Changing Quality And Honoring Individual Preferences Near The End Of Life

Changing Quality And Honoring Individual Preferences Near The End Of Life

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Chapter
When Caregiving Ends
“The time is now for our nation to develop a modernized end-of-life care system.”
–Victor J. Dzau, M.D., President the Institute of Medicine
Introduction
A
major 2014 study by the Institute of Medicine (IOM) states that talking about death will improve health care and the experience of patients facing their mortality. The study recommends payment to doctors to discuss with their patients end-of-life-care plans, just as they discuss living wills.
The Institute of Medicine is concerned over high-tech interventions resulting in futile suffering, often at great emotional, physical, and financial cost. In September 2014, the IOM released its report titled: Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life. The report was a result of 21-member nonpartisan committee appointed by the Institute of Medicine, which is the independent research arm of the National Academy of Sciences that called for sweeping change. David M. Walker, Chairman of the panel, stated: “The bottom line is the health care system is poorly designed to meet the needs of patients near the end-of-life.” He also states: “The current health care system is geared toward doing more, more, more, and that system by definition is not necessarily consistent with what the patients want, and is also more costly.”
A few of the report’s recommendations will require congressional action while others could be accomplished without legislation. One recommendation urged by the panel is for insurers to reimburse health care providers for conversations with patients on advanced care planning. The plan called for a “major reorientation and restructuring of Medicare, Medicaid, and other health care delivery pro...


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...g a direct reference to our mother – indicating that she was just another poor and nearly illiterate country woman. Let’s just say, I had a few stern words for him about his attitude toward our mother and Southern people. He was young with a very poor bedside manner.
Let’s finish the report. It also states that hospitals need to be calling family members daily so they or the designated person can step in for the patients who may be too impaired to make their own medical decisions. The study found that 59 percent of the time, daughters are the ones who must make the tough decisions, followed by sons at 25 percent, and spouses at 21 percent. What compounds this problem is that few patients put their wishes down in writing before hospitalization. Only 7.4 percent had a living will, and only 25 percent had a health care representative documented in their medical records.

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