Trajectories of Care at the End of Life: implications for health systems with ageing populations
Presented by the Economics of Palliative and End-of-Life Care SIG (EPEC)
The webinar is taking place at 2:00 PM ET.
Please check your time zone online here.
In many developed countries the success of the health system means people are living longer, but potentially also with longer and more complex trajectories at the end of life. In New Zealand there are projected to be large increases in the numbers of deaths as the baby-boomers reach the end of their lives, and the deaths for all ethnicities are projected to occur at much older ages.
The Trajectories Study used linked national data for all deaths occurring and registered in New Zealand in 2015. Mortality data was linked to the Cancer Registry, hospitalisations, inpatient procedures, emergency department events, outpatient visits, pharmaceuticals, laboratory tests, disability support services and primary care capitation. For the first time, we were also able to link subsidy data for aged residential care (ARC), interRAI data (assessment at home and in long-term care), and hospice data. This provided a history of utilisation over the last ten years of life, with detailed information on place of care and daily utilisation in the last three years of life.
Five trajectories groups were extracted, with differing demographics and patterns of utilisation:
Dementia, Cancer, Chronic Disease (the frail elderly requiring some assistance), Need and Maximal Need (congenital deaths and younger people with chronic disease), and Other Sudden Deaths.
The extraction from the linked data of those dying with dementia as opposed to from dementia shows that deaths with dementia are already the largest trajectory group, across all age bands. There are also new findings on the use of aged residential care at the end of life and the numbers with cancer who die of other causes.
The research shows the use of hospices at the end of life and the use of specialist palliative care (hospices and hospital palliative care). From a policy perspective, the results show the extent to which groups need to rely on aged residential care and primary care, including district nursing, for end of life care.
The analysis of place of care by trajectory group has provided new insights into the last years of life. Projections by trajectory group to 2038 and a costing of the last years of life, by trajectory group, were also performed. Work is on-going with regional planning and funding groups, and the national health quality and safety institute. The transitions in care at the end of life have informed the planning for emergency services and the design of delivery of services at home.
Speaker: Heather McLeod
Heather is an actuary by training and consults on healthcare financing and health policy issues.
Heather was born and lived in South Africa for most of her life. Since the early 1990s she has worked in healthcare financing, initially as director of a consulting firm advising employers and unions. She joined the University of Cape Town in 1998 to develop courses in healthcare financing and consulted to the South African government and public sector, including the Department of Health, the Department of Social Development, National Treasury, and the regulator for private health insurance.
From 2003 onwards, she assisted with technical work on designing and costing National Health Insurance (NHI) for South Africa. She chaired the Formula Consultative Task Team for the Minister of Health in 2003 and the Risk Equalisation Technical Advisory Panel for a further four years. In 2006 and 2007 she worked on retirement reform for the Department of Social Development and since 2008 has worked with National Treasury on healthcare and retirement issues.
In 2010, Heather married a New Zealand citizen and moved her consulting practice to New Zealand.
She worked for the Ministry of Health in New Zealand, supporting the Palliative Care Council, from 2012 to 2015. In 2015 she returned to full-time consulting and continues to work with Ministry of Health, the Palliative Care Advisory Panel, District Health Boards, Hospice New Zealand and other NGOs on strategic issues related to end of life care.
Heather has visiting appointments with the Te Arai Palliative Care and End of Life Research Group at the University of Auckland, and with the University of Stellenbosch. Her current research interests are the impact of longevity on palliative care and the financing of end-of-life care.
A country girl at heart – she lives in a small village of 800 people in the mountains of South Island, New Zealand.
Professor Heather McLeod
Honorary Senior Research Fellow, School of Nursing, University of Auckland|
Extraordinary Professor, Department of Statistics and Actuarial Science, University of Stellenbosch
Heather McLeod and Associates Ltd
P.O. Box 70, Hanmer Springs 7360