End-of-life care costs in Los Angeles are much higher than San Diego. In San Diego, 45% of those who died were in hospice during the last six months compared to 22% in LA. For those who died, LA spent 78% more than San Diego for ICU and 53% more for hospital care. The number of days a person spent in the hospital during the last six months of their lives was 65% higher in LA than San Diego. Hospital beds per 10,000 were 35% higher in LA. Intensity of service use, particularly during the last two years of life, was significantly higher in LA, and costs were dramatically higher. Source: Variation between End-of-Life Health Care Costs in Los Angeles and San Diego: Why Are They So Different? Robert M. Kaplan, PhD. Journal of Palliative Medicine, Vol. 14, No. 2, 2011

Hospital palliative care is associated with significant hospital cost savings. Researchers found: For palliative care patients who were discharged alive, there was a savings of $1,696 in direct costs per admission and $279 in direct costs per day. For palliative care patients who died in the hospital, there was a savings of $4,908 in direct costs per admission and $374 in direct costs per day. Source: Cost Savings Associated with U.S. Hospital Palliative Care Consultation Programs, R. Sean Morrison, Joan D. Penrod, J. Brian Cassel, Melissa Caust-Ellenbogen, Ann Litke, Lynn Spragens, Diane E. Meier, for the Palliative Care Leadership Centers' Outcomes Group, Arch Intern Med.2008;168(16):

Those with advance directives often receive less aggressive treatment when death is near. Researchers found 41% of Medicare patients with an advance directive entered hospice care, compared to 24% of those without a directive. Patients with advance directives were much less likely to die in the hospital. Source: Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures, Lauren Hersch Nicholas, PhD, MPP; Kenneth M. Langa, MD, PhD; Theodore J. Iwashyna, MD, PhD; David R. Weir, PhD. JAMA, Nov 9, 2011.

One in four elderly will eventually need someone to make end-of-life decisions about their medical care. Source: Advance Directives and Outcomes of Surrogate Decision Making before Death. Silveira, MJ, Kim, SY, Langa, KM. NEJM, April 1, 2010

What Happens when Healthcare Professionals Have End-of-Life Conversations with Patients? Researchers found: Patients who had end-of-life discussions have a DNR and preferred medical treatment that focused on relieving pain and discomfort over life-extending therapies. End-of-life conversations were not associated with patients feeling “depressed,” “sad,” “terrified” or “worried.” Source: Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. Wright, Zhang, Ray, Mack, Trice, Balboni, Mitchell, Jackson, Block, Maciejewski, Prigerson. JAMA, October 8, 2008, Vol. 300, No. 14

Alzheimer’s Disease Is Now the 6 th Leading Cause of Death in California Source: Alzheimer’s Disease Facts and Figures in California Statistics, Alzheimer’s Association, February 2009.

Californians Aged 65 and Older with Alzheimer’s 2000 to 2025 Source: Alzheimer’s Disease Facts and Figures in California Statistics, Alzheimer’s Association, February 2009.