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Hospice Care in Southeast Michigan: Comparative Analysis

Hospice Care in Southeast Michigan: Comparative Analysis. Agenda. I. Agenda. II. Overview of Competitors. III. Overview of Hospice Care in Michigan. IV. Customer Needs. V. Summary. VI. Appendix. Agenda. Agenda. I. II.

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Hospice Care in Southeast Michigan: Comparative Analysis

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  1. Hospice Care in Southeast Michigan: Comparative Analysis

  2. Agenda I Agenda II Overview of Competitors III Overview of Hospice Care in Michigan IV Customer Needs V Summary VI Appendix

  3. Agenda Agenda I II Overview of Key Competitors(Hospice of Michigan, Hospice of Washtenaw, Angela Hospice, Henry Ford Hospice) - Consolidated Service Area - Service Area by Competitor - All Service Providers in 7 County Area - Summary by Identified Characteristic - Promises Made - Response Time - Patient Processing - Visit Frequency III Overview of Hospice Care in Michigan IV Customer Needs Summary V VI Appendix

  4. Consolidated - Service Area Arbor Hospice, Hospice of Michigan, Hospice of Washtenaw, Henry Ford Hospice, Angela Hospice Arbor Hospice, Hospice of Michigan, Hospice of Washtenaw, Henry Ford Hospice Arbor Hospice, Hospice of Michigan, Hospice of Washtenaw Hospice of Michigan, Henry Ford Hospice, Angela Hospice Hospice of Michigan, Hospice of Washtenaw Hospice of Michigan, Henry Ford Hospice Hospice of Michigan Source: Michigan Hospice & Palliative Care Organization

  5. Hospice of Michigan - Service Area Source: Michigan Hospice & Palliative Care Organization

  6. Hospice of Washtenaw - Service Area Source: Michigan Hospice & Palliative Care Organization

  7. Angela Hospice - Service Area Source: Michigan Hospice & Palliative Care Organization

  8. Henry Ford Hospice - Service Area Source: Michigan Hospice & Palliative Care Organization

  9. Arbor Hospice - Service Area Source: Michigan Hospice & Palliative Care Organization

  10. Competition within Service Area Arbor Hospice Service Area Competitor Source: Michigan Hospice & Palliative Care Organization

  11. HospiceofMichigan

  12. Service Summary – Hospice of Michigan Mission • Hospice of Michigan's mission is to ensure quality of life and a comfortable, peaceful death for all patients receiving care, and to provide support for their loved ones. Will serve everyone in communities who needs and seeks care, and strive to improve the state of end-of-life care. Vision • Hospice of Michigan will be the premier provider of expert, compassionate care for people who are experiencing life-threatening illnesses. Partnerships with patients, families, customers, employees and communities will enhance ability to provide care to all those who need it. Excel at service, innovation and research which will improve the quality of care for those served. Approach / Goals • Behave as a true interdisciplinary team. • Plan for the future. • Continually seek to eliminate barriers and improve access to services. • Set and exceed best practice standards for end-of-life care. • Measure everything in order to improve. • Provide opportunities for staff development and reward staff for their contributions to vision, mission and goals. Services • Physical support: pain management, symptom control, personal care • Emotional and spiritual support: helping patients and families cope • Grief support: helping families, friends for 13 months after the loved one’s death • Volunteer services: providing respite care, doing chores, listening • Financial assistance: helping all terminally ill patients, regardless of ability to pay Source: http://www.hom.org/; Hospice of Michigan Public Relations

