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Expand access to palliative care for the seriously ill

On Jan. 1, the first of 79 million baby boomers turned 65. From that moment on, one boomer will turn 65 about every eight seconds, which works out to more than 10,000 a day. By 2030, there will be 72 million Americans 65 and older. Their life expectancy will increase substantially. They may live longer, but, as a result, many will have to manage multiple chronic diseases and need additional and better educated caregivers. Effective, compassionate and coordinated delivery of health care will be critical. And rest assured, the baby boomer generation will demand it.

While it has received little attention by the media, a new trend in medicine has been growing steadily over the last decade and may hold a partial answer to the health care needs of an aging population, especially those who are most seriously ill. It is known as palliative care.

Palliative care is a unique medical specialty that focuses on and improves quality of life for patients living with serious or life-threatening illnesses. It is aimed at those who require creative team approaches for coordinating and managing their care, especially the symptoms and emotional distress that accompany so many of these diseases. In short, the success of palliative care is based on one overriding principle: it's not just about the illness; it's about the patient.

Palliative care works best when it begins in the early stages of an illness, along with curative treatments. Its rapid growth can be attributed to the fact that it is a demonstrably effective solution, proven to relieve suffering, improve communication and coordinate transitions from one care setting to another over the course of an illness.

The benefits of palliative care to the patient, the caregiver and the health care system are enormous. Teams meet extensively with patients and their families to establish appropriate and realistic goals, support families in crisis and plan for safe transitions out of hospitals to more supportive settings or back home as a patient's condition improves or worsens. Such discussions reduce family burdens while improving a patient's quality of life.

Because palliative care is highly coordinated, it can also be more targeted and effective, identifying unnecessary testing and better managing medications. This improves the life of patients while reducing costs for both families and the health care system.

Palliative care may also prolong life. In a recent study, published in the New England Journal of Medicine, of 151 patients with advanced lung cancer, those given early palliative care survived 11.6 months, nearly three months longer than those who did not receive such care.

While palliative care is covered by most private insurance, as well as Medicare and Medicaid, it is not readily accessible to all Americans. It is offered primarily in hospital settings, with only a few major medical centers providing outpatient or home-delivered palliative care programs.

As of 2008, 50 percent of U.S. hospitals (with at least 50 beds) and 81 percent of hospitals (with more than 300 beds) reported having a palliative care team. While this represents an increase of 125 percent from 2000, it is not good enough.

As Congress revisits the issue of health care reform, it would do well to consider ways to increase patient access to palliative care, assure that more physicians are being trained in and enter this new specialty, increase research funding and encourage Americans to ask their doctors for palliative care when faced with serious or chronic disease. Health care transformation should be about creating a compassionate, caring and cost-effective health care delivery system where the patient always comes first.

Right now, despite the highest per-person spending on health care in the world, Americans report a rushed, fragmented and confusing health care system. Our country can do better, and Americans deserve better. Palliative care should be a part of that transformation.


Diane E. Meier, M.D., is director of the Center to Advance Palliative Care and has contributed to more than 20 books on the subject of geriatrics and palliative care.

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