Do you know anyone who wants to die in a hospital ICU, perhaps intubated and on dialysis, surrounded by strangers? I don’t. Most New Jerseyans want to die at home surrounded by the people they love. They want comfort and compassion. They don’t want interventions that have little value to patients with advanced illness.
Yet year after year data show that people in our state receive among the highest rates of aggressive medicine at the end of life — medicine that rarely extends lives or improves the quality of lives.
CMS just released 1991-2014 health care spending data by state, and New Jersey had the nation’s highest per enrollee Medicare spending in 2014 at $12,614. That’s roughly 15 percent above the national average of $10,986. And the Dartmouth Atlas of Health Care, which also explores Medicare spending, continually finds that we far exceed the national average on end-of-life care utilization — from days spent in the hospital, to hospital care intensity, to number of physicians seen.
And we’re near the bottom when in comes to days spent in hospice care.
But we can change the way we die in New Jersey. The first place to start is a low-tech, low-cost intervention: A Conversation … with your physician, with your family members, with people in your community. It’s not just about changing the culture of medicine but also about changing the culture of our communities around end-of-life care issues. The Quality Institute’s Conversation of Your Life (COYL) program — part of our Mayors Wellness Campaign — attempts nothing less.
This June marks the third year of COYL, which is funded by The Horizon Foundation for New Jersey. COYL local task force members, who are all volunteers, organize activities in their communities to help patients and their families better understand the benefits of advance care planning and the choices available to them.
COYL helps people feel more empowered to implement the steps needed to make sure their end-of-life care wishes are honored. Advance directives are a gift to a person’s loved ones. Without directives, we know that family members can have differing views about medical interventions. Conflicts can arise in these tense times that fracture families.
We started COYL in three towns: Gloucester, Princeton and Tenafly. Communities embraced our program and many of our events were standing-room-only. Our program spread further throughout Camden, Mercer and Bergen counties. Now we are continuing to develop the program in these three counties and are adding four more: Middlesex, Somerset, Burlington and Gloucester.
We need your help. As we move into four new counties and expand in the existing three, we need volunteers to serve on COYL task forces, to engage clergy, health care professionals, and community leaders, and to provide meeting space, communications and resources to support this important work.
None of us can do this alone. Here’s what I’d like you to do:
- Check out our COYL
- If you want to help, as a task force member, communications advisor, subject matter expert, community or health care professional connector, contact me or Deborah Levine at email@example.com.
- Get engaged in towns where we already have programs or start a COYL in your community. Learn more from our tool kit
Our Quality Institute members are leaders in their communities and can truly make a difference.