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Communicating Care at the End of Life


Carey Candrian

While health care at the end of life is changing, the language for talking about treatment options and patient preferences around the end of life is taking longer to change. This book carefully details the way language shapes decisions around end-of-life care. Using ethnographic research from two sites that offer emergency care and end-of-life care – a hospice and an emergency department – the author illustrates common themes around language use that serve as microcosms of the larger healthcare system in the United States. The sites have different purposes for providing care, yet the themes from both serve as guidance and reflection for other areas of caregiving.
The language used to talk about death holds consequences and opportunities for understanding and making decisions about care practices. This book uses personal stories and perspectives from patients, family members, and medical workers to paint a picture of some of the issues and tensions individuals and caregivers face. With an aging population – one that represents a major public health challenge in the twenty-first century – Carey Candrian argues that examining the care we provide for individuals, especially aging individuals, is fundamental to creating a developed, ethical, and engaged society.
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Chapter 1. Dying in the 21st Century


Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. Medicare, the federal health insurance program insuring 47 million elderly and disabled Americans, helps to pay for hospital and physician visits, prescription drugs, and other acute and post-acute services (Centers for Medicare and Medicaid Services, 2010; Department of Health and Human Services Center for Medicare & Medicaid Services, 2013).

More than 90 million Americans live with at least one chronic illness, and seven out of ten Americans die from chronic disease (Dartmouth Atlas, 2010). As chronic disease progresses, the amount of care delivered and the costs associated with this care increase dramatically. Patients with chronic illness in their last two years of life, for example, account for about 32% of total Medicare spending, with much of it going toward physician and hospital fees associated with repeated hospitalizations (Medicare Part A and Part B). Further, 16% of the gross national product (GNP) is spent on healthcare, and this number is expected to rise to 20% by 2015 (Centers for Medicare and Medicaid Services, 2010; Department of Health and Human Services Centers for Medicare & Medicaid Services, 2013). This statistic is two times higher than other nations, and the U.S. ranks 40th in quality indicators. ← 5 | 6 →

In 2000, 35 million American people were 65 and older. Between longer life spans and aging baby boomers, the population of Americans aged 65 years...

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