The elephant in the room

There are two experiences everyone who lives on this planet shares – birth and death.  Birth is something we don't have awareness of and tend to experience through stories from our parents. Death on the other hand is a much more personal, first-person experience.     

Because our culture is one of life, few of us spend much time thinking, much less talking, about how we would like to die. As Congress and the nation have entered into the healthcare reform debate, how we die has become the elephant in the room. 

One of the facts about healthcare expenditures is that a disproportionate share occurs in the last year of life. A large percentage of these costs can further be classified as "futile care" since they neither change health outcomes nor improve the quality of life. Because our cultural and healthcare delivery system focuses on life, we are seldom willing to step back from aggressive treatment and ask the question, "Why are we doing this?"

The good news is there are alternatives in the form of Palliative Care and Hospice. Both of these programs work with the patient and their families to help them on their journey while allowing them to make their own decisions on which paths they would like to take. 

Palliative Care is available to anyone who is faced with a life-threatening illness and is still seeking curative treatment. It provides assistance with pain and symptom management, emotional and spiritual support and assistance with navigating the healthcare system.

The most important aspects of Palliative Care may be the support in establishing and clarifying the goals of care and providing education regarding the end of life. When the time comes and that cure is no longer an option, transition to Hospice care allows the patient and family to focus on quality of life. The primary goal is controlling symptoms so that life can be enjoyed as long as possible. Wherever hospice care is provided, there is an interdisciplinary team working with both the patient and the family to provide physical, emotional, and spiritual support and education.

From a public policy perspective, Hospice has the additional benefit of saving Medicare approximately $2,300 per patient. These savings are mainly the result of reduced "futile care" that does nothing to change the outcome or enhance quality of life.

One of the challenges of healthcare reform is the added cost of insuring an additional 40 million people. Legislation currently debated in Congress calls for about 50 percent of the cost to come from reduced Medicare expenditures – causing a reduction in Hospice and Home Health, two of the most cost-efficient Medicare programs.

In addition, the state of Washington is looking to totally eliminate Hospice for Medicaid to help solve their budget challenges.

On the federal level, Oregon Sen. Ron Wyden has offered an amendment to the Senate bill that reduces the Hospice cuts. As of press time, Sen. Maria Cantwell and Sen. Patty Murray, both of Washington, have not signed onto this amendment. 

If you have an interest in preserving options for everyone on their end of life journey, please contact Senators Cantwell and Murray and urge them to endorse the Wyden amendment to the Senate's healthcare reform bill.

For more information on Hospice and Home Health, visit the National Hospice and Palliative Care Organization at

Marc Berg is director of HomeCare and Hospice at Southwest Washington Medical Center in Vancouver.