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When Does End Of Life Begin: Hospice Under Scrutiny

This article points to a more fundamental, systemic problem, one that is likely to overwhelm us as millions of Americans come to the last part of life. Thanks to advances in modern medicine and public health, more of us will survive the diseases that once killed us swiftly and predictably—cancer and heart disease—and will instead live out our final years plagued by multiple chronic conditions of aging. Half of us who make it to 85—and there will be many—will suffer from dementia, an array of illnesses that will make it hard for us to live on our own, and harder still for our families to provide the hands-on care that is needed. Hospice provides a good model of care for the cancer patients it was originally designed to serve, and for whom prognosis was more predictable. But it does not serve efficiently or comprehensively what the majority of us will need and Medicare doesn't cover. In terms of our changing healthcare patterns, those near the end of life can be viewed as sentinels - the veritable "canary in the coal mine" - sensing and signaling the quality of our healthcare system and the way in which we treat those who are seriously ill and dying.
What, exactly, do we need? More than anything, we need programs that support family caregivers, those individuals who provide an estimated $450 billion dollars worth of care for older adults. We need hospice-like wraparound services that would help people from the time they are seriously ill or disabled, and that offer home care services, respite for our caregivers, and supports for what we can no longer manage or cope with on our own. We need social structures and public policies that support families as they live through years in which they simply cannot piece it together on their own.
As a country, we’ve done a remarkable job of creating a health care system that does well at treating acute problems and curing much of what ails us. But that system, with all its fragmentation and problems, is simply not one that is going to be able to serve our aging population. At the Altarum Institute Center for Elder Care and Advanced Illness, we aim to do just that. You can learn more about our work—and join in!—on our blog at

February 5, 2013 at 12:23 p.m. ( | suggest removal )