GIC Health Articles - How We Die in Massachusetts

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(summer 2007)

How do you want to die?  That’s a tough question to broach with loved ones.  Americans are much more likely to talk with their children about safe sex and drugs than we are to talk with parents about end-of-life choices.  Eighty percent of Americans wish to die at home -- alert, without pain, and surrounded by family and friends according to National Hospice Foundation research.  Yet only 22% of Massachusetts terminally ill patients die at home.  Forty-five percent die at hospitals, followed by 33% who die in nursing homes. 

On average, 154 people die in the Commonwealth every day according to the Massachusetts Department of Public Health.  Forty of these people die from heart disease, 37 from cancer, 17 from respiratory disease, and 9 from strokes.  Other causes make up the remainder.  Many of these conditions are chronic, often giving time for families to discuss end-of-life wishes.

Facing up to the fact that you or a loved one is dying is difficult, and often we want the medical profession to do everything it can to prolong patients’ lives.  According to research conducted by the Division of Health Care Finance and Policy in July 2006, 41.9% of terminally ill patients in teaching hospitals and 22% in community hospitals have more than three significant procedures in an attempt to prolong their lives.  The most common procedures prolong life for only a very brief time:

• Insertion of a continuous mechanical ventilator
• Insertion of an endotracheal tube

Forty-six percent of terminally ill patients spend time in the Intensive Care Unit at teaching hospitals; 36.8% of community hospital patients do.

However, hospitals are not necessarily the best places to treat terminally ill patients.  Hospice patients live an average of 29 days longer than terminally ill non-hospice patients, according to a study published in the Journal of Pain and Symptom Management in March 2007.  Several factors were cited for the longer life of hospice patients.  Most prominently, patients in a weakened condition avoid the risks of over-treatment.   Secondarily, the study surmises that hospice care improves patients’ monitoring and care.  Additionally, hospice care focuses on the emotional, spiritual and physical health of the patient. 

Hospice programs provide quality care, focusing on comfort and dignity for persons who are ill and their loved ones.  It is a fully covered benefit under all GIC plans:

• A team of professionals offering expert medical care, pain management, emotional and spiritual support in keeping with the patient’s needs
• Emotional support for the patient’s loved ones
• Aggressive treatment of pain to make the person comfortable
• Choice of in-home, hospice facility, or nursing home care
• 24-hour, seven days a week care
• A comprehensive care plan incorporating the needs of the patient, his/her medical team, and loved ones
• Grief services and support for family members for at least 12 months after death

According to the Division of Health Care Finance and Policy’s research, the vast majority of patients do not have an advance directive (written instructions outlining your care and treatment wishes in the event you cannot speak for yourself). 

“How would you like your choices honored at the end of life?”  “Would you like to spend your final days at home or in a home-like setting?”  These are two good approaches into difficult discussions about end of life preferences.  To ensure that your end-of-life care wishes are followed, regardless of your health, you should:

• Have a medical power of attorney indicating who will make medical decisions for you if you are unable to do so (also called a Health Care Agent)
• Draw up an advance directive (living will)

Encourage your loved ones to do the same.  State-specific advance directives, instructions, and information on where to keep them, are available on the National Hospice and Palliative Care Organization’s website.  The Organization can also assist you with finding hospice professionals in your area.  Physicians, nurses, social workers, clergy and the Commonwealth’s Executive Office of Elder Affairs can also be helpful.