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It's time we make dying at home easier

Sarah Romanelli, a geriatric nurse practitioner, wrote an important article about how difficult it is for families to care for someone at home. There are two powerful takeaways:

  1. Research demonstrates that most individuals would strongly prefer to die at home. Yet, Medicare insurance will spend hundreds of thousands of dollars on ICU and other expensive coverage for futile care without a question and then pay nothing for the much more important and substantially less expensive home care that families need. This nurse has been recommending Hospice to her patients for years because it is their best care option. However, she learned firsthand with her 89-year grandmother’s death the cost to her family.

  2. Hospice does not offer sufficient home care coverage for families. Sarah suggests that Medicare should restructure Hospice coverage to provide more home care. She then highlighted a legislative bill called the WISH ACT (well-being insurance for long-term care). This bill went nowhere because our Congress uses an incomplete approach to evaluating real costs. The Congressional cost analysis does not look at the savings they would have achieved by avoiding unnecessary hospital care because it is difficult to document. However, it is common sense that it would cost less for people to die at home than in ICU.

We should legislatively make it easier for individuals to die at home, because in aggregate it is less expensive and it is better care for the patient. My book, The Journey’s End, offers recommendations for solutions to this problem through changes to Hospice and Medicare. Research evidence demonstrates that these recommendations would save money for Medicare and improve end-of-life care for families.

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