Elder patients typically spend many weeks or months of their final years in hospitals. Seldom, however, do hospital providers have bedside discussions with them about their personal goals of care. Goals of Care (GOC) was founded to address these problems, setting new standards for elder care and treatment.
According to the Dartmouth Atlas, New Jersey ranks the highest in the nation for health care dollars spent on Medicare beneficiaries. Seniors in New Jersey can expect to see more doctors, take more tests, and undergo more aggressive treatments during their final years of life than in any other state. While this high level of service may sound beneficial, health outcomes for New Jerseyans are actually no better, and perhaps worse, when compared to other states. Unnecessary, burdensome care involving the aggressive use of hospital services may be out of sync with patients’ wishes.
As patients age and enter their final years of life, their goals may change from cure and longevity to more comfort and better quality of life in the time remaining. Examples of specific goals may be for the patient to live long enough to attend a family event such as a wedding or graduation, or to continue engaging in activities like gardening or other hobbies. By aligning therapies to achieve specific patient goals, the quality of patient care as well as patient satisfaction with the care will improve.
In the present model for health care delivery in New Jersey and in many locations across the country, physicians and advanced practice nurses tend to pursue aggressive and curative therapies until the patient has approached an actively dying phase. Not until the physician recognizes this actively dying phase are goals of care discussed with the patient or patient’s family. At such an emotional time, the patient and family members are often unprepared to handle this sudden switch in approach to care, from one of aggressive intervention for cure to one of non-curative treatment for palliation. It is not unusual for the patient and family members to be disappointed with the medical care and to feel abandoned by their primary physician. Wouldn’t you, if you were the patient, want to have a say in the goals for your care before such a time? It is our goal to provide every patient in New Jersey with such an opportunity.
Through government, academic, and community education, GOC hopes to improve medical decision-making in the state of New Jersey, regionally and nationally to better serve the patient’s goals of care, be it full therapeutic measures to promote longevity or more palliative measures to promote comfort. By creating partnerships to unite private and public organizations, we strive to improve geriatric care in the state of New Jersey and beyond.