End-of-Life Care in the U.S.

“End-of-Life Care, Not End-of-Life Spending” (2)

People in the U.S. spend a lot of money at the end of life; in fact, about one-quarter of all Medicare spending goes toward care for people during their last year of life (25). Our healthcare system is currently structured to treat many sick people, often with chronic yet sometimes life-limiting conditions. Ongoing advances in modern medicine, from clinical trials and organ transplants to robotic surgery and stem cell infusions, aim to add years to one’s life. Patients with multiple chronic diseases can spend upwards of $57,000 per year on their health care. While these care models remain the mission of our healthcare system, the lines are often blurred when it comes to terminal illnesses and end-of-life care. End-of-life spending often gets confused with spending money on people who are sick because some of them ultimately die.

As the Medicare program struggles to control expenditures, there is increased focus on opportunities to manage patient populations more efficiently and at a lower cost. A major source of expense for the Medicare program is beneficiaries at the end of life (4). It is estimated that 13%-25% of Medicare costs are tied to the last year of a patient’s life. More effective use of palliative care and hospice benefits offers a lower cost, higher quality alternative for patients at the end of life versus traditional hospital settings.

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Medicare costs increase sharply in the last few days of life, particularly for patients who die in hospitals. Hospice and palliative care offer the possibility of higher quality care at a lower cost to Medicare if patients enter hospice earlier. These programs are designed to align with a patient’s expressed goals for end-of-life care, items that are often not available in a traditional hospital setting. 

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Modern medicine has not only prolonged living but has also prolonged dying. Recent advances in medicine have converted the once thought of “grave illnesses” like cancer into “chronic illnesses” (5). As we know it now, the healthcare system must adapt to this reality and offer alternative care models to support this patient population.

It is valuable for hospice nurses to be aware of the costs of end-of-life care in the U.S.

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