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Hi it’s Patrik Hutzel from INTENSIVECAREATHOME.COM where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomy by improving their Quality of life and where we also provide tailor made solutions to hospitals and Intensive Care Units to save money and resources, whilst providing Quality Care!
In last week’s BLOG I shared
INTENSIVE CARE AT HOME: AN OPPORTUNITY OR THREAT?
You can check out last week’s blog here.
In this week’s blog I want to share
Do Intensive Care Units have a “ONE SIZE FITS ALL” approach when it comes to dying?
I can’t tell you how often I’ve heard families in Intensive Care saying “it would be so much nicer to have our loved one die at home instead of in Intensive Care”.
When critically ill Patients in Intensive Care approach their end of life, most Intensive Care Units and most Intensive Care teams have a standard approach to death and dying.
They usually say things like “we’ve tried everything that we could…” or they say things like “any further medical treatment is futile…” or they say things like “it’s ‘in the best interest’ for your critically ill loved one to let them die…”
Whilst all of the above may well be true, the current approach to dying in Intensive Care still leaves little room to give people choice and certainly doesn’t focus on giving people what they want!
So what do people want according to what they have already told us?
Research and surveys have revealed that 75% of the population in first world countries- if given a choice- want to die at home.
The reality however reveals that less than 15% of the population actually do die at home…
Therefore, Intensive Care services as well as other health services are failing to deliver what the vast majority of people actually want in end of life situations.
Most Intensive Care Units all over the world have a standard “one size fits all” approach when it comes to end of life situations in Intensive Care.
The keep ignoring what people are telling them and they say things like “it can’t be done to have an end of life situation at home”! or they say things like “It’s too difficult to let your loved one die at home”!
It’s all a whole lot of crap, because it can be done, we have shown and proven this!
It can be done with a positive “can-do” attitude and it can be done by having proven and evidence based policies and procedures in place, like we do with our third party accredited quality manual, to safely deliver INTENSIVE CARE AT HOME services.
Once critically ill Patients in Intensive Care are approaching their end of life, ICU’s follow certain policies and procedures to aid critically ill Patients dying.
This “one size fits all” approach leaves little to no room to give critically ill Patients and their families what they want but is rather a reflection of current limiting paradigms in Intensive Care.
It also goes totally against what more than 75% of the population wants, which is to die at home…
Related case study:
- MARY IN HER LATE SIXTIES SPENT THE LAST YEAR OF HER LIFE AT HOME DESPITE BEING INTERMITTENTLY VENTILATOR DEPENDENT AND ON CHEMOTHERAPY!
Should we start listening to people?
A much better approach to end of life in Intensive Care is to listen to people and offer them end of life situations on their terms, follow people’s wishes and give them the opportunity to die at home. Thankfully, a service like our INTENSIVE CARE AT HOME is making this possible now, creating win-win situations for all stakeholders!
Albert Einstein once famously said
“A problem can never be solved by thinking about it at the same level it was created”.
Having people die in Intensive Care even though Patients and their families want to die at home means that the problem can’t be solved on an Intensive Care level.
It needs to be solved on a different level.
What do I mean by that?
Well, Intensive Care is a volatile, dynamic, stressful and non-family friendly environment!
Death and dying are usually very private matters that should be managed by families and not by health professionals.
Health professionals should be there to aid and facilitate the process of dying in a manner that is conducive to the wishes of a critically ill Patient and their family.
And again, those wishes are crystal clear according to research and surveys that more than 75% of the population in first world countries want to die at home and yet, less than 15% of people actually do die at home…
Therefore there is a big mismatch in delivering people on what they want during a crucial and important time in people’s and their families lives.
I think that overall I have a very good understanding of what Patients and their families in Intensive Care want after nearly 20 years Intensive Care nursing in three different countries.
After all, having been involved in many end of life situations in Intensive Care as well as at home instead of Intensive Care has given me the ability to compare both environments!
And I know for a fact that dying at home instead of Intensive Care is the way to go. If 75% of people in first world countries want to die at home instead of an institution why are we not giving it to them?
INTENSIVE CARE AT HOME does…
The current “one size fits all” approach of Intensive Care teams when Patients are dying has failed on a moral, ethical, cultural, religious, spiritual and clinical level…
It’s also failing on a level that creates “win-win” situations….
What do I mean by that?
A “win-win” situation is a situation where all parties benefit in a situation!
Let’s look at the interests of all parties in an end of life situation in Intensive Care
- Families in Intensive Care want to mostly have end of life situations on their terms in their own homes. At the end of the day they want to make informed decisions, they want to have peace of mind, control, power and influence
- Families also want to have a sense of meaning and belonging that they can find in a home care environment and not in an Intensive Care environment
- Intensive Care Units want to have access to beds, staff, equipment and other resources in Intensive Care and they want to maximize their revenue, it’s as simple as that…
- A bed in Intensive Care costs around $5,000 per bed day, therefore health funding agencies have an interest in keeping their costs down in such a high cost environment like Intensive Care
- In order to meet all needs of the stakeholders when Patients are inevitably approaching their end of life Intensive Care one doesn’t have to be too creative to come up with a solution that provides everybody with a win.
Especially when in some situations Patients are dying over many weeks and sometimes many months in Intensive Care… often on life support such as mechanical ventilation with tracheostomy…
Therefore INTENSIVE CARE AT HOME is providing a win-win situation for all stakeholders.
INTENSIVE CARE AT HOME enables critically ill Patients and their families to
- Be in an environment of their choosing, where they can be in control
- Give them peace of mind and have more control about the situation
- Meets their individual cultural, religious, spiritual and family needs in a home care environment, removed from a sterile and depressing Intensive Care environment
- Have an end of life situation on their terms
- Gives families of critically ill Patients meaning and belonging
But a service like INTENSIVE CARE AT HOME also gives Intensive Care Units what they want by
- Giving ICU’s the ability to discharge their critically ill Patients earlier and freeing up their precious, “in-demand” and expensive Intensive Care beds
- Admitting other critically ill Patients
- Free up other “in-demand” resources such as beds, equipment and staff
- Maximizing their revenue by having a higher throughput of critically ill Patients
- And last but not least a service like INTENSIVE CARE AT HOME is giving health funding agencies the ability to save costs by reducing the cost of an Intensive Care bed to around 50% in a home care environment
- Supporting Patients, their families and Intensive Care Units by focusing on their needs
- INTENSIVE CARE AT HOME is a proven and evidence based concept and it’s a concept widely accepted since it was introduced in the late 1990’s in Europe.
What are your thoughts? Do you think that current Intensive Care paradigms serve Families in end of life situations?
Leave your comments and views on the blog.
If you want to find out how we can help you to get your loved one out of Intensive Care or Long-term acute care(also nursing home) or if you find that you have insufficient support for your loved one at home on a ventilator or if you have any questions please send me an email to [email protected] or call on one of the numbers below.
USA/Canada +1 415-915-0090
Australia/New Zealand +61 41 094 2230
UK/Ireland +44 118 324 3018
Also, check out our careers section here
We are also a NDIS, TAC(Victoria) and DVA(Department of Veteran affairs) approved community service provider in Australia.
Thank you for tuning into this week’s blog.
This is Patrik Hutzel from INTENSIVE CARE AT HOME and I see you again next week in another update!