New Jersey is falling short in end-of-life care. Despite spending more per capita on health care than most other states, our outcomes are no better — often worse — than states that spend far less.
Consider this: 80% of people say they would prefer to die at home, yet only 31% actually do. Instead, many spend their final days in facilities, enduring aggressive medical interventions that don’t prioritize their quality of life. New Jersey ranks near the bottom nationally in cost-effective end-of-life care, with some of the highest rates of hospitalizations, ICU stays, and medical interventions in a patient’s final months — yet these costly measures do not always lead to better outcomes.
The issue isn’t a lack of funding. The U.S. spends over $12,000 per capita on health care — double or even quadruple what other developed nations spend — yet our health care quality lags behind, with poorer outcomes in key metrics like life expectancy and infant mortality. The last year of life is financially exorbitant, but the money we pour into the system doesn’t translate to better experiences.
So, why is this happening? The problem lies in a health care system that incentivizes volume — more procedures, more hospital visits, more interventions — over patient-centered care that respects individual preferences and quality of life. The system financially rewards doing more, even when more is unnecessary, ineffective, or even harmful.
To fix this, New Jersey must rethink its approach to end-of-life care:
- Invest in care that aligns with patient wishes: Most people want to spend their final days at home, yet our cultural norms and medical habits often lean toward aggressive interventions and potentially futile treatments. We must expand access to high-quality home-based care and ensure patients receive support that prioritizes comfort and dignity.
- Shift the focus from facility-based care to a home-based, palliative approach: Too often, patients undergo unnecessary treatments simply because they are available, not because they lead to significantly better outcomes. We need to ensure patients and families have access to meaningful discussions about their care options, including palliative and hospice care.
- Stop incentivizing unnecessary treatments: Payment models should reward quality of life, patient satisfaction, and care that aligns with individuals’ goals and wishes — not just the number of procedures performed. A shift toward value-based care — where providers are rewarded for shared decision-making and prioritizing comfort over excessive interventions — could dramatically improve outcomes while lowering costs.
I see firsthand the impact of patient-centered care on those with late-stage chronic illnesses. When care is aligned with what patients truly want, outcomes improve, satisfaction increases, and unnecessary medical spending decreases. But this requires a shift in mindset — not just among policymakers, but among health care providers, insurers and families.
New Jersey has an opportunity to lead the way in improving end-of-life care. We can’t afford to keep spending more without seeing meaningful improvements. It’s time to realign our priorities and give people the care they deserve — before it’s too late.
Alex Binder is the VP of the Parker Advanced Care Institute at VNA Health Group. He oversees operations that help patients with late-stage chronic illnesses stay home comfortably with the help of Visiting Physician Services and a Palliative Care team.
