Minnesota's 'health care homes' aim to fill gaps in support for late-in-life patients

As the giant boomer cohort of Americans begins to reach senior status, neither individuals nor the disparate components of the U.S. medical system have fully prepared for a new reality: People can expect to live far longer than their forebears. And as they age, patients frequently will need years of coordinated care and support services before they enter the end stage of life. Yet disproportionate amounts of spending go for desperate treatments at the very end.

For example, for the average patient who died in Minnesota in 2010, more than half of the Medicare money paid out in the last two years of life was spent in the final six months. In surveys, the vast majority of patients say they would prefer to avoid hospitalization and intensive care during the terminal phase of illness. But when doctors offer options, patients generally opt to pursue all chances for cures. In a system where intensive medical interventions are the main options offered, it is human nature to grab for those lifelines, said Dr. Robert Kane, who directs the Center on Aging at the University of Minnesota. “People — and Americans, particularly — are not very good at making wise decisions at the margin,” Kane said. “They tend to want whatever they can get. ...  In America, if you can pay for it, you can have it.”

“In some cases you could say that’s bad social policy because we are doing a lot of stuff that doesn’t really make good sense,” Kane said. “But it may be bad personal policy as well because they are basically putting the rest of their life at risk to live in a miserable situation in order to gain very little. ”As a result, Kane said, “we spend a fair amount of effort in this country dealing with problems where the benefit does not necessarily outweigh the harm; we put people through very expensive and debilitating treatment that is not necessarily in their best interests.”