McKown, 1

Arden McKown
Nettie Kelly
Research in the Community
10/18/13
Research Paper Rough Draft
Everyone grows old. Even though modern medicine has allowed people to live well into
their eighties, death is still inevitable. For many people, death is a source of anxiety. But death is
natural, and should not be feared. The real questions are: Who will be there to support you when
you start to decline? Will you want to try and fight your ailment until the end? Or would you
rather focus on pain management and quality of life? Do you want to die at home? These last
two questions are very important. They guide two of the most important geriatric medical models
today: hospice and palliative care.
What makes hospice and palliative care so great? These two medical models are patient
centric. They focus on patients pain management and quality of life. Most hospitals use a
disease centric model of medical care. Curative care has only one incentive, to keep the patient
alive. In some cases, this is very effective, but most often treatments leave patients bedridden and
delirious.
My mother worked in hospice care, helping elders in San Francisco make the dying
experience as enjoyable as possible. From time to time I would visit patients with her and help
out where I could. When she fell ill, everything happened so quickly that she was never able to
enroll in hospice care. She was stuck in the ICU, attached to IV bags and monitors. No part of
her experience was painless, quick or peaceful, which is how many people wish their death to be.
Ever since then, Ive seen the differences between a patients wishes, and a patient's actual care.
This was concerning to me, which led me to ask the question: Should the United States use
hospice and palliative care as the main medical model? This question is very pertinent to our

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society because of the rise in the elderly population due to the Baby Boomer generation. This
increase means that there will be in the very near future a sudden, urgent demand for quality
geriatric care. If our nation wants to respect patients wishes, we need to start building a medical
platform that can support that. To do this, all medical facilities across the United States should
focus on hospice and palliative care instead of curative care, which would improve patients
quality of life and reduce costs.
Before switching the entire United States healthcare system, one should know what the
other proposal is. Hospice care is a subset of palliative care, so to understand hospice, one must
understand palliative care. Palliative care at its simplest is a patient centric model of care.
However, a fully developed model can be very complex. According to the government, palliative
care uses a patient and family-centered care that optimizes quality of life by anticipating,
preventing, and treating suffering (Federal Register). This type of care is called patient centric
and places focus on comfort and satisfaction of the patient and their family. People who enlist in
palliative care will receive a wide variety of care from a team of specialists that will help you
through your illness. These teams include doctors, nurses, nurse practitioners, counselors, social
workers, physical and occupational therapists, speech-language pathologists, hospice aides,
homemakers and many more. Although hospice uses patient centric care as well, it is specifically
designed to tend to the dying. The first documented hospice care center was founded in 1974
which shows how new the branch of medicine is. The government describes hospice as a service
that uses an interdisciplinary approach to deliver medical, nursing, social, psychological,
emotional, and spiritual services through use of a broad spectrum of professionals and other
caregivers, with the goal of making the individual as physically and emotionally comfortable as
possible (Federal Register). Many people confuse hospice with palliative care because they are

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so similar. It is important to understand the difference because many people do not consider
palliative care because they consider it to be a treatment system for the terminally ill. When this
happens, people put off signing up to hospice or palliative care until it is too late. And by then,
there is not enough time to give the patient the quality care that they deserve. Because of this
many sickly elders are left to die in hospitals or understaffed nursing homes alone.
Our current medical system is created to cure diseases in any way possible. This is
because if possible, curing a disease is always a wanted outcome. But focuses on curing diseases
is also a way to increase lifespans which positively affects the status of the current healthcare
system. If people are living longer, we must be doing something right, right? Not necessarily.
Usually, the added couple of months are spent in a hospital bed being pumped full of medicine
while in a semi-state of consciousness. If patients do not get to enjoy their final months of life
our medical system is doing something wrong. The United States uses a medical system called
curative care, which is disease centric form of medicine described above. Dr. Bruce James
Miller, a long time palliative care doctor says, Cancer centers and hospitals are filled with
people who know everything about diseases but not so much about life. And thats a shame. In
training to become a doctor you study for years, and then intern for more. It takes over a decade
for the average student to become a doctor. But through all of that training, very few are taught
about the effects of these treatment on a persons life. It is not important for a doctor to know
what makes a patient want to live, but shouldnt it? After all, are they not spending thousands of
dollars and countless hours of work to try and cure this person of disease? A persons goal in life
should not be to live as long as possible, but to feel fulfilled by the end of it. The objective of
curative care is to elongate the patients life no matter what the cost.

