By Laurie Robinson
DID YOU KNOW?
Did you know that hospice care is over three decades old? That’s right. Hospice care has been around in the United States for over 30 years. Originating in the United Kingdom over half a century ago, hospice services are designed to provide care for individuals facing advanced stage incurable disease. Despite this level of care being around for some time now and recognized as a reimbursable service by Medicare since 1983, studies show that hospice is very underutilized.
Many aspects of hospice care are misunderstood by physicians as well as patients and their families. Fear and lack of knowledge about qualifying for hospice, reimbursement for hospice and the types of services that hospice provides contribute to the underutilization of this valuable service. There are still many myths and misunderstandings about hospice by clinicians, patients and families.
The following are common misconceptions and truths about hospice care:
MYTH: Hospice is a service that is reserved for patients with terminal cancer and should be used only in the last weeks of life.
BUSTER: Actually the New England Journal of Medicine reported in 2007 that fewer than half of the patients cared for under hospice had terminal cancer. Admissions included diagnoses such as end-stage cardiac disease, dementia, pulmonary disease and stroke. Optimally, patients are cared for over the course of months not days. The attending physician and hospice medical director certify to the best of their knowledge that a patient is likely to die within six months. This however is only a guideline and patients may remain under the care of a hospice provider for longer than six months.
MYTH: Hospice services are paid for by Medicare just like home health care.
BUSTER: Hospice care delivered in the patients home is reimbursed fully under Medicare. Expenses related to the patient’s terminal diagnosis are fully covered. This actually includes medications and equipment, as well as visits by the hospice nurses and home health aides. No co-pays are required.
MYTH: Once a patient elects hospice they can’t disenroll and the primary focus is pain control.
BUSTER: Some patients may actually get better and disenroll. Patients can also change their mind and disenroll at any time, and as a result, they revert back to their previous Medicare coverage. Hospice care is designed to handle all end of life concerns of patients and families. This includes dying with dignity in their home without excessive pain and burden to the family and caregivers. In addition to medication and nurse visits, intensive emotional and spiritual counseling and 24 hour crisis intervention is provided. Bereavement support is provided for at least 12 months after the patient dies. While the agressive treatment of pain is essential, other symptoms such as insomnia, dyspnea, depression, constipation, agitation, nausea and emotional and spiritual distress are just as aggressively addressed.
An 83 year old male with congestive heart failure (CHF) stage IV, end-stage coronary artery disease and is insulin dependent with his third admission for exacerbation of CHF in the past six months. He was put on a ventilator and after having responding well to diuresis, he was moved out of the coronary care unit. Would you consider this patient a candidate for hospice? While the answer is obviously yes, many physicians are reticent to make the referral.
Studies have been conducted to determine the impact of physician attitude on referrals to hospice. Many physicians see the death of a patient as a professional failure and struggle with letting go of the “cure” mentality. Many also fear that referring the patient to hospice may destroy the patients hope, and they see hospice as a service reserved for those whose death is imminent.
Hospice agencies are here to provide clinicians, patients and families with the information they need to make informed decisions about end of life care and strive to improve care for the terminally ill patients and their families in our community.