Help patients and families as they struggle with end-of-life issues.

When patients appear to be reaching the end of life, case managers should find out their wishes, alert the treating physician and the rest of the staff, and ensure that patients' wishes are carried out. In an effort to encourage discussions about end-of-life care, the Centers for Medicare & Medicaid Services (CMS) has begun paying physicians for consultations on advance care planning. CMS' push toward pay for performance and bundled payments creates financial incentives for hospitals to consider alternatives to admitting patients as inpatients. Providers' feelings sometimes make them hesitant to talk about end-of-life issues with patients and family members. Case managers should take a patient-centered approach and find out patients' goals before bringing up hospice care, and educate family members on what to expect when they get home.