FCRP Policy Statement
November-1995-Volume-5-
Edition-4
Hospital Cost Containment and the Burden and Impact
on Families Caring for Elderly Cancer Patients
Should early discharge for cost containment be seen as
an important element of health care reform? As a part of
the "Family Home Care for Cancer -- A Community-Based Model"
project, researchers from Michigan State University's Family
Care Research Program examined how cost containment through
early discharge -- a cornerstone of many health care reform
plans -- may adversely affect the elderly population and
their family caregivers.
The project was funded by the National Institute
of Health and the National Institute for Nursing Research
to investigate the impact of cancer diagnosis and treatment
on cancer patients more than 65 years of age and their family
caregivers. A primary area of focus is the relationship
between the formal (e.g., hospital, nursing home, physician)
and informal (e.g., family members and friends) care systems.
Preliminary data from ninety-nine patients
were examined to determine how shortened lengths of stay
and shifts to outpatient care related to the burden of illness
imposed on elderly patients and their family caregivers.
Burden of illness is defined by determining the change in
physical functioning, number of symptoms, and number of
health care activities occurring at home.
| |
Years
Survived |
%
5-year Survival |
Cost
to Death |
| Breast |
9.5 |
80
|
$53,758 |
| Colorectal |
6.5 |
59
|
$61,081
|
| Prostate |
7.0
|
79 |
$52,933
|
| Lung |
1.7 |
13 |
$47,779
|
| Bladder |
7.3 |
80
|
$52,953
|
The study revealed that patients are being
discharged from the hospital while experiencing many treatment-related
symptoms and a decline in physical functioning. This requires
a significant number of care activities by family members.
Therefore, early discharge results in a higher burden of
illness on patients and families. The resulting out-of-pocket
costs (e.g., medicine, medical supplies, wages lost by family
members providing care) may represent a shift in costs from
the formal health care system to patients and families.
Policy Implications
These findings strongly suggest that in order
for early discharge to be an effective means of cost containment,
families of older patients with cancer should receive added
instruction in home care for their patients. Possible programs
include:
-
Informational classes or booklets that
give patients and families necessary information about
cancer care at home.
- A follow-up telephone call or visit from an oncology nurse
who can ensure that the families are adequately meeting
the patient's needs.
- A toll-free, 1-800 number that patients and families can
call to ask questions.
- Use of advanced practice nurses as care managers, to be
responsible for a caseload of patients, to monitor progress,
and to provide periodic follow-up.
From Wiernasz, C. J., Given,
B. A., Given, C. W., & Stommel, M. (1995). The impact of hospital
cost containment upon added burden to families caring for
elderly cancer patients. Paper presented at the 20th Annual
Conference for the Oncology Nursing Society, Anaheim, CA.
Research supported by grant #RO1 NR/CA19015, "Family Home
Care for Cancer -- A Community-Based Model," funded by the
and the National Institute for Nursing Research. |
