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What Factors Affect the Cost of End of Life Care?

By Susan Abe
Updated Feb 09, 2024
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End of life care refers to medical care and treatment administered to a dying patient who has no reasonable chance of recovery. This type of care can take place in a hospital's intensive care unit (ICU), a regular hospital bed, a nursing home, a hospice or at the patient's home. After a traumatic injury or an acute illness, dying patients are cared for within acute care hospitals or ICUs. Patients with chronic or advancing illnesses can be cared for in a hospital, hospice or their own homes. The primary factors affecting the cost of end of life care are the location and degree of nursing and medical care provided to the dying patient.

Intensive care unit treatment has the highest cost of end of life care. ICUs are designed to aggressively treat critically ill patients with the most advanced technology and methods available. It becomes apparent to the medical staff in some situations, however, that a critical care patient using life-sustaining technology has no reasonable chance of recovery.

In the US, the outcome of such a case varies depending upon whether the patient has an existing advance directive stipulating the extent of allowed care if recovery is not possible. With an advance directive that limits life-sustaining technologies, the patient can be transferred — if time allows — to a hospice or a regular hospital bed for a less expensive cost of end of life care. In the absence of such a directive, aggressive care to maintain the patient's life must be continued until a spouse, parent or other responsible family member makes a decision regarding the extent of desired treatment.

The cost of end of life care in a nursing home or inpatient hospice is less than hospital care. In the US, inpatient hospice services are covered by Medicare, Medicaid and most private health insurance carriers. For those patients covered by Medicare, there is usually a small co-payment expense incurred by their care; however, a wide variety of treatment modalities are covered for up to six months prior to the patient's demise as estimated by his physician. Hospice services can also be provided to nursing home residents for those modalities not already offered by the extended care facility.

Home hospice care provides the least expensive cost of end of life care of all of these options. In the US, nursing care, certified nursing assistant (CNA) care, medications and durable medical equipment (DME) are all provided at no cost to Medicare patients and some covered by private health insurance carriers. Hospice does not provide 24-hour per day care, but does provide around-the-clock contact. Some families prefer the reassurance of continuous assistance and so assume this cost of end of life care privately.

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Discussion Comments
By bythewell — On Aug 11, 2014

@KoiwiGal - The problem is defining the point of no return. My mother has always stated that she never wants to be taken off life support, if it comes to that, because there might be a miracle and she might come back alive.

Other people might be willing to be on life support if they are in a coma from an accident, but not if they are on end of life care. And some people might simply not be able to afford end of life care. So who should get to have it and who should decide? I'd say leave it up to the doctors, but I don't always trust what they have to say either.

By KoiwiGal — On Aug 10, 2014

@browncoat - My grandfather was in a hospice for several months before he passed on and I'm not sure anyone would necessarily choose to be in that state. His body would just not give up even though his mind had left a long time ago.

It's a tough era for this kind of debate, because we have the technology available to extend the life of the body almost indefinitely, even long past the time when the person could still be considered to be a person. And it's so expensive to pay for something that really only provides grief for the family and very little solace.

The only thing worse would be to not pay for it when it was necessary, but I know I'm going to arrange my will so that my family will never be put in that position. It's going to state without conditions that if I get to the point of no return, they shouldn't try to keep my body alive.

By browncoat — On Aug 09, 2014

My father used to hate the idea of this and always said that if he got to the age where he was being cared for in this way (being a burden was what he called it, but of course we wouldn't have seen it like that) that he would just swim out into the ocean and let the fishes have him.

But I always told him to stop being silly, because we would miss him if he wasn't there and trying to bypass this kind of treatment was actually kind of a selfish thing to do. He ended up dying of a heart attack anyway, so it became a moot point, which I suppose is just as well, because we were both quite serious about our differing points of view.

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