life spans by up to 25 percent in some cases and help people live better and longer.”
That upward trend mirrors national palliative care practices.
A 2014 report by the Center to Advance Palliative Care (CAPC) discovered that palliative care teams in hospitals with 50 or more beds grew from 658 in 2000 to 1,734 in 2012. Figures indicate that today nearly 8 in 10 U.S. hospitals that have 50 or more beds have palliative care programs.
Palliative may be used concurrently with hospice care, Jackson said, but may also be exclusive. Palliative care is intended to help patients get relief from serious and/or chronic illnesses and improve quality of life at whatever stage the patient may be in and may be used in addition to curative measures.
“The benefit for the patient is greater quality of life, and that is also an enormous benefit for family and friends,” Jackson said. “There is also the benefit to the medical system and providers because it can decrease costs and improve quality and create a more efficient system of treatment.”
He is also clinical assistant professor, Department of Psychiatry, at the University of Tennessee Health Science Center, where the school started a fellowship program in 2007 that focuses on palliative care.
From one fellowship at the beginning, the program now offers four such fellowships each year and has trained 15 doctors to date in subspecialties of hospice and palliative care.
“Our palliative care helps us reduce the frequency of hospitalizations for patients who are in that stage of illness,” Jackson said. “This focus also helps us improve the level of care for patients who need these services, and it improves their stay when they’re in hospice.”
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Methodist Hospice and Palliative Care
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