Arrow-right Camera

The Spokesman-Review Newspaper The Spokesman-Review

Tuesday, October 27, 2020  Spokane, Washington  Est. May 19, 1883
Partly Cloudy Day 30° Partly Cloudy

Endorsements and editorials are made solely by the ownership of this newspaper. As is the case at most newspapers across the nation, The Spokesman-Review newsroom and its editors are not a part of this endorsement process.

Opinion >  Editorial

Editorial: End-of-life care with compassion, cost savings

Paul Dunham died at his daughter’s home on Monday, just as he had chosen. Like most people, Dunham didn’t want to grow old in unfamiliar surroundings. Thanks to the increased flexibility of government-subsidized care, he was able to stay at his Hayden mobile home, with assistance from a visiting caregiver.

Not only did this fulfill his wishes, it saved taxpayer dollars. Instead of government paying for more expensive nursing home care, it granted a Medicaid waiver so that Dunham, who had a debilitating neuromuscular disorder, and his ailing wife could get 25 hours a week of help at home. The monthly cost was $1,500, as opposed to the $5,000 to $7,000 it would take to cover a nursing home.

It’s not often that compassion and cost-cutting go hand in hand, so it’s unsurprising that this has become a popular trend. Nearly 30 years ago, four of every five dollars for government-paid long-term care in Washington state went to nursing facilities. Now, about two-thirds of those dollars go to people who remain in their homes.

Still, there is room for improvement. And when you consider that one-third of all U.S. health care spending is directed toward the last year of life, it’s clear that there are huge opportunities for saving money. Dr. Jonathan Bergman of UCLA recently conducted a study of the issue and told Reuters, “We might be able to do a better job with end-of-life care and cut costs not by rationing care but by making it more rational and treating each patient based on their original goals.”

Please note that he is not talking about rationing care, which has become a political hot potato, but about respecting the wishes of patients. As long as patients make their desires known and health care providers abide by them, this aspect of health care spending can be reined in. That’s why our system should encourage advanced-care directives by paying doctors who take the time to assist families with thoughtful discussions about end-of-life care. Currently, it only rewards testing and treatment.

Hospice is an encouraging avenue, but Bergman found that one-quarter of hospice patients are there for less than a week. To reap the full benefits, patients need to enroll sooner. Such care typically lasts a maximum of six months and enrollees opt for less intensive care.

Though most cancer patients prefer to spend their last days at home, 29 percent died at hospitals from 2003 to 2007, according to the Dartmouth Health Atlas. Regional variations are startling and suggest that a lot of care is wasted. In Spokane, 25 percent of cancer patients died at hospitals. In Los Angeles, it was 40.5 percent. In Mason City, Iowa, it was 7 percent.

Similarly, inpatient care in the last six months of life varies widely throughout the country. For Medicare patients, Dartmouth found that it was 6.7 days in Spokane and 14.7 days in Los Angeles. Life expectancy was not improved with more intensive care.

We’re encouraged by a trend in end-of-life care that fosters independence, compassion and cost savings. But if we hope to get health care spending under control, we must do better.

The Spokesman-Review Newspaper

Local journalism is essential.

Give directly to The Spokesman-Review's Northwest Passages community forums series -- which helps to offset the costs of several reporter and editor positions at the newspaper -- by using the easy options below. Gifts processed in this system are not tax deductible, but are predominately used to help meet the local financial requirements needed to receive national matching-grant funds.

Subscribe to the Coronavirus newsletter

Get the day’s latest Coronavirus news delivered to your inbox by subscribing to our newsletter.



New health insurance plans available Nov. 1 through Washington Healthplanfinder

 (Photo courtesy WAHBE)
Sponsored

Fall means the onset of the cold and flu season.