Improving the Quality of Life for
Patients with Incurable Diseases at
the Terminal Stage of Illness
Khatereh Hadi
October , 2011
Readmission
20% of hospital discharges are followed by
readmission within 30 days…..
Readmissions usually stem from:
- Discontinuity and fragmentation of care
- Lack of standards
- Disorganized action
Readmission Outcomes
• High readmission rate is considered as low
hospital quality
• No reimbursement for readmissions less than
30 days
• Increasing costs
Readmission of patients with
incurable diseases
• Patients with incurable diseases are frequently
readmitted
• Reasons:
- Declining quality of life
- No improvement in disease
symptoms
- Demanding situation for
families
- Lack of coordination between caregivers
Who are patients with incurable
diseases?
• People with cancer
• People with organ failure
• Frail older people
Each category has different types of physical
decline.
When do they die?
1. Cancer: Long, high function plateau followed
by decline
2. Organ failure: Punctuated decline with acute
exacerbation
3. Frail older people: Slow progressive demise
Preferred place of death for terminally
ill people
Over 50% of them prefer to die at home
IF IT IS POSSIBLE…
Less than one third of those succeed in that
Studies are needed to improve the quality of life
at home so as to decrease readmission rates
Hospices
According to Medicare regulation:
You can go to Hospice after discharging from
hospital IF life expectancy is 6 months or less
Except for cancers, it is hard to predict
the death time.
Only 20% die at Hospices
Readmission
Low quality of
care and life
Home
Discharge from
Hospital
Hospices
The Sea Inside - A 2004 Film
A real life story - Unable to move for 29 years after a diving accident, spending
his life on a bed, decided to commit suicide with dignity.
Literature on considering home as
preferred place for death
• No negative effect on quality of life
• Positive influence in terms of
- Patients’ satisfaction
- Physical and psychological aspects
- Reduction in readmission rates
Home does not improve the quality
by itself:
It provides a good opportunity and a convenient
place to improve the quality of life by touches
that are important at the end of life
What do terminally ill patients want?
•
•
•
•
•
Support
Independence
Not being a burden
Medical care
Peace
What are their basic needs?
To move sometimes…
To eat always…
Medical Care…
Communication and entertainment…
Aware Home
Inventions in chronic disease
management by home
technologies
• Facilitating communication
• Coordination of activities
between caregivers
• Independent life
Beds as “the home”
What is going on?
• Limited activities
• Limited motion
• Medical care
• Different types of
equipment
• Basic needs
Beds
• Can we improve the quality of life
by making patients more
comfortable?
• Do these patients need a special
kind of bed?
• What special features are
needed?
Every person with a incurable
illness has a right to good
end-of-life care.