They’re also less likely to have access to palliative care or use hospice: Among Medicare patients who die, nearly half
of whites use hospice compared with one-third of African-Americans and 28 percent of Asian-Americans, studies show.
or congestive heart failure are far less likely than patients with cancer or dementia — diseases
we typically associate with the end of life — to receive palliative care consultations.
We’ve made significant progress in recent years: The availability of palliative care services has increased 150 percent over the past decade,
and compared with patients in other developed countries, older Americans with cancer are now the least likely to die in a hospital (22 percent versus up to 51 percent).
Two interventions have consistently been shown to help patients live their final days in accordance with their wishes: earlier conversations about their goals and greater use of palliative care services, which emphasize symptom control and greater psychological and spiritual well-being — and which recognize
that longer survival is only part of what patients want.
Medicare spending for patients in the last year of life is six times what it is for other patients, and accounts for a quarter of the total Medicare budget — a proportion
that has remained essentially unchanged for the past three decades.
Patients with end-stage organ failure are also less likely to receive hospice services, and their families are less satisfied with their care.
Patients treated at for-profit and public safety net hospitals (known for taking in those who have no
insurance) are much less likely than those in nonprofit hospitals to have access to palliative care.
Minority patients are more likely to be hospitalized
and receive aggressive care during their last six months, research shows, and are more likely to die in the hospital.