  13. Service Summary – Hospice of Michigan (con’t) Differentiating Factors • Statewide. Hospice of Michigan was the first statewide hospice program in the country when it was founded in 1994 in a merger of 10 hospices across Michigan. Serves 45 counties throughout Michigan's Lower Peninsula. • Larger. Because of size, Hospice of Michigan can offer many services smaller hospices cannot afford, including complex and costly comfort care for patients who need it. • Specialists. Hospice of Michigan has specialists in many areas, including pediatric hospice care, high-tech palliative care and care for people with AIDS. Have more doctors and nurses who are board certified in hospice and palliative care. • Open admissions. Hospice of Michigan has no restrictive admissions criteria. Anyone with any terminal illness can be admitted to HOM, whether or not they have a caregiver at home. • Recognized leader. Hospice of Michigan is currently participating in several nationwide research projects to improve end-of-life care in the United States. President and CEO, Dorothy E. Deremo, is one of 12 members of Michigan Governor John Engler's Commission on End of Life Care. Executive Medical Director, Dr. John Finn, is president-elect of the American Academy of Hospice and Palliative Medicine. • Specialized programs. Hospice of Michigan has programs tailored to meet the needs of diverse cultural and religious groups. Source: http://www.hom.org/; Hospice of Michigan Public Relations

  14. Service Summary – Hospice of Michigan (con’t) Promises Made • Hospice of Michigan's makes no promises to admitted patients. The patient is informed as to all the people and services that will be available to them through Hospice of Michigan. Response Time • Depending on where the patient lives, response time can vary from 15 minutes to 75 minutes. Patient Processing • Depending on the time of day of the referral, a patient can be processed anywhere from 4 – 24 hours. Visit Frequency • Depending on the patient and symptoms, visit frequency can vary from daily to weekly. Source: http://www.hom.org/; Hospice of Michigan Public Relations

  15. HospiceofWashtenaw

  16. Service Summary - Hospice of Washtenaw Mission • Hospice of Washtenaw offers a wide range of services that meet the many physical, emotional and spiritual needs of patients and their families. Vision • Hospice of Washtenaw focuses not on healing and recovery, but on comfort and quality of life. Through specialized services, help patients and their families manage physical, emotional, social and spiritual needs. Patients live their final days with peace and dignity in the comfort of their own home or care facility. Work with family and friends to help them cope with end of life transition and stress of the approaching loss. Approach / Goals • The goal is to achieve constant control over pain without impairing alertness. Patients are encouraged to remain as active as possible and stay in close contact with family and friends. Differentiating Factors • Home Care and Hospice together offer to patients with a life-limiting illness the option of a "Bridge Program.“ • Staff assist in the management of end-of-life issues while the patient is still receiving treatment for the disease process. Source: Hospice of Washtenaw Public Relations

  17. Service Summary - Hospice of Washtenaw (con’t) Promises Made • Pain control: To provide patient centered care and to assist them to be pain free or at the pain level they desire • Respect patients’ wish: To be able to die in the place and way that they wish • Family assistance: To support the patient’s family and to provide follow up care for the family after the patient's death. Response Time • Phone response is within 30-45 minutes; will try and be at their home within 1 hour for an urgent request, such as a pain crisis. Patient Processing • Hospice of Washtenaw tries and admits all referrals ASAP and within 24 hours of time of referral. Visit Frequency • It is based on their acuity, i.e how sick they are and the intensity of their needs; some patients receive daily visits and some once or twice per week; they are visited by RNs, Social Workers, Spiritual Care Coordinators, Volunteers, home health aides, etc. Source: Hospice of Washtenaw Public Relations

  18. AngelaHospice

  19. Service Summary - Angela Hospice Mission • Caring for people with an incurable illness in the warmth and comfort of their own home is the heart of the Angela Hospice philosophy. Vision • Hospice seeks to empower the patient to carry on an alert and pain free life, to promote dignity and to maximize quality of life. It focuses on living rather than dying. Approach / Goals • Hospice is a philosophy rather than a place. Hospice is best when begun early enough that the patient and family can benefit fully from support and counseling. Differentiating Factors • Angela Hospice is the first freestanding hospice care facility built in Michigan (1994). In addition to in-patient, in-home, and bereavement care, Angela Hospice offers Pediatric Services titled, “Nest is Best.” Source: Hospice of Washtenaw Public Relations; http://www.angelahospice.org

