Die at Home? Few Do

If you ask just about anyone, they'd rather die at home.  But one in four cancer patients dies in the hospital.

According to a study done by the Robert Wood Johnson Foundation, most advanced cancer patients only go to a hospice within the last three days of their life, something that caused a wonderful hospice organization, where patients could sit in the garden with their families, or have any dinner they liked, even have a family member stay with them, to have to close its doors in my hometown.

"While patients are spending fewer days hospitalized in the last month of life, the number of days in ICUs has increased," the foundation reports. Hospice days have also increased, "but a growing proportion of patients begin receiving hospice services in the last three days of life, a time period often too short to provide patients the full benefit of hospice care."

Here are some key findings from the Dartmouth Atlas Project:

  • Between 2003-2007 and 2010, the percentage of Medicare patients with advanced cancer dying in hospitals and the average number of days they spent in the hospital before their deaths declined across most regions, medical centers, and cancer centers.

  • Overall, Medicare patients with cancer were significantly more likely to spend time in the ICU, as the percentage of patients admitted to the ICU during the last month of life increased by nearly 22 percent, from 23.7 percent from 2003-2007 to 28.8 percent in 2010.

  • Medicare patients with advanced cancer were more likely to receive hospice care in 2010, as 61.3 percent of patients were admitted into hospice care during the last month of life, compared to 54.6 percent in 2003-2007.

    Is it different if you're younger?  Not so much.  A dear friend who died of breast cancer at the age of 37 spent the week before her death in the hospital, then entered hospice two days before she died. Why does this happen?

    Paula Span at The New York Times reports that many doctors don't discuss the idea with their patients, so hooked are they on agressive treatments meant more for "cure" than "care."   Others believe that they must go live in a hospice in order to die there.  (Not true.  More and more hospices are providing services inside the home.)  Still others, as I do, associate hospices with death.  If you go there, you die there.

    “Nobody wants to say yes to death,” Don Schumacher, president of the National Hospice and Palliative Care Organization, told Span in 2009. “America is a death-denying society, much more than others. And the health care system wants to continue to treat and treat and treat.”

    So families wait, Span writes. "And the parent dies anyway — maybe in pain that could have been eased, maybe with fears that could have been assuaged or lessened had hospice workers been able to offer more than brief crisis management."

    So how do we solve this, especially with elderly parents?  Experts suggest talking about it beforehand with both the doctor and your parent, and looking into what services are available.  I would have given anything to have my mother die at home, not under the thrusts of doctors trying to restart her heart, nurses rushing everywhere and a sense of panic and pandemonium everywhere.


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