“Hospice helped reassure and comfort Dad as he struggled with spiritual pain. On the final day of his life, he asked his nurse practitioner, Tamara: ‘Why hasn’t God taken me yet?’ She replied with understanding and humility: ‘Maybe your work isn’t done. Maybe you need to be here for someone.’ Sure enough, one of my brothers had not yet arrived at our house.
That night, with the knowledge of a sage, my father announced to his family: ‘I am going to die tomorrow.’ It was not scary or sad. Dad was telling us he was ready. Several hours later, the last of my three brothers arrived. Then, with Mom and his four sons holding him close, Dad took his last breath and left this world.
This moment, and all the moments leading up to that Friday night, will never be forgotten. The team of Hospice of the Western Reserve gave us our Dad’s life, moment by moment, when each moment was precious. Now, we move forward and learn to live a new reality. Dad is not here physically, but Barry William Finn is present in our hearts and minds every day.”
Bill Finn recounts his late father’s experience with hospice care in this excerpt from a 2017 LinkedIn post titled “Hospice first hand: Caring for my father.” Experiences like these are common with hospice care, with several patients and families expressing emotions of peace and acceptance during their final days. End-of-life care gives patients the power to choose how they spend their last days. In fact, various evidence indicates that end-of-life care positively impacts patients’ medical outcomes as well.
In recent years, there has been a trending rise of at-home deaths and concurrent fall in hospital deaths (Bone, 2018). This presents the issue of whether the supply of end-of-life care will be able to meet the rising demand. Anna Bone’s team analyzed these trends and have recommended that in order to accommodate to the phenomenon of population aging and rise of at-home deaths, there ought to be an urgent policy response that plans for this increased demand for end-of-life care staff and facilities (Bone, 2018). Bone claims that these reforms ought to make changes to hospital infrastructure to support rising annual deaths to decrease hospital deaths overall. This infrastructure includes end-of-life care training for nursing home staff and at-home service staff, funding toward care homes, and public education (Bone 2018). Though this paper focuses on England and Wales, the phenomenon of population aging and trends mentioned in the article apply to the United States as well. Policy geared towards end-of-life care is necessary, and social factors that affect this care are important to understand in order to enact effective policy.
Though the popularity and advances of end-of-life care have grown exponentially in the past few decades, these improvements have not been equitably distributed to everyone. There are disparities in access to care, quality of care, and knowledge of care along the lines of urban versus rural residence, immigration status, ethnicity, and race. Since there is evidence that high quality end-of-life care can help improve end-of-life quality of life by decreasing hospitalizations and emergency department visits in patients, state and federal governments ought to address these disparities in order to ensure equitable care across geographical barriers to both rural and urban populations (Cerni, 2020). Though future research is needed to understand these social determinants further, I believe that it is important to improve funding and resource allocation, facilitate better communication between healthcare providers and recent immigrants, and encourage culturally competent care for ethnically and racially disadvantaged groups.
Sources:
Finn, Bill. “Hospice first hand: Caring for my father”. Linkedin (2017). https://www.linkedin.com/pulse/hospice-first-hand-caring-my-father-bill-finn/
Cerni, Jessica. “End-of-Life Cancer Care Resource Utilisation in Rural Versus Urban Settings: A Systematic Review”. Int J Environ Res Public Health (2020). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400508/
Bone, Anna. “What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death.” Palliative Medicine (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788077/