  20. Service Summary - Angela Hospice (con’t) Promises Made • Good quality service care • Comfort Care • Pain-free • Emotional Support • Spiritual Counseling Response Time • Angela Hospice tries to respond by phone in under one hour, and get to the patient’s home ASAP for urgent crisis requests. Patient Processing • Processing can be completed in less than 24 hours after referral from the physician. Angela Hospice likes to be setup in the patient’s home before the arrival of the patient from the hospital. Visit Frequency • During the first, setup visit, an admitting nurse assess the patients needs and determines how many visits nurses, aides, volunteers, etc. will need to make. This varies greatly by patient needs. Source: Hospice of Washtenaw Public Relations; http://www.angelahospice.org

  21. Service Summary - Angela Hospice (con’t) Services Offered • There are currently 77 patients in in-home care under Angela Hospice. • Professional Services include: • Registered Nurses/Nurses Aides • Hospice Physicians • Certified Home Health Aides • Social Work • Spiritual Staff • Bereavement Services • Volunteers • Other therapies, as needed. Source: Hospice of Washtenaw Public Relations; http://www.angelahospice.org

  22. Henry FordHospice

  23. Service Summary - Hospices of Henry Ford Mission • Henry Ford Hospice is dedicated to providing compassionate hospice care of the highest quality to serve the needs of terminally ill patients and their families within the community. The hospice services will be comprehensive, efficient, clinically effective and enhanced by education and research programs. Vision (Henry Ford Healthcare System) • To offer a seamless array of acute, primary, tertiary, quaternary and preventive care backed by excellence in research and education. Approach / Goals • The primary objective is quality of life, not cure. Hospice care is comfort oriented, and is intended neither to shorten nor to prolong life -- but to assist patients and their loved ones through the dying process with dignity. • Diversification • Community Outreach • Clinical Improvement • Physician Organization Differentiating Factors • A seamless health care system (resources) • Extensive hospital (feeder) network • Performance measurement through family and physician satisfaction surveys • Largest volunteer network, 200 volunteers (37,500 volunteer hours in 2002) • Variety of settings for care; area nursing homes (50 contracts), assisted-living center (12 beds), adult foster-care homes, homes for the aged, & senior citizen apartments Source: www.henryfordhealth.org. Hospices of Henry Ford Office of Public Relations

  24. Service Summary - Hospices of Henry Ford (con’t) Promises Made • Hospices of Henry Ford Health System is dedicated to providing compassionate hospice services of the highest quality to terminally ill patients and their families. • Team members committed to honoring the wishes of the patient and caregivers during this difficult time of transition • Care advice and availability around the clock, 365 days a year. • Hospice services designed to meet the individual needs of patient and family. Response Time • Will travel to patient within 1 hour of call • Will visit hospital within 24 hours of referral Patient Processing • For home-care patients evaluations, care-plan and infrastructure are complete within 7 days Visit Frequency • Daily visits or as determined by per care-plan Source: www.henryfordhealth.org. Hospices of Henry Ford Office of Public Relations

  25. Service Summary - Hospices of Henry Ford (con’t) Services Offered • Social work services • Visits by hospice registered nurses • Nutritional services • Durable medical equipment • Trained volunteers • Children's hospice • Spiritual care and counseling • Medications for pain and symptom control • 24-hour availability • Skilled-care facility placement • Care for the caregiver • 13-month bereavement support and follow-up • Legal aid • Education Quality Assurance • Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) • A 98% satisfaction rate as measured by the Family Satisfaction Survey developed by the National Hospice Organization. The survey assess family satisfaction with care and service in the following areas: • Symptom Management • Customer service • Access to care • Simplicity of instructional materials • Support of caregiver Source: www.henryfordhealth.org. Hospices of Henry Ford Office of Public Relations

