Abstract
Swiss Health Care System
World news from Switzerland has been dominated by the role that euthanasia has played in the country. What a relief to read that Switzerland’ government reports its health care system is not properly prepared to ease the suffering of those with terminal illnesses. The country’ health minister, Pascal Couchepin, who stepped down at the end of October, joined Pierre-Yves Maillard, President of the Swiss Conference of the Cantonal Ministers of Public Health, to present a concept on palliative care in Bern.
Norwegian Academic Center
Formal academic research centers in palliative medicine continue to grow in number. While a few exist in the British Isles and North America, they are more rare in continental Europe and elsewhere in the world. Professor Stein Kaasa announced the establishment of the European Palliative Care Research Centre at the Norwegian University of Science & Technology. The center is based at the University’ Faculty of Medicine and at St. Olav’ Hospital/Trondheim University Hospital. The center will focus on coordinating efforts between groups and individual researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany, and Switzerland, along with the United States, Canada, and Australia. Researchers hope to boost the amount of international multicenter studies, as well as create an international doctoral program to educate young researchers in palliative care and to initiate and develop evidence-based guidelines for palliative care.
Home Funerals
Whether in response to the overall economic downtown or a response to the “green” movement in funerals, it is interesting to note that the bulletin of the American Association for Retired Persons reported that home funerals are on the rise. Embalming the body and caskets are foregone. Instead, usually with the assistance of “death midwives,” family members bathe, dress, and lay out the body—preserved with dry ice—for up to 3 days in their homes, enough time for fond farewells. In some cases, states allow families to conduct burials on private property in rural areas after obtaining the necessary permits. Such funerals can cost as little as $250.
Perverse Trends
It is a world-wide trend to try to limit the use of hospitalization because of cost. In many Western countries, the phrase to describe contemporary patterns of hospitalization is to discharge “quicker and sicker.” This contrasts with an older cultural norm of hospitalizing until the patient is restored to the same level of health as when he or she was admitted. Consequently, many patients need a level of assistance in the period after hospitalization they cannot receive at home. The period of recuperation notwithstanding, such patients may need careful monitoring and drug treatments that are beyond the abilities of most family caregivers or informal caregivers. So where will they get this care? The Kaiser Health Foundation reports that, coincident with this trend, is also a trend away from nursing homes. The number of facilities in the United States has fallen by nearly 1000 to about 15,700 since the year 2000. More than 80,000 beds have been closed over those 9 years. And the number of beds able to be funded by the government-sponsored insurance for nursing home care for the poor and disabled, Medicaid, has plunged by half since the year 1995, to approximately 114,000. All this is happening even as the population of those 75 and older—those most likely to need long-term services—has grown from 16.6 million to almost 19 million. This looks like a potential bonanza for new approaches to home care, or a potential disaster.
New England Journal of Medicine
It makes the heart glad to see information relevant to hospice and palliative care published in the New England Journal of Medicine—the medical journal with the highest impact in the world. It is even more wonderful when those articles are picked up as news by the popular media. Such was the case when the Associated Press reported that frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives. They reported the data that nursing home residents on dialysis did not improve their quality of life. They reported that many with advanced dementia will die within 6 months and should have hospice care instead of aggressive treatment. A geriatrician and palliateur, Greg Sachs, was a media celebrity for a moment.