Survey: 72% say the US health care system does not take good care of the elderly

About 72 percent of respondents to a National Partnership for Health and Hospice Innovation (NPHI) survey said they did not believe the U.S. health care system was taking good care of an aging population.

NPHI conducted the survey in September in collaboration with Emergence Creative and consulting firm SIR. The study follows a 2017 report by the Kaiser Family Foundation and The Economist to assess whether perceptions of health care have changed in subsequent years, particularly in light of the pandemic.

Among 2,009 survey participants, 82% indicated they believed the system prioritized profits over patients. Although 74% expressed a positive opinion of hospice care, only 31% said they trusted the health care system as a whole.

“The lack of trust in our health care system seems really troubling,” NPHI President Carol Fisher told Hospice News. “Because what people don’t seem to believe is the profit-making aspects, making money off of their illnesses at a time when they feel most vulnerable.”

White respondents and those with health insurance expressed more confidence in the system than members of other communities and the uninsured.

Trust is also higher among members of the Baby Boomer generation than younger Americans. Hospices may want to take this into account when communicating with families about their loved one’s care, according to Debbie McCarron, director of special projects at NPHI.

“It was overwhelming that the younger generations were distrustful and didn’t feel we were ready. They will likely be the ones making some of these decisions for the aging generation in the coming years,” McCarron told Hospice News. “We talk a lot about trying to get people on board earlier, and I think those are going to be the people that need to be swayed a little bit.”

Other key findings show that many in the United States do not believe the nation is ready to care for an aging population or its associated impact on society. While 76% of respondents indicated they thought the aging population was a problem, only 14% said the country was ready to deal with it.

Some of the most important areas for improvement include support for family caregivers, an emphasis on comfort care at the end of life, and social determinants of health.

The results also highlighted the need for more communication between patients and providers regarding the goals and wishes of individuals at the end of life. Although 89% of respondents indicated they felt comfortable talking about death, 81% said they had never had a conversation about end-of-life care with a healthcare provider.

“People want to have these conversations, but maybe doctors who aren’t trained in hospice and palliative medicine don’t know how to have the conversation,” Fisher said. “I really hope that this research shines a light on the fact that health care systems and providers could do a better job of bringing in experts to have some of these challenging conversations, and we could serve as partners in greater collaboration, to help people understand their choices.”

Consistent with previous research, most respondents indicated that they would prefer to age in place and die in their homes, comfortably and without uncontrolled pain. They also wanted to avoid putting the burden of their end-of-life decisions on family members, although 66% said they had not documented their wishes.

According to Ethan McChesney, policy director at NPHI, hospices can use the survey data to inform their outreach to the communities they serve.

“We know that only about 51% of Medicare beneficiaries in a given year use hospice. So there is fertile ground for people who are not getting the benefits of comprehensive, multidisciplinary end-of-life care,” McChesney told Hospice News. “We hope there are some components of this research that help people in different markets differentiate themselves more effectively and market better to emerging populations.”

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