  26. Service Summary - Hospices of Henry Ford (con’t) Education The Hospices of Henry Ford have committed to raising awareness and broadening public understanding of the hospice philosophy. The Hospice Speakers Bureau serves social, civic, professional, educational and religious groups throughout southeast Michigan. Speakers are available to address the following topics: • What is hospice? • Services provided by hospice • Pain and symptom management • The nurse's role in the hospice care plan • Advance Medical Directives • DNR (Do-Not-Resuscitate) orders • Hospice volunteer opportunities • Hospice home safety • Patients' Bill of Rights • How to talk with children about death • How adults can help grieving children • Living wills • The nature of grief • Pastoral care for hospice patients • Medicare and hospice benefits Source: www.henryfordhealth.org. Hospices of Henry Ford Office of Public Relations

  27. Assisted Living (12 bed facility) Expansion Plans Service Summary - Hospices of Henry Ford (con’t) The assisted-living facility managed by the Hospices of Henry Ford operates on a wait list system. There are currently no plans for expanding the assisted living facility. Since its launch in 2000 the facility has not been profitable. The Henry Ford System and its Hospice operation have applied for Acute Symptom Control and Respite Care Certifications. Upon certification it is their objective to include these additional services to increase profitability. Advertising & Promotion Channels • Marketing within geographic areas (through local groups) • - Church & fraternal organizations, and speaking engagements • Promotion among doctors (5 primary feeder hospitals) • - Hospice nurse on site each day • Educational Programs • - Nursing Student Education Program (500 nurses graduate annually) • - Classroom training (affiliations with local area universities) • Routing of medical care professionals • Target advertising in community newspapers • Billboard (7 alternate sites in Detroit area) • Underwriters of PBS documentary series • TV commercial produced and launched in 2002 • Public radio service announcements Source: www.henryfordhealth.org. Hospices of Henry Ford Office of Public Relations

  28. ArborHospice

  29. Service Summary – Arbor Hospice Mission • “To give comfort, assurance and care to families and patients who have life-limiting illness, and to educate and nurture others in this care” Vision • Establish AHHC as leader in premium end-of-life care and related support services • Build “brand equity” • Create context for AHHC in minds of employees, consumers, and donor prospects • Communicate in a consistent voice Approach / Goals • Continued patient and revenue growth through: • A defined marketing strategy addressing public and physician education, brand differentiation, and defined presence in satellite branches. • Cultivation of new markets • Strengthening of existing referral base • Overcoming cultural issues: • Misperception that hospice is “the place where one goes to die” • Reluctance to come to terms with the fact that a loved one is going to die • Streamlined operations • shift in organizational philosophy towards “growth and development” drives adjustments in staff structure • Management of limited resources to vie with larger competitors • Overcoming “historical financial difficulties” through improved project management and accounting Differentiating Factors • Arbor Hospice Residence, extensive grief counseling services, comprehensive pediatric hospice care, Pathfinders program (grief support for children, adolescents, and adults), extensive home care services Source: Arbor Hospice

  30. Service Summary – Arbor Hospice (con’t) Promises Made • Top quality medical care • Weekend admissions and prompt referrals • Continuity of service • Over 15 years of service • Referring physicians and discharge planners like to work with AHHC Response Time • A phone call back within 15 minutes (weekends, phone answered by pager, returned within 15 minutes) • 800 line gives immediate access - though rarely an emergency call, still makes sense for rapid response Patient Processing • Residence – average of two weeks to get patient in residence, from time of phone call • 24 hours (average) from time of call to time bed considered a hospice (or home care) bed • Average length of stay 6-8 days • Can admit field patient and then put on waiting list for residence • Can also go from hospital to home care to residence • If in a hospital, patient is discharged from hospital & admitted to AHHC, and no hospital nurses take care of • patient any longer – all hospice care at that point. Source: Arbor Hospice

