Planning for dignity in the future. 

According to Last Acts Partnership, a national coalition to improve care and caring near the end of life, "Americans often die alone in hospitals or nursing homes, in pain and attached to life support machines. This happens despite the modern machine's ability to ease most pain, the existence of good models of delivering supportive care, and the increasing availability of excellent end-of-life care through hospice and palliative care programs.  All these services, however, are underused -- in large part because, in our death-denying culture, many Americans don't want to discuss death and dying, or because many Amercans don't know about these options for good end-of-life care and they don't ask for them."

In fact, about 50 percent of Americans 65 and older die in hospitals, often after extensive and expensive life-prolonging treatments.  Another 20 to 25 percent die in nursing homes, and this proportion is growing.  Only 24.9 percent of Americans die at home, although more than 70 percent say that is their wish.

Hospice care, although widely available, is underutilized.  Even though experts suggest that patients should be enrolled in hospice for at least 60 days to maximize its benefits, the average national hospice stay has dropped from 70 days in 1983 to 36 days in less than 20 years.  In 1998, 28 percent of hospice patients were enrolled for one week or less before dying.

New England is no exception in the underutilization of hospice care due to a myriad of issues facing hospice today.  Although there are adequate numbers of hospice programs in the area, service capabilities vary, as do resources designated to educate healthcare professionals and the public.

Beacon's mission is to help increase hospice use in New England.  We believe that a partnership among nursing homes, hospitals, and hospice-care programs can begin to alleviate some of the pressures facing end-of-life care in coming decades.

According to Eric Hardt, M.D., Clinical Director, Geriatrics Section, Boston Medical Center, "I predict that the government will realize that giving more personal care at the end of life will keep people out of the hospital.  It would require almost no major change in the bureaucracy and hospice would be the natural and logical way to implement it."  Dr. Hardt also feels that palliative care will become a standard part of the training in medical schools in the future.  "I tell my students that in order to graduate from medical schools, you should be there when someone dies a natural death, and you should be there when somebody is born."

However, a change like this must begin with education and collaboration -- both on the part of the public and the physicians and clinicians who care for the chronically ill.  Kate Callahan, coauthor of the national Five Wishes advance directive document, believes that, "The end of life will include more drugs, more pain medication, more family participation -- but a lot depends on the physician.  The physician is still the person who will drive the way you're cared for at the end of life."