What Do People Want at the End of Their Lives?

November is National Hospice and Palliative Care Month and I would like to recognize my Gilchrist teammates for all they do every day to assure that people are getting the care that they want at the end of their lives.  

Gilchrist is a wonderful eldercare company that includes the largest hospice in Maryland and is repeatedly recognized nationally for its work. Annually, Gilchrist provides in-home primary care to approximately 900 individuals, hospice care to 6,736 people, and grief counseling and bereavement services to thousands of family members. The organization also counsels individuals on care planning, guiding them through decisions about their treatment and helping them make informed choices for their advanced chronic disease.

Our first aim is the best possible health outcome. But we recognize that restoring patients to health is not always possible. In end of life care, we must do our best to minimize pain and suffering and make sure that we focus on what the patient truly wants. 

Surveys of the American people show that most of us would prefer to die at home surrounded by our loved ones in as little pain as possible. Unfortunately, today the majority of Americans are dying in the hospital - clearly not what they want. We must ensure that every person is asked what they want in end-of-life care. The conversation needs to happen when the person is still up to the conversation and not in the last hours before death. 

As we celebrate National Hospice and Palliative Care Month, I've asked Cathy Hamel, President of Gilchrist and our system’s Vice President of Continuing Care, to talk about palliative care consults and the vital role they play in delivering the care that the person wants. 

Cathy says:
In recognition of National Hospice & Palliative Care Month, I’d like to highlight the critical work of our Integrative & Palliative Medicine teams. 

As medical professionals, we are often focused on treatments and cures above all else. But in some cases, that’s not what patients want. As a person’s disease progresses, sometimes more treatment leads to diminishing returns. Particularly for frail and elderly patients with serious illness, interventions such as surgery, hospitalization, chemotherapy, or radiation may not be effective and may even be harmful. 

For some, the burdens of treatment outweigh the benefits. If informed of their options, a person who is unlikely to get better may wish to spend more time at home with family and friends rather than in the hospital or pursuing long-shot treatments.

People with serious and terminal illnesses may experience untreated pain and other symptoms, and lengthy hospitalizations involving costly and often futile treatment. And sadly, while more than 80% of Americans would prefer to die at home, only 20% actually do, while 60% die in the hospital.

Palliative care is a solution. Palliative care allows patients to choose the kind of care they want rather than having others choose for them. It is centered on meeting the needs and preferences of each patient. Gilchrist’s palliative teams are experts at having frank conversations with patients about their treatment options and goals of care. They help patients understand the likely progression of their illness and what to expect. As a result, patients can receive the kind of treatment they want and avoid the treatments they don’t want. 

Once a care plan is established, Gilchrist’s interdisciplinary team consisting of palliative nurse practitioners, physicians, a social worker, mind-body specialist, acupuncturist, and music therapists helps ease symptoms such as pain, anxiety, nausea, and stress, while focusing on quality of life.

As a health system, GBMC is doing a far better job of integrating palliative care than most. In our hospital, 19.6% of medical/surgical admissions are referred to Integrative and Palliative Medicine, compared to the national average for similar size hospitals of 6.9%. Our Gilchrist palliative teams consult on about 145 new patients a month throughout all departments in the hospital. Last year, the team consulted on a total of 4,509 patients. 

In addition to leading to a higher quality of life, palliative care saves money. Palliative consults for GBMC patients resulted in a reduction of nearly $23,000 in charges per patient per month, one-month post-consult.

The reason we have been so successful is because we work hard to educate everyone about the importance of palliative care, from staff to patients and families. Studies show that once people are informed about palliative care, 92% report they would be highly likely to consider palliative care for themselves or their families.

Palliative care is not about giving up. It’s about shifting the focus of care to what is most important to the patient. Good medicine is about treating the whole person—not just the disease. Asking about and documenting a patient’s wishes is the key. 

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Our community is so fortunate to be served by Gilchrist. I want to express my deepest gratitude to Cathy and Dr. Tony Riley, Chief Medical Officer of Gilchrist, and their entire team for their devotion to making the end-of-life journey a peaceful and positive one for so many families throughout the years.  You can also read more about the fantastic work of Gilchrist in The Gilchrist Blog.

National Medical Staff Services Professionals Awareness Week
This week is National Medical Staff Services Awareness Week, and I would like to recognize the important role that our medical services professionals play in our healthcare system. Often called the “gatekeepers of patient safety,” medical staff professionals are critical to our system’s high safety and quality standards. They work behind the scenes to ensure our providers are properly credentialed, licensed, and trained in their respective specialties. Please join me in thanking them this week.