'Affordable' Death in the United States: An Action Plan Based on Lessons Learned from the Nursing Economic$ Special Issue
Kovner, Christine T., Lusk, Edward, Selander, Nellie M., Nursing Economics
*An eight-point action plan is proposed for lowering costs associated with end-of-life health care in the United States, as well as improving the quality of life experienced by patients and their families.
*This action plan was derived from an analysis of the six articles presented in this special issue of Nursing Economic$.
*The two major features of this action plan are: (a) expansion of hospice and palliative care, as well as (b) increased use of advance directives.
*Additionally, as pre-conditions for the effective operation of this action plan, the political, cultural, and legislative contexts that merit attention are discussed.
*Finally, arguments as to the desirability, feasibility, and sustainability of this action plan are offered.
THE PRECEDING SIX ARTICLES presented in this special issue of Nursing Economic$ illustrate with uncommon clarity the nature and scope of the end-of-life cost problems facing the U.S. health care system. They tactfully navigate the sensitive and often contentious subject of death, while acknowledging that it must be addressed by patients, by their families, and ultimately by all Americans, if we are to efficiently and expertly dodge the catastrophic effects of the "perfect cost storm" that several of the authors reference. The storm - rising health care costs, particularly at the end-of-life, and the aging baby-boomer generation - is just beginning to lap at our shores; predictably soon it will be a tsunami. Taking the necessary actions to deal with the nexus of the Cost and the Dignity of Death issues will require making difficult decisions about the extent and types of care delivered, as well as the mode of health care delivery offered in the United States. The authors of the articles that you have just read provide convincing evidence for why and how these decisions should now be made. To give a sense of the most salient points that each of the preceding authors make, we will next summarize them. Following our summaries, we will offer an eightpoint action plan that policymakers and lobbyists would do well to consider to avoid the impending tsunami that inaction will surely invite.
Lessons Learned from Papers Addressing the Question, How Can We Afford to Die?
In "End of Life Care in the United States: Current Reality and Future Promise - A Policy Review," Lisa A. Giovanni, BSN, RN, details the end-of-life reforms, or lack thereof, in the 2010 Patient Protection and Affordable Care Act and the inherent potential of the 1991 Patient Self-Deter - mination Act, specifically as it pertains to advance directives and their ability to curtail end-of-life health care costs. Stressing "that the unique needs of the terminally ill remain poorly addressed," she explains the benefits of hospice and palliative care and advance directives, and suggests their integration, bringing forward their individual benefits but also anticipating the synergy created by folding these initiatives together. Giovanni also raises an alert that must be considered - that of dis- parity in access and funding for these cost-controlling measures.
Marlene McHugh, DNP, DCC, FNP-BC; Joan Arnold, PhD, RN; and Penelope R. Buschman, MS, RN, PMHCNS-BC, FAAN, in their article, "Nurses Leading the Response to the Crisis of Palliative Care for Vulnerable Populations," posit that nurses are innately qualified to provide palliative care. They poetically suggest that the qualities and duties of palliative care compose the essence of nursing and that all nurses can be palliative care generalists, whereas nurses with more specialized, advance knowledge in the field can lead the implementation and expansion of palliative care. Beyond simply encouraging the expansion of palliative care, McHugh and co-authors argue palliative care must be expanded to vulnerable populations, as these populations are especially in need of palliative care and should have easy access to it. The authors go on to detail recent innovations in encouraging and expanding palliative care in the United States and recommend all nurses should be aware of these initiatives. …