Dying Expensively

"To make the case for improved end-of-life care, we thought that looking at costs -- and specifically at costs that could be prevented -- would be a powerful tool to change policy."
"I think most people would want to die at home and spend their last days at home. ...(But) it often happens in an acute-care hospital."
"For the majority of the dying population, you can kind of see when death is coming within the last month or two. Unfortunately, that is also the time we see, still, the increase in hospital costs."
Dr. Peter Tanuseputro, co-author, Canadian study on elder-death and hospital care 

Chris Roussakis for National Post   Dr. Peter Tanuseputro believes that documenting the cost of dying in hospital could be a tool to help change policy.

Canada's health care system is under siege. Too many of its citizens are doing what comes naturally; living out their natural life span. Alternately, succumbing to the illnesses commonly associated with old age, or a chronic disease, but their lives ending, regardless. There was a time when the elderly died slowly as their lives neared the end, while living among family with many hands to help care for them. Those hands are now those of professional strangers, involved in what's called administering palliative care.

Families are simply too busy to be integrally involved, and too far removed from the realities of age and death to feel comfortable dealing with the condition. It's the most common condition in the world, afflicting all living things. We have a designated lifespan, give or take a few years, taking into account genetic endowment, lifestyle, accidents, exposure, all of that and more. But when it comes to our health we head directly to a hospital.

And hospitals are meant to give ameliorative care to people whose health has temporarily declined for one reason or another. Old age is the ultimate decline from which there is no possibility of escape. Nothing yet has been devised in medical science to turn back that aging clock, and time is resistant to manipulation. What to do with those aging carcasses withered and grey, in pain and with the knowledge that their lifeforce is ebbing? Slowly for some, more accelerated for others.

Fotolia “I think most people would want to die at home and spend their last days at home.… [But] it often happens in an acute-care hospital.”

Dr. Tanuseputro and colleagues from the Universities of Toronto and Ottawa feel that their study represents an analysis of health-care data in Ontario over a three-year span that may in fact be the first such study to examine spending across a variety of health sectors for a large population specifically targeting end-of-life care in hospitals. According to their study the province of Ontario rang up an annual cost of caring for patients in the year before death at $4.7-billion.

Their study, published in the journal PLOS One, pointed out that as costly as this has been to the provincial health care system in the past, costs are rising steadily. They found the average cost per individual cared for was $54,000. Costs which rose exponentially in the final few months and weeks of a person's life, when admitted to hospital. In-patient services represented the largest portion of spending at 43 percent, followed by long-term care at 15.5 percent.

The cost of physician care in hospital for attending to the needs of patients reaching their end-of-life experience was a relatively modest ten percent. While homecare represented 8.3 percent of the total outlay per person. Barely one in ten of the elder population ending up in hospital, however, entered care for palliative services. Yet other research has suggested that only about one in four deaths arrives as a surprise.

The study conclusion was that many such admissions could be avoided if a program were to be set up to provide additional palliative care in the home setting. This could perhaps be achieved by training more family practitioners to provide that kind of service. Currently, one in five people only, receive any kind of home visit by a doctor in their last year. At the present time, doctors seem to have their hands full, looking after their office practise, along with hospital visits.

At one time it was common enough for busy family practitioners to count home visits in with their regular routine, looking after the health needs of their patients. Much has changed since then; not only do doctors refrain from spending time visiting patients at home, they no longer provide the kind of simple medical services once commonly performed in doctors' offices, beyond diagnosing symptoms and prescribing antidotes or referring their patients onward.

At a time when not all families have the services of a family doctor, and those in the profession of family care at the most basic level have very large patient rosters, it hardly seems likely that family doctors would be pleased at the recommendation that they incorporate house calls into their already overstressed schedules. Such an arrangement might be better made with nurse-practitioners able to perform many of the routine things that doctors do.

It is not the process of dying alone, not the aging population generally, the results demonstrate, that will place an increasing strain on health budgets as the population becomes older, according to Livio Di Matteo, a health economist at Lakehead University in Thunder Bay. Changing the equation is no simple matter, he said; the situation requires the development of improved palliative and home care services.