End of Life Care in this country is NOT going well.
Let me tell you why I make this statement:
People used to die at home surrounded by family and friends. Caring for our dying was a skill that was passed down from one generation to another until the last 50-75 years when people started dying in hospitals, nursing homes, and locations away from their families and away from the public view.
When surveys are done, 90% of people say they want to die at home. Yet, In reality, 60% die in hospitals and 20% die in nursing homes, leaving only a small percentage who actually get their wish to die at home.
Why is there a discrepancy between what we want and what we get?
The three main reasons are
(1) Death has been medicalized.
In our culture, death is viewed as a medical event. But in reality, death is NOT a medical event – death is a natural process. It’s part of the cycle of life; as we all know, when we are born, we will certainly die like every natural thing in the plant and animal kingdoms.
(2) The elderly population explosion coupled with a shortage of healthcare workers:
At the same time, the baby boomers born between 1946 and 1964 will reach 65 by 2030 and constitute 23% of the US population. Of these boomers, about a quarter do not have children. Children today do the bulk of the caregiving when their parents are dying. And we won’t have enough nurses and doctors to care for all these boomers; in fact, according to the American Nurses Association, we will need 12 million new nurses to care for them all. It’s also predicted we will be short about 120,000 doctors by then.
Hospice provides support at the end of life, but as many of us who volunteer or work for hospice (or who have had loved ones under hospice care) know, hospice nurses are not caregivers. They manage end-of-life medication and monitor the patient medically. The hospice nurse is the case manager, but she is not required to see her patients more than once every 14 days (Medicare requirement). If the average time in hospice care is only 14-16 days, a patient may only see a hospice nurse once. The current hospice model will not be the answer to the looming end-of-life care crisis.
We are headed for a “perfect storm” of too many dying, not enough medical personnel to monitor them, and not enough caregivers.
(3) We are not doing a good job planning for death. It's been shown that those who plan for their death have a far better outcome than those who leave it to others to figure it out for them.
But there is an answer – bringing back non-medical caregivers who can help patients and families plan for the end of life and who can spend unlimited time supporting them. That is what a Death Doula can do.
Death Doulas will change the way end-of-life care is managed in this country and reverse the trend of people dying alone in hospitals or unsupported at home with family members who are afraid and unprepared.
The definition of a Death Doula is a non-medical professional who provides holistic support for dying people and their loved ones. The Death Doula profession has the
potential to change the course of end of life care.
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