This monograph is a comprehensive primer on the population aging and palliative care needs as a public health problem throughout the aging societies of Europe, with obvious parallel implications for the U.S. Because it is written primarily for a more general audience of policy-makers rather than specialists, it is parsimonious and cogent. The monograph is divided into six parts that address 1) the implications of population aging for palliative care needs and why these are a public health priority, 2) a descriptive summary of the needs and rights of older people and their families, 3) a summary of the evidence pertaining to the widespread underassessment and treatment of older peoples’ problems and their lack of access to palliative care, 4) a synopsis of the evidence for effective palliative care solutions (e.g., better pain relief, improvements in home care services), 5) a review discussing the key challenges for academic researchers and policy-makers in the governmental and nongovernmental sectors of society, and 6) specific recommendations to improve care in ways that promote the security and dignity of older people in the final stages of life. Although too lengthy for an assigned reading, certainly segments of the report on specific issues are a rich source of learning. In addition, this monograph serves as an excellent source for lecture material.
This relatively short article summarizes the findings from the research literature on alternative approaches to the integration of palliative care with conventional hospice programs. Its primary value is that it highlights, through analysis of hospice and palliative care utilization data, the kinds of challenges confronted in trying to promote new innovations in palliative care within the current system of health care finance in the U.S. The findings do not suggest that hospice programs, under the current hospice care financing mechanisms available through Medicare, can offset the introduction of palliative care services earlier in the course of a final illness through cost savings realized by less intensive use of services and supplies over time. Instead, the findings suggest that the cost savings that may be essential to the fiscal viability of palliative care services must come from the curative side of health care—that is, those curative interventions that provide the least benefits in either prolonging life or increasing its quality.
Although a number of articles summarize the state of the palliative care field in the U.S., this article is highly recommended as an assigned reading of choice for a social work in health care course. The article is succinct, yet provides the essential background structure of the health care system and financing as pertains to palliative care, with depth, clarity, and precision. Of particular value to readers who are not well versed in the structure of the health care system and how palliative care differs from the more dominant “cure or care” hospice care model, the article provides easily interpreted graphics that aide conceptual understanding. After establishing the policy context of palliative care, the article then provides an excellent review of the recent research on palliative care, with particular emphasis on the evidence of beneficial outcomes for patients and caregivers relative to cost.
Although written from the disciplinary perspective of nursing, this article provides a well organized and fairly exhaustive review of the palliative care literature as pertains to policy issues. While some readers may be put off somewhat by the extend to which the focus on policy issues is relatively specific to the concerns of the nursing profession, the brunt of the policy analysis provided speaks to all disciplines involved in the development and delivery of more humane and cost-effective approaches to palliative care. The author’s background research for this article included not only the published literature, but also a variety of policy briefs, advisory panel meeting minutes, monographs, and research reports from government, professional, and private organizations involved in the shaping of palliative care policy. Perhaps the most valuable contribution of this article is the author’s cogent synthesis of the state and federal policy initiatives, through the early years of the current decade, that are determining the structure and direction of national palliative care policy. Finally, the references cited for this article are of great assistance to students and faculty interested in pursuing more in-depth analysis of specific domains of palliative care policy.
CSWE Gero-Ed Center
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