  31. Service Summary – Arbor Hospice (con’t) Visit Frequency Field • On call 24 hours • Frequency for hospice – determined on a case by case basis • Nurse/nurses aide - on average, 2 times a week (M-F), though towards end of life, increases to 5 times a week. • AHHC social workers - 2-3 times a month if needed, tend not to be needed as much for home care, though toward end of life winds up being m-f • Physical therapists, chaplain, speech therapists used fairly infrequently • Family or volunteers usually goes by 2-3 times a week take care of clothing, food, etc. • Residence • Nurses/aides go in every 2 hours to turn patients, and are on call 24 hours • Social workers range from several times a day to once a week (social worker does admissions, • evaluations, understanding end of life issues, legal or financial issues, wills, clergy, etc.; essentially helps • the whole family as liaison between patient and the world of hospice care) • Chaplain from several times a day to once a week (non-denominational, hired by hospice, four total, one • for each region and one for residence, share weekend and on call). • 4 medical directors/physicians (arranged like chaplains), and overall medical director (managing • physician, who reviews every case, manages policy, etc.). Though nurses have doctor’s order to sign off • on death certificate. Source: Arbor Hospice

  32. ServiceComparison

  33. Promises Made Hospice of Michigan • Hospice of Michigan's makes no promises to admitted patients. The patient is informed as to all the people and services that will be available to them through Hospice of Michigan. Hospice of Washtenaw • Pain control: To provide patient centered care and to assist them to be pain free or at the pain level they desire • Respect patients’ wish: To be able to die in the place and way that they wish • Family assistance: To support the patient’s family and to provide follow up care for the family after the patient's death Angela Hospice • Good quality service care • Comfort Care • Pain-free • Emotional Support • Spiritual Counseling * Please see respective organizational slide for source information.

  34. Promises Made (con’t) Henry Ford Hospice • Hospices of Henry Ford Health System is dedicated to providing compassionate hospice services of the highest quality to terminally ill patients and their families. • Team members committed to honoring the wishes of the patient and caregivers during this difficult time of transition • Care advice and availability around the clock, 365 days a year. • Hospice services designed to meet the individual needs of patient and family. Arbor Hospice • Top quality medical care • Weekend admissions and prompt referrals • Continuity of service • Over 15 years of service • Referring physicians and discharge planners like to work with AHHC • Arbor Hospice Residence • Committed to staff education • Specialized care for children • Grief support services for adults and children * Please see respective organizational slide for source information.

  35. Response Time Hospice of Michigan • Depending on where the patient lives, response time can vary from 15 minutes to 75 minutes. Hospice of Washtenaw • Hospice of Washtenaw: Phone response is within 30-45 minutes and we can try and be at their home within 1 hour for an urgent request, such as a pain crisis. Angela Hospice • Angela Hospice tries to respond by phone in under one hour, and get to the patient’s home ASAP for urgent crisis requests. Henry Ford Hospice • Will travel to patient within 1 hour of call • Will visit hospital within 24 hours of referral Arbor Hospice • A phone call back within 15 minutes (weekends, phone answered by pager, returned within 15 minutes) • 800 line gives immediate access - though rarely an emergency call, still makes sense for rapid response * Please see respective organizational slide for source information.

  36. Patient Processing Hospice of Michigan • Depending on the time of day of the referral, a patient can be processed anywhere from 4 – 24 hours. Hospice of Washtenaw • Hospice of Washtenaw tries and admits all referrals ASAP and within 24 hours of time of referral. Angela Hospice Processing can be completed in less than 24 hours after referral from the physician. Angela Hospice likes to be setup in the patient’s home before the arrival of the patient from the hospital. Henry Ford Hospice • For home-care patients evaluations, care-plan and infrastructure are complete within 7 days Arbor Hospice • Residence – average of two weeks to get patient in residence, from time of phone call • 24 hours (average) from time of call to time bed considered a hospice (or home care) bed • Average length of stay 6-8 days • Can admit field patient and then put on waiting list for residence • Can also go from hospital to home care to residence • If in a hospital, patient is discharged from hospital & admitted to AHHC, and no hospital nurses take care of • patient any longer – all hospice care at that point. * Please see respective organizational slide for source information.

