Hospice: Hope in the Changing World of Healthcare

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deVero | November 18, 2016
by Robert Love

More than 1 million people each year have to make a life-changing decision: continue intensive treatment to fight a chronic illness or pursue the best quality of life possible in their final months, weeks, or days (NHPCO, 2014). When faced with this scenario, most people would prefer to stop intensive treatment and be kept comfortable at home, surrounded by their loved ones. In fact, seven out of 10 Americans say they would prefer to die at home, according to a CNN poll, but according to the Centers for Disease Control and Prevention, only 25 percent actually do (Hