Handling end-of-life health care

An elderly patient lies in a bed.

When it comes to health care, costs during the last two years of life are the most expensive in the industry. According to the Dartmouth Atlas of Health Care, which investigates health care costs and issues around the country, "patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations."

Why are those costs so high?

According to Dr. James Weinstein, president of the Dartmouth-Hitchcock Health System, much of it has to do with how difficult and complicated that time can be for families. "Caring for a loved one ... [there's] always a challenge in that, I don’t want to feel like I’ve left them down," Weinstein says. "I lost my daughter, who wasn’t a parent, or grandparent, but a child. And the dilemma that my wife and I went through at the end of her life, not wanting her to be in the hospital, but certainly wanting to do everything we could, really puts it in my heart. I think we knew that the end was near, but we also had to talk about it."


Learn more: The cost of caregiving


Dr. Weinstein says those conversations are important not only from a financial standpoint, but a personal one as well. "I think that a lot of families don’t know how to talk about it, but I would encourage the listeners and the families to try as hard as it is to have open and honest discussions as a family," Weinstein says, "and then spend that time so that you’re not in a hospital doing a lot of things to a loved one that won’t matter, as far as saving their life. And I think that amount of money in the last couple of years really is a product of what we’ve gotten used to as a society, right or wrong, and I don’t sit here judging it. I sit here saying I question it, whether people who were well informed and had the right discussions would want heroics in those last few moments, more ICU bed days ... would they really want that if they had that honest discussion?"

One option for patients dealing with chronic illnesses, Weinstein says, is palliative care, which focuses on relieving pain and suffering of patients. "Most patients just assume and their families assume that wherever they’re getting care, that their insurance or somebody else is going to pay for it. When you’re in an environment in a hospital, the dollars that we spend to do every little thing, runs the cash register up faster than you can imagine."

And despite the lower costs, Weinstein says the care is just as effective. "The patients I visited in hospice palliative care facilities, it’s really just dealing with their pain and discomfort, so they may pass on to their next world in a safe and comfortable way," says Dr. Weinstein. "I hope more people ask those questions. Could my mother be in a place to keep her comfortable that might be less expensive and better for her?"

About the author

Lizzie O'Leary is the new host of Marketplace Weekend.

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