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Even if our current system was perfect, it is not big enough to support all of the elder
population. According to Masters In Health Care, there are not enough nursing home beds to
serve the entire elderly population They continue to state that, in 2008, there were only 1.8
million total nursing facility beds, but there were 18.8 million people aged 65-74, and 14.7
million people aged 75 or older (Masters In Health Care). The sudden increase in the elder
population the United States will be seeing in the next couple of years means changes need to be
made in the end of life care in our health care model. Otherwise the country will not be able to
support the enormous numbers that will be demanding quality care. The results of a study
conducted by the Administration of Community of Living shows that, from 2000 to 2030 the
population over sixty-five years will nearly double (ACL). Other studies produced by the ACL
show that increase in the elder population will not stop increasing for a very long time. This
means that the United States needs to begin creating a model of medicine that will be sustainable
now in order to prevent over worked over populated sloppy care.
Curative care is the method all public hospitals across the United States use to treat
patients. In 2014 we spent 3 trillion tax dollars to support our health care systems, and that
number is still increasing. The United States spends around twice as much in health care as the
average budget of other countries. This is concerning because most Americans are still suffering
from all sorts of illness and competing countries still have longer life expectancies. One of the
causes of this expensive phenomena is that we spend our money fixing the symptoms and do not
invest in preventative care. Currently, our budget is being spent on expensive curative treatments
such as surgeries and chemotherapy, high tech machinery, basic supplies, emergency response,
salaries, and training. Furthermore, many of these large budget surgeries and treatments end up
not working out. Morrison and colleagues reported that providing costly care did not improve

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patient outcomes and often increased the patient's physical and emotional suffering (KublerRoss). After the death of a patient, family members are left with costly medical bills from
treatments that did not cure their loved one of disease, and if anything, made their last days even
more painful. On the subject of lifespans, Dr. Miller says [the scientific community is] seeing
more and more that people who are de-stressed, whose pain is better treated, anxiety, depression,
etcetera, whose families are supported. They have more energy, they function better. They
actually live longer(Dr. Miller). This is an amazing and important breakthrough because
currently we have a system which is trying to extend lifespans, but in the process causing
patients stress, pain, anxiety, and depression, which does the complete opposite. This means the
health care system should turn its attention to something that focuses on treating these symptoms
that shorten lifespans and decrease happiness.
One model that attempts to do so is palliative care. After placing palliative care across the
hospitals of the United States, we would see positive results almost immediately. the Center to
Advance Palliative Care has done studies which show that palliative care drives down
readmission rates and mortality rates, while increasing HCAHAPS scores, pain management,
symptom control and, satisfaction of care. Not only does this type of care provide quality
treatment, but it also benefits the government in many ways. In 2008, CAPC produced another
report showing that, up to 80% of nursing home residents could benefit from palliative care
(Diane Meier). Such a large number of Americans benefiting from a form of care that reflects so
positively on the government is a very compelling reason to turn our health care system in a
different direction.
A point of concern for many people would be the budget of a program that produced
incredibly positive results. However, palliative care is a very cheap form of medical care. It

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makes huge cuts to the current budget by cutting out unnecessary expensive surgeries or
treatments that end up being detrimental to the patient. A study was conducted in a hospital in
rural xxx looking at the cost effectiveness of palliative care. They found the average cost per
day for the palliative care recipients was $754, and an average cost per day for the non-palliative
care recipients was $1,027. When the team looked at how much the hospital had saved they
found that, the net savings for palliative care patients was $273 per day. Total savings for
providing palliative care for 76 patients who died in the rural community hospital was $148,47.
(Kubler-Ross). More than 300 dollars was saved a day, per person. On top of this, palliative
care also reduces 911 calls, emergency department visits and hospitalizations (Diane Meier). All
of these result in a decrease in costliness of the budget. With quality of life increasing for
patients, and costs decreasing, switching out health care to palliative care would be the smartest
option.