When I first started working in nursing homes, I was struck by the sheer volume of rules and regulations governing the care of residents. Unfortunately, those rules often inhibited patient-centered care rather than offering protection. The result was an institutional approach to care with strict rules based on the diagnoses of the resident. For some residents, food was one of life's simple pleasures they could still enjoy. Despite this reality, most residents were placed on a special diet, based on their medical condition, instead of one based on their individual goals. Many residents would awaken to the smell of bacon cooking in the morning only to be told that they were not allowed to have it because of their low sodium diet. Of course, medical conditions must be taken into account, but the goals of each person must be considered—first and foremost.
This is also true outside of nursing home walls. All too often, care is overwhelmingly curative and narrowly disease-specific instead of goal-focused. My father, who had heart failure and Type 2 diabetes, had his diabetes strictly managed until the end of his life, despite the fact his life expectancy was far less than likely to benefit from strict blood sugar control. If his diabetes would have been managed according to his goals of care, instead of by the results of his hemoglobin A1c, his quality of life would have significantly increased. In fact, the results of strict management interfered with the goals of care as it caused several hospitalizations from hypoglycemia. According to an editorial in British Medical Journal (BMJ), "People with disabling, progressive illnesses expect active care, but they also seek comfort, control, and dignity."
Palliative care offers a potential patient-centered solution for the aging population facing the burden of chronic illnesses. Palliative care is specialized medical care for people with serious illness that focuses on improving the quality of life for both the patient and the family. It employs a multi-disciplinary approach consisting of specially trained doctors, nurses, social workers and other specialists who work alongside patients' doctors to provide an extra layer of support. Unlike hospice care, palliative care does not require a terminal diagnosis and includes curative/life-prolonging treatment. It is also associated with higher quality outcomes at lower costs.