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.