  37. Visit Frequency Hospice of Michigan • Depending on the patient and symptoms, visit frequency can vary from daily to weekly. Hospice of Washtenaw • It is based on their acuity, i.e how sick they are and the intensity of their needs; some patients receive daily visits and some once or twice per week; they are visited by RNs, Social Workers, Spiritual Care Coordinators, Volunteers, home health aides, etc. Angela Hospice • During the first, setup visit, an admitting nurse assess the patients needs and determines how many visits nurses, aides, volunteers, etc. will need to make. This varies greatly by patient needs. Henry Ford Hospice • Daily visits or as determined by per care-plan * Please see respective organizational slide for source information.

  38. Visit Frequency (con’t) Arbor Hospice Field • On call 24 hours • Frequency for hospice – determined on a case by case basis • Nurse/nurses aide - on average, 2 times a week (M-F), though towards end of life, increases to 5 times a week. • AHHC social workers - 2-3 times a month if needed, tend not to be needed as much for home care, though toward end of life winds up being m-f • Physical therapists, chaplain, speech therapists used fairly infrequently • Family or volunteers usually goes by 2-3 times a week take care of clothing, food, etc. • Residence • Nurses/aides go in every 2 hours to turn patients, and are on call 24 hours • Social workers range from several times a day to once a week (social worker does admissions, • evaluations, understanding end of life issues, legal or financial issues, wills, clergy, etc.; essentially helps • the whole family as liaison between patient and the world of hospice care) • Chaplain from several times a day to once a week (non-denominational, hired by hospice, four total, one • for each region and one for residence, share weekend and on call). • 4 medical directors/physicians (arranged like chaplains), and overall medical director (managing • physician, who reviews every case, manages policy, etc.). Though nurses have doctor’s order to sign off • on death certificate. * Please see respective organizational slide for source information.

  39. Basic Comparative Statistics # Patients Served # Beds # Physicians # Employees 196 30 1,400+ 5 Arbor Hospice 42 7,000 18 500 Hospice of Michigan 145 16 100 1 Angela Hospice 1,850 Henry Ford Hospice 12 5 150 3 part-time Hospice of Washtenaw 0 450 30 * Please see respective organizational slide for source information.

  40. Overview of Service Summary In Nursing Home & Hospital Spiritual Care Clinical Resources Hospice Home Grief Support Home Care X X X X X X Arbor Hospice X X X X X X Hospice of Michigan X X X X X X Angela Hospice X X X X X X Henry Ford Hospice X X X X X Hospice of Washtenaw • Due to the broad characterization of hospice benefits combined with the hospice requirements set forth by the state of Michigan, hospice organizations look similar to the customer upon initial inspection. * Please see respective organizational slide for source information.

  41. Agenda Agenda I Overview of Competitors II III Overview of Hospice Care in Michigan - Basic Care Requirements - Medical Training and Hospice Care - Issues with Financing - Michigan End of Life Care - Demographics Customer Needs IV V Summary VI Appendix

  42. General Services Offered Medical Care Nursing Care Social Work Spiritual Care Quality Assurance Program Using an interdisciplinary committee to identify problems Patient Rights and Responsibilities Develop and post in public place the rights of patients Governing Board An organized governing body to conduct operations Administrator who ensure implementation of all procedures Basic Care Requirements Source: Michigan Commission on End of Life Care

  43. Hospice-Related Educational Environment in Michigan Availability of education in medical residency and fellowship programs in Michigan • A recent survey of residency and fellowship programs in Michigan reflects that “physicians are not well educated in end-of-life care.” • The table above reiterates the continuing struggle hospice organizations will have as they try to grow and gain legitimacy with patients and doctors. Source: Open Society Institute, “Project on Death in American”

  44. Hospice-Related Educational Environment in Michigan (con’t) Adequacy of education in medical residency and fellowship programs in Michigan • There seems to be room for improvement when it comes to physician training relative to end of life care in general and specifically hospice care. • Only 20% of the respondent's reported any required formal training in hospice care. • Less than one-third of the doctors responded to having any formal training in hospice care.

