{
  "id": "R40235",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "R40235",
  "active": false,
  "source": "EveryCRSReport.com",
  "versions": [
    {
      "source": "EveryCRSReport.com",
      "id": 353508,
      "date": "2009-02-23",
      "retrieved": "2016-04-07T02:44:12.754988",
      "title": "End-of-Life Care: Services, Costs, Ethics, and Quality of Care",
      "summary": "End-of-life care can be broadly defined as health care provided to persons who are very ill, have a prognosis that is likely to worsen, and most likely will die in the near term from their illness. End-of-life care may be in the form of acute care provided in the days or months prior to death or palliative care, which focuses on relieving the patient\u2019s suffering and reducing the severity of disease symptoms as well as improving quality of life. Hospice care is a form of palliative care that delivers comfort care to those who forgo curative treatment and have a life expectancy that can be measured in months. Achieving a health care system where the provision of end-of-life care services are sensitive to and accommodate the needs of all those involved requires attention to a range of ethical and policy issues, including personal choice, cost, and quality of care.\nOver the past century, several demographic and historical changes have affected the experience of death and dying in the United States. The development of new technologies, and the associated prospect of longer, more protracted deaths, has focused some policy discussions on the topic of patients\u2019 preferences. Federal law generally defers to state law concerning health-care decision making. Given the complexities in decision making surrounding medical interventions that have life-extending potential, states have passed laws to address end-of-life care issues, such as advance directives. However, there is considerable variation among state laws.\nCosts of care at the end of life may be paid by Medicare or Medicaid, private insurance, or out-of-pocket. According to CMS, about one-fourth of total Medicare spending is for the last year of life. This share has remained generally constant for the past 20 years. The majority of Medicare end-of-life costs are from inpatient hospital expenditures. Researchers have also found that there is wide geographic variation in end-of-life Medicare costs. This geographic variation may reflect differences in practice patterns of physicians and is not necessarily due to differences in prevalence of disease among chronically ill patients.\nEnd-of-life care presents numerous challenges and opportunities for quality measurement, assessment, and improvement. Assessments of quality end-of-life care are often based on family and patient satisfaction. Factors associated with perceptions of higher quality care include expressions of patients\u2019 wishes, discussions of families\u2019 spiritual needs, documentation of a living will, and family presence at the time of death. A number of initiatives are currently underway to improve the quality of care individuals receive at the end of life, and specifically the quality of palliative and hospice care.\nAs the nation prepares for an aging population and likely increase in the need for high quality end-of-life care services among the elderly, Congress may face a decision whether to expand the role of the federal government in providing support to individuals and families to assist with end-of-life care. This report provides information on various aspects of end-of-life care. The report is divided into six sections that address (1) demographic and historical changes affecting death and dying in the United States; (2) the definitions of end-of-life, palliative, and hospice care; (3) costs associated with end-of-life care; (4) end-of-life care laws and ethics; (5) quality of care at the end of life; and (6) policy issues that would modify or expand the federal government\u2019s role in addressing end-of-life care. This report will be updated as warranted.",
      "type": "CRS Report",
      "typeId": "REPORTS",
      "active": false,
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          "url": "http://www.crs.gov/Reports/R40235",
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      "topics": []
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  ],
  "topics": [
    "Aging Policy",
    "Health Policy",
    "National Defense"
  ]
}