Patient-Centered Palliative Care in the Home
In America and other wealthy countries, the average life expectancy has increased and the burden of acute illness has decreased dramatically during the twentieth century (Covinsky et al., 1994). Contemporary Americans overwhelmingly die from chronic, progressive diseases (Glaser and Strauss, 1968). In their last years, chronic disease(s) and increasing disability challenge the resources of most Americans. Changes in the family structure (including smaller size), increased likelihood that children live at some distance from their parents, and the fact that most families require that two people work in order to be financially viable, mean that family members are less likely than in prior generations to be able to provide the increased levels of care required by aging relatives (Lynn and Adamson, 2003). Data from the Study to Understand Prognosis and Preferences for Outcomes and Risk of Treatments (SUPPORT) study indicate that when family members do provide this care, it requires significant sacrifices: almost one third of families spend down to poverty in order to care for their dying loved ones (Lunney et al., 2003). Despite the evident need for assistance, family members received inadequate information about existing community services to which they were entitled. Managing the current patterns of old age and death requires changes in the way health care is conceived, delivered and financed. Here we primarily focus on the role of Palliative Care in the changes in the conception and delivery of health services.
KeywordsPalliative Care Home Care Primary Care Provider Nurse Practitioner Advance Directive
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