In the latest episode of MGMA's Mindful Medicine Podcast, host Daniel Williams welcomes Dr. Andrea Sankar, a medical anthropologist and co-author of the newly released third edition of Dying at Home: A Family Guide for Caregiving. Dr. Sankar discusses the evolution of end-of-life care, including the challenges faced by family caregivers and the crucial role medical practices can play in supporting patients and their loved ones during this sensitive time.
Dr. Andrea Sankar's Healthcare Journey
- Dr. Sankar's healthcare journey began through doctoral training in Chinese studies along with dissertation research in a Buddhist nunnery in southern China. Her postdoctoral research at the University of California, San Francisco during the AIDS epidemic led to her eventual focus on community-based care and caregiving.
- Dr. Sankar's personal experience of caring for her dying mother with her sisters led to her writing Dying at Home. "We were all young professional women. We all had young children, and it was very difficult to do, "she said. "And so my sisters, at their urging, they said, 'with your background in medical anthropology and the research you're doing on care, you should do a study on this and write this book. And so that's when I began to do the research."
Evolution of Dying at Home
- Dying at Home has evolved into a third edition, which highlights changes in the demographics of those dying and the advances in medical technology and pharmacology. "Things have changed a lot since the first edition,” Dr. Sankar said. “The people who are dying have changed in the sense that, in the United States, fortunately, because of our excellent health system, people live longer, and they live into advanced old age. And that means that when they're dying, they're very frail."
- Highlighting the impact of the TEFRA Act, which expanded Medicare and Medicaid coverage for hospice care, Dr. Sankar emphasized the increased availability of care and the role of medical practices in supporting home care.
Challenges of Family Caregiving
- Caring for frail family members takes an emotional and physical toll on family caregivers, which elevates the importance of support through adequate reimbursement and resources.
- Citing UK and Scandinavian research showing the long-term health impacts on caregivers, Dr. Sankar stressed the need for better support systems and resources to help caregivers cope with the stress of providing end-of-life care.
Medical Practices and Home Care Coordination
- It is becoming increasingly important for clinicians to understand the caregiver's role and the strain it places on families.
- In addition to better training and communication between medical professionals and caregivers, medical practices can provide support through resources such as lists of available community services and volunteer organizations.
Training and Communication for Caregivers
- Dr. Sankar commends the training provided and emphasizes the need for similar training in other medical practices. “In the United States, there's not a centralized system of medical care. So it's really up to the individual provider or community that decides to provide the kind of training you're talking about,” she says.
- She also discusses the importance of caregivers keeping detailed records and having access to medical professionals for support.
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