Most Patients Wary of End-of-Life Care, Senior Healthcare Experience

November 29, 2022 - A meager 4 percent of Americans think the healthcare industry is prepared to manage a growing senior population, with communication about senior care options and patient trust in senior clinical quality being massive problems with the healthcare experience, according to surveying from the National Partnership for Healthcare and Hospice Innovation.

Around three-quarters (72 percent) of the nearly 2,000 US adults surveyed said they don’t think the nation’s healthcare system does a good job caring for the current senior population.

That’s a bad sign for the future as the US sees the Baby Boomer generation moving into the high-needs senior population. Seventy-six percent of respondents said they are concerned about how the medical industry will manage an aging population.

Caring for seniors is a key task for the US healthcare system. Older patients who manage multiple chronic illnesses tend to generate more healthcare spending than their younger counterparts. And at the end of life, adhering to patients’ wishes is not only empathic but should also be a clinical best practice. Following patients’ end-of-life care plans reduces the risk of high-cost, high-acuity care being administered.

But right now, patient perceptions of senior care is a mixed bag, with the NPHI report showing that the bulk of patients say end-of-life care is only fair and that the nation’s preparedness for treating an aging population is moderate.

The survey indicated that poor communication about senior care might be leaving some in a lurch. Most people said individual families are only moderately prepared to care for aging loved ones, and that’s likely because they have not had the chance to chat with a medical professional about senior healthcare ahead of time.

Less than a fifth of patients have had a conversation with a provider about their end-of-life care wishes, with a quarter of the Silent Generation and 14 percent of Baby Boomers reporting as much.

And even when a patient has an idea of their end-of-life care wishes, it’s unlikely those wishes have been documented. Only about a third of patients have their medical wishes written down; around half of the Silent Generation and 38 percent of Baby Boomers do.

Patients are eager to have these conversations, however, with 89 percent saying they are comfortable discussing their own death and 67 percent saying they are comfortable discussing their end-of-life wishes with their providers. Three-quarters agree advanced care planning should be covered by Medicare.

The researchers said these findings indicate a disconnect in patient and provider priorities. Although the survey did not measure why providers may not have these advanced care planning conversations, previous studies have indicated that clinicians need more training in the area to become more comfortable broaching a sensitive topic.

The NPHI survey did show that patients don’t entirely trust the medical industry, especially as it relates to senior and end-of-life care. Patient trust in the healthcare industry as a whole remains at around 31 percent, the survey showed, but when zooming in on senior care, it’s only at 18 percent trust. Patients said they do not trust the US healthcare industry to put well-being over profits.

Trust is generally higher among older and insured patients, the survey showed.

Increasing the level of communication about end-of-life care may help improve patient trust because it could help people become more familiar with these models of care, the survey indicated. Hospice, for example, enjoys somewhat higher levels of patient trust because most people have at least heard the term before.

Around three-quarters of patients know a little or a lot about hospice care. Hospice saw approval ratings that were six times higher when people were familiar with the care model.

The healthcare industry needs to focus on openness and communication about senior healthcare, the survey authors suggested. By facilitating more dialogue on the topic, healthcare providers may help patients and their family caregivers become more comfortable with the topic.

That should have downstream impacts, like improving patient trust, documenting end-of-life care wishes, and more engagement with managed care at the end of life.

“The healthcare system—particularly in the serious illness and end-of-life space—is under immense strain,” the survey authors concluded. “Workforce shortages, high costs, and a growing population of elderly Americans demand a large-scale, strategic transformation of how healthcare supports individuals and families as they age. It is absolutely essential that such a transformation is rooted in the needs and preferences of the population.”