They’re also less likely to have access to palliative care or use hospice: Among Medicare patients who die, nearly half<br />of whites use hospice compared with one-third of African-Americans and 28 percent of Asian-Americans, studies show.<br />or congestive heart failure are far less likely than patients with cancer or dementia — diseases<br />we typically associate with the end of life — to receive palliative care consultations.<br />We’ve made significant progress in recent years: The availability of palliative care services has increased 150 percent over the past decade,<br />and compared with patients in other developed countries, older Americans with cancer are now the least likely to die in a hospital (22 percent versus up to 51 percent).<br />Two interventions have consistently been shown to help patients live their final days in accordance with their wishes: earlier conversations about their goals and greater use of palliative care services, which emphasize symptom control and greater psychological and spiritual well-being — and which recognize<br />that longer survival is only part of what patients want.<br />Medicare spending for patients in the last year of life is six times what it is for other patients, and accounts for a quarter of the total Medicare budget — a proportion<br />that has remained essentially unchanged for the past three decades.<br />Patients with end-stage organ failure are also less likely to receive hospice services, and their families are less satisfied with their care.<br />Patients treated at for-profit and public safety net hospitals (known for taking in those who have no<br />insurance) are much less likely than those in nonprofit hospitals to have access to palliative care.<br />Minority patients are more likely to be hospitalized<br />and receive aggressive care during their last six months, research shows, and are more likely to die in the hospital.
