Sick To Death > Chapter 3 > Palliative Care in Hospitals
Nearly 70 percent of all deaths in New York City occur in hospitals, and 63 percent of these deaths are among patients age sixty-five or older. Yet very few receive comprehensive palliative care (Zuckerman and Mackinnon 1998). In response to this statistic, the United Hospital Fund implemented its Hospital Palliative Care Initiative to share information about end-of-life care in hospitals. In addition, New York's Mount Sinai School of Medicine launched a palliative-care program in 1997 to give patients access to palliative-care services and to educate new physicians, house staff, fellows, and medical students (National Coalition for Health Care and Institute for Healthcare Improvement 2000). That model gave Mount Sinai the experience to lead the Center to Advance Palliative Care (CAPC), which helps hospitals nationwide to establish palliative-care services (Center to Advance Palliative Care 2000b).
A decade ago, almost no hospitals had programs directed at palliative care. Now, nearly one-fifth of community hospitals and one-fourth of teaching hospitals have some sort of program in place, and many more are being planned (Center to Advance Palliative Care 2000a). In fact, in 2002 the American Hospital Association reported a 20 percent increase in the number of hospital-based palliative-care programs over the previous year (Center to Advance Palliative Care 2003). These programs are providing substantial consultation services for hospitalized patients, and they are being supported by billings, grants, and subsidization by the hospital (Milbank Memorial Fund and Robert Wood Johnson Foundation 2000). Some programs have generated special units whose staff members receive special training and orientation, while others take care of people throughout the hospital, wherever they happen to be. Certain programs have special expertise in symptom control (especially pain from cancer), others in decision making and family counseling (especially for geriatric patients), and a few in special services for ventilator withdrawal (Coyle 1997; Campbell and Frank 1997).
Because various models of palliative care match the needs of varying situations, many models are in place. Services that a particular hospital should develop must be a function of several variables including resource potential, population needs, and availability of staff trained in palliative care (Center to Advance Palliative Care 2000b). No specific funding supports these programs yet. Physicians' billings for consultations and procedures have been the backbone of most budgets, along with philanthropic funds. In many hospital settings, the shortened length of stay and reduced use of redundant, unnecessary, or ineffective tests and pharmaceuticals have been enough to make palliative care a good investment for the hospital (Center to Advance Palliative Care 2000a; Smith et al. 2003). Many facilities clearly see the value of palliative-care expertise, which serves perceived needs in a way that was not otherwise possible (National Hospice and Palliative Care Organization and Center to Advance Palliative Care 2001).