Maintaining Dignity and Independence
The priorities in this goal area track whether patients facing advanced age and illness are obtaining services that enable them to maintain independence and dignity consistent with their wishes to the greatest degree possible.
Goal Highlights
End of Life Indicators
70 percent of Californians want to be at home at end of life1
A large majority of Californians say they would prefer a natural death if they became severely ill, rather than receiving treatments that artificially lengthen their life span. Although most individuals say that they would prefer to die at home, many die in hospitals where they often receive highly aggressive care.1
Use of an ICU within a hospital stay at the end of life is one indicator of a potential mismatch between patient preferences and care delivered.1 Tracking the number of hospitalizations that end in death and included an ICU stay is one way of measuring our ability to provide care to patient preferences.
Millions of Californians haven't communicated their choices for end-of-life care.1
End of life is one of the most difficult stages of life and is in need of attention to improve the care and experience of individuals who are dying. Many patients at the end of life could benefit from palliative care.
Palliative care is specialized, team-based care that focuses on relieving symptoms and improving quality of life for both the patient with a serious illness, and the patient’s family.1 It can be provided at any stage of a serious illness, and can be provided together with curative treatment. Further, providers of these services work with other health care team members to make sure that the care that is delivered is aligned with patient goals, values, and preferences.
Tracking the percentage of California hospitals that provide in-patient palliative care helps to make sure that hospitalized patients with serious illness receive care that meets their physical, emotional, and spiritual needs.
Learn More » about Increasing Access to Hospital Based Palliative Care
Californians use hospice less than the rest of the nation1
Hospice care is a form of palliative care for patients who have a prognosis of six months or less to live. Palliative care is specialized, team-based care that focuses on relieving symptoms and improving quality of life for both the patient and family.1
Tracking hospice enrollment rate helps to measure not only the rate of use, but also the duration of these services, to make sure that they are not under-utilized for a given patient. Patients who are enrolled in hospice receive better symptom control, are less likely to receive aggressive care in the final days of life, and their families are more likely to be satisfied with the care they received.3
Only 10 percent of Californians talk about end of life care with their doctors. Have you had the talk?1
Advance care planning is the process of making sure that every individual determines and documents their preferences for treatment to guide decision-making, in situations when they cannot speak for themselves.1 This indicator measures use of Physician Orders for Life Sustaining Treatment (POLST) as part of advance care planning among nursing home residents.1 Other measures that monitor patient preferences for care and the processes for documenting and complying with those wishes need to be identified and will be critical additions to the dashboard in the coming years.
Although there is currently no indicator to measure statewide levels of advance care planning, this has been identified as an opportunity for further data development to monitor this priority area of attention.
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