When lives end slowly, it's costly

Baby boomers have redefined much about the way Americans live.

Now, they have an opportunity to change the way we die -- and, from a financial standpoint, they might have no other choice.

"Society may not be able to afford our current way of dying," said Dr. Thomas J. Smith, chairman of the division of hematology/oncology and palliative care at the VCU Massey Cancer Center.

In the next 10 years, health care spending in the U.S. is projected to double to more than $4 trillion a year, or 20 percent of the gross domestic product, according to the Centers for Medicare and Medicaid Services.

The burden is felt on a national level as well as a personal one. A 2005 study by Harvard Medical and Harvard Law schools found medical bills and illness were by far the biggest reasons for personal bankruptcy.

As 78 million boomers reach old age and medical advances continue to extend their lives, the financial crunch promises to get worse -- unless boomers re-evaluate the expectations and delivery of end-of-life care, said Stephen P. Kiernan, author of "Last Rights: Rescuing the End of Life from the Medical System."

Kiernan will speak in Charlottesville on March 26 as part of the Virginia Festival of the Book.

"This is a problem of success," Kiernan said in a phone interview. "Baby boomers are living longer. It's great, but it's a challenge because we're still mortal. It's just that instead of our lives ending suddenly, they end slowly.

"The bad news is, it's scary to contemplate your mortality. . . . But the good news is, there's a lot of opportunity for people to choose what that experience is going to be like."

. . .

Kiernan, 47, a former newspaper reporter who lives in Vermont, is a proponent of hospice and palliative care, which focus on managing pain but not taking extraordinary medical measures to extend lives.

His views developed from research and personal experience. His father died a prolonged death after suffering an aneurysm. The family demanded medical intervention to try to keep him alive, and he spent his last four weeks hooked to tubes in a hospital.

Four years later, Kiernan's mother chose to spend her final days at home, dying of cancer, surrounded by loved ones in a more peaceful setting.

"We learned," Kiernan said.

Studies show hospice care generally costs less than regular hospital treatment. Intensive care can cost thousands of dollars a day; hospice no more than a few hundred, Kiernan said.

"The fact that hospice and palliative care save money is a wonderful side effect to the fact that they provide people with quality care," Kiernan said.

Despite that, hospice and palliative care remain foreign concepts for many Americans. Kiernan said boomers can change that by becoming more astute medical consumers and demanding those options without documents that say patients must be in the last six months of life to qualify for hospice coverage under Medicare.

. . .

VCU's Smith, co-founder of the palliative-care unit, said there needs to be "incentives that reward doctors and patients for having these discussions rather than rewarding" greater medical intervention.

"We started our palliative-care unit to have a place where the staff were expert in relieving symptoms and helping people adjust to bad medical circumstances," Smith said. "We anticipated . . . we might save 5-10 percent [in health care costs].

"Instead, we found that for people who die in the hospital, our patients cost society about 50-60 percent less. We did fewer diagnostic tests and spent a lot more on symptom control. The end result was much better symptom control at a cost society could well afford."

Contact Bill Lohmann at (804) 649-6639 or wlohmann@timesdispatch.com.