{'fraction_non_alphanumeric': 0.02555110220440882, 'fraction_numerical': 0.002004008016032064, 'mean_word_length': 4.89807976366322, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Advanced Illness Care: We Can Do Better

There's a wistful story noised about among gerontologists that everyone should live in good health to a ripe old age, well into their nineties, and then have life end with a quick bullet-fired by a jealous lover. But we all know that is not the way most people in America head offinto the Great Beyond. Too much of the time, in our current American culture, dying can be protracted and especially painful, isolating, and costly.That's often the reality of dying-with or without-the support and services provided by our health system today. But what is it that people actually want when they are seriously ill and know they may be approaching life's end? Research tells us they want to be at home, with family and friends-to have their pain managed, their spiritual wishes and needs respected and honored, and, to be assured that those who love them are not emotionally and financially devastated in the process.So there is a great deal of difference-a very large gap-between the kind of care and treatment people say they want at the end of life and what our society and health system provide. Things have to change, or they will get worse instead of better. America's population is aging rapidly and as this occurs, more and more people are living with multiple chronic diseases, with the limitations of managing personal care, and of where they are able to live and with what degree of independence.And then there's technology, in many ways the great blessing of our age. But in the world of serious illness, technology has the perverse potential to keep people "alive" regardless of their condition or what they want.Though anyone can be seriously ill, advanced illness is common among the frail elderly and occurs when one or more chronic conditions progress to the point where general health and functioning decline, response to treatment is reduced, and care needs increase. Trips to the emergency room and hospitalizations frequently occur, prognosis and treatment plans may become uncertain, patient goals and preferences may change, and often there is stress and crisis among patients and their families. Along with this, people must struggle to navigate a fragmented care delivery system that is unprepared to respond to their goals and preferences in the latter stages of life.It doesn't have to be this way; we can do much better. We can create the change needed so that people with advanced illness receive comprehensive, high-quality, person- and family-centered care that honors their dignity and is consistent with their goals and values. How? By empowering consumers to engage in comprehensive, in-depth conversations with their providers and families regarding care goals, wishes, and preferences, working to reform the care delivery system, improving public and private policies, and enhancing provider capacity.The Evolution of End-of-Life CareThe landscape of end-of-life care has certainly improved over the past decade. Since the release of the 1997 Institute of Medicine (IOM) report, Approaching Death: Improving Care at the End of Life, hospice has become mainstream, both inpatient and community-based palliative care programs have sprung up nationwide, and innovative care delivery models have been developed to address the needs of this population and focus care on the person, rather than the patient, going through the medical system (IOM, 1997).During the passage of health reform a few years ago, political controversies surrounding the language and messaging of advance care planning led to misguided notions regarding government panels and end-of-life care decisions. This turned the debate into one that was toxic, strikingly partisan, and devoid of rational, open discussion.But we have come a long way since then. Recently, there has been a renewed sense of interest and engagement in this issue that is unmarred by false perceptions and suspect accusations regarding the role of government in end-of-life care. …