The SCAN Foundation

“Patients in American hospitals receive intensive medical treatments,” that are not always the best for end-of-life situations, according to the June 28, 2010 report “The Quality of Care Provided to Hospitalized Patients at the End of Life," in the Archives of Internal Medicine. “However, when life saving treatments are unsuccessful, patients often die in the hospital with distressing symptoms while receiving burdensome care,” the report said.

Women, usually having the caregiving responsibility for people who need long-term services and supports, “are often called upon to be the proxy decision maker” for their loved ones near the end of life, according to the National Older Women’s League (OWL) May 2010 report, “End-of-Life Choices: Who Decides?” The current hospice benefits provides coverage for six months after two doctors certify that a patient has a life expectancy of six months or less. OWL wants to increase “Medicare and Medicaid coverage of end-of-life care from six months to 18 months, and allow patients to pursue both curative and palliative treatments concurrently,” the report said.

High-quality care at the end of life is an important but elusive goal, according to a Robert Wood Johnson report offering the views of 35 experts. “Palliative programs are concentrated in leading medical centers in urban areas; spiritual needs have been trumped by clinical concerns; the needs of large groups marginalized by race, ethnicity, disability, sexual orientation, income, and geography are too little considered; hospice is still underutilized and misunderstood; reimbursement systems are inadequate; and accepted standards for decision-making face attacks from many quarters,” according to the May 2006 report, “State Initiatives in End-of-Life Care: Issue 25: Thirty-Five Leaders Map the Future of Reform.”

The following entry is considered a seminal work.

Whereas issues such as termination of medical interventions once dominated discussion of bioethics and aging, the subject of long-term care policy and decision-making is now equally significant.  In the book, Long-Term Care Principles, Programs and Policies, by Rosalie Kane and Robert Kane (Springer Publishing, 1987), the authors include a comprehensive and in-depth analyses of the complex phenomena of long-term care.