  45. Discrepancy in Hospice Training by Type of Care Primary Care Non-primary Care • Due to the broad characterization of hospice benefits combined with the hospice requirements set forth by the state of Michigan, hospice organizations look similar to the customer upon initial inspection.

  46. Michigan End of Life Care Challenges in Financing Hospice Care (for the patient) • Great variation exists in how services are provided and funded within various settings: • - Uncoordinated mix of Medicare, Medicaid, private insurance and out of pocket funds • Small proportion of Medicare and Medicaid patients enroll in hospice benefit, < 20% • Arbitrary hospice care eligibility criteria: • Rule that states patient must have life expectancy of six months or less • Medicare reimbursement requires that 80% of hospice services be provided in the home • Hospice reimbursement not based on actual costs of delivering care • Cultural attitudes delay decision to move from curative therapies to end-of-life care options • Generally patients preferences for treatment at end of life are unknown, few standardized policies to communicate these preferences to health care providers Source: Michigan Commission on End of Life Care, Report to the Governor July 2002

  47. 2000 2010 2020 2030 Population (in millions) 275.4 299.9 324.9 351.0 Median Age 35.8 37.4 38.1 38.9 Median Age 36.5 37.9 39.2 40.2 Michigan End of Life Care (con’t) Demographics: An aging population • There are 1.8 million people age 65 and older in Michigan, expected to grow significantly • Nationally, 70% of annual deaths occur among people age 65 and over; • of the 84,906 people who died in Michigan in 1998, 75% were over 65 • Michigan trends likely to parallel Census Bureau projections, which highlight an increase in the total U.S. population as well as in the median and mean ages over the next 30 years. Source: U.S. Census Bureau, Population Projections Program, Population Division. January 13, 2000

  48. Michigan End of Life Care (con’t) Population Distribution Income distribution by household Source: http://quickfacts.census.gov/qfd/states/26000.html

  49. Michigan End of Life Care (con’t) Most Frequent Causes of Death (Michigan, 1998) • Diseases of the heart (27,851) • Cancer (19,442) • Stroke (5,760) • Chronic obstructive pulmonary disease, COPD and allied conditions (3,807) • Unintentional injuries (3,096) • Pneumonia and influenza (3,090) • Diabetes mellitus (2,449) • Alzheimer’s (644) The top 5 disproportionately affect the elder population Medical treatments make it possible to live with these diseases but care is intensive, prolonged, and often costly. It is difficult to determine when patients with such illness can be diagnosed as terminal. Source: Michigan Resident Death Files, 1990-1998.

  50. Michigan End of Life Care (con’t) Where Death Occurs In general, people in Michigan and in the nation die in one of three locations: Source: Michigan Resident Death Files, 1990-1998 • Many advocates consider it a positive trend that an increasing number of people dies in the home • Increase reflects an acceptance of the preference to die at home • Improvements in technology, increased outpatient services and more access to home heath care are all likely contributors to upward trend. • A challenge to be considered, is that those dying at home present an additional burden to the informal caregivers and the household for services previous rendered by health care providers. • Data shows a decreasing reliance on hospitals for end-of-life care • Nursing homes are often the setting of last resource for most people who are elderly and disables,m with complex diagnoses and health care needs, data indicates the nursing facility residents must be included in any targeted end-of-life care quality improvement efforts. Source: Michigan Commission on End of Life Care, Report to Governor July 2002

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