high cost

End of Life Care: The High Cost Of Dying

by Reut Cohen and
Laura Coverson

The end of life can be quite costly, especially for senior citizens, even if they have Medicare coverage or supplemental insurance. Many healthcare experts maintain that big spending in the last year or two of life has no meaningful impact on the quality of life.

Los Angeles Times columnist Steve Lopez tells Your Turn to Care, "You begin to do the math and people are spending four, five, six, eight, ten thousand dollars a month on their last years of life."

Dealing with caregiver issues before his own father died, Steve Lopez began exploring the subject of death and dying in his column for the Los Angeles Times: http://articles.latimes.com/2011/nov/12/local/la-me-1113-lopez-dying-20111113.

"Quite a few people have emailed or written to me at the LA Times about watching their parents just burn through huge sums of money."

Health expenditures in the United States are soaring--estimated at $2.6 trillion in 2010; approximately $7,000 per person each year. A study published by Dr. Jonathan Bergman of the University of California in Los Angeles reveals about a third of all healthcare resources are actually spent in the last year of life. And those costs are rising.

The health insurance industry is not solely to blame for skyrocketing costs according to healthcare economists. The reasons are complex, but experts say a large part of the problem is the lack of controls on the behavior of patients and doctors, as well as insurance providers.

"Health insurance is the one to pay for services, but no one is responsible for the costs," claims Dr. Jeffrey McCombs, a health economist at USC's Shaeffer Health Policy Center. "What controls do you have? None! The whole system is designed to explode. Nobody ever seems to go back to diagnosing the pathology that got us here."

Prior to his father's death, Lopez watched his parents savings dwindle. "My mother and father have been married for 60 years. They've got this small nest egg, and this is what they spend it on? They spend it on my dad dying for three years?" laments Lopez. "They don't take trips. They don't go to a movie. They don't go to dinner. They're spending their life savings on his death."

Solutions?

Any meaningful overhaul of the healthcare system is likely to take years. But advocates for reform suggest there are some options worth considering that are available now.

One hedge against the high cost of dying in America might be as simple as having an advance health directive: http://www.kcet.org/shows/yourturntocare/talk/forms-101-mary-winners-on-important-documents.html. According to a recent study by researchers at the University of Michigan, having an advanced directive could cut end of life medical expenses by as much as $5,585: http://www.healthfinder.gov/news/newsstory.aspx?Docid=657551.

While surveys suggest most Americans prefer to spend their last days in their own home, seventy-five percent of senior citizens actually die in a hospital or nursing home. Palliative care and hospice may not only offer a better quality of life for the seriously ill or dying, but at a significant cost savings according to recent studies: http://blogs.wsj.com/health/2011/03/08/study-palliative-care-for-medicaid-patients-reduces-their-hospital-costs/tab/print/.

Hospice offers individuals who have a life expectancy of six months or less the opportunity to stay at home in comfortable surroundings. Hospice is also more economical than an extended hospital stay involving costly medical tests and interventions that do not extend life.

Hospice care often involves palliative care--the compassionate managing of pain and suffering by a team of nurses, doctors and social workers. But palliative care is also available to those expected to live longer but need pain and symptom relief that can be provided less expensively, outside of a hospital setting.

"As we examine how health care dollars are spent in this country, there are cheaper, more effective ways to deal with end of life medical issues," said Lopez. "So we need to have that conversation about supporting more hospice and palliative care."

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Funders
MetLife Foundation The Lippey Family Trust Gladyce L. Foster
California Community Foundation