Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace [www.engagewithgrace.org] – a movement

aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important – and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.

So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.

Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go” [http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande]– it is a work of art, and a must read.

Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.

Thank you to TEDMED [http://www.thehealthcareblog.com/the_health_care_blog/2010/10/engage-with-grace.html] for letting us share our story and our vision.

And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.

Costs of Care at EOL

Discussions About End-of-Life Care Reduce Healthcare Costs in Last Week of Life

NHPCO Encourages Dialog between Patients and Physicians

(Alexandria, Va) – Patients with advanced cancer who reported talking about their end-of-life wishes with their physicians had significantly lower healthcare costs in the last week of life. Researchers found that these conversations between patients and physicians led to fewer cases of aggressive care, which saved money and resulted in a far more peaceful death for patients.

The study in the March 9 issue of Archives of Internal Medicine suggests a tangible benefit to advance care planning discussions with physicians – lower costs and reduced utilization of aggressive care, including admission to the Intensive Care Unit.

Thirty percent of Medicare’s annual costs are spent on the five percent of beneficiaries who will die in a given year. Additionally, about one-third of those dollars spent in the last year of life are spent in the last month.

“Discussions about care at the end of life result in a higher quality of life for patients – and cost the healthcare system less money, that is something that hospice and palliative care providers have long known” said J. Donald Schumacher, president and CEO of National Hospice and Palliative Care Organization.

A 2007 study out of Duke University found hospice saves Medicare about $2,300 per beneficiary that receives hospice care.

Researchers in this recent survey looking at costs in the last week of life indicate that if 50 percent of people had a discussion with their physician about end-of-life care preferences, the cost difference in a year could be more than $76 million dollars.

Study participants who discussed end-of-life care preferences were more likely to be referred to hospice sooner than those who did not.

“In fact, patients who received less invasive or aggressive treatments lived as long as patients who did not, indicating that attempts to prolong life in end-stage cancer patients might be futile,” noted Schumacher.

Research published in the Journal of Pain and Symptom Management (March 2007) found that Medicare beneficiaries who opted for hospice care at the end of life lived on average 29 days longer than similar patients who did not take advantage of hospice.

NHPCO has been a longtime advocate for people having frank discussions about the care they would want – primarily to ensure that a person’s wishes are honored and that they experience the highest quality of life possible.

“An important time to talk to your doctor about the kind of care you would want at the end of your life is not when you’re days away from death but much earlier in the course of an illness,” said Schumacher.

“In fact, I cannot stress the importance of advance care planning for all people. Taking time, right now, to have these discussions with family and loved ones can be very important in making sure wishes are honored should a medical crisis come along,” added Schumacher.

Last year, more than 1.4 million Americans with life-limiting illness received the quality care from the nation’s 4,700 hospice care providers.

Information on care at the end of life, starting these important conversations with loved ones and care providers, and state specific advance directive forms, are all available free-of-charge on NHPCO’s Caring Connections Web site, www.caringinfo.org, or from the Helpline at 800-658-8898.

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For more information visit, http://www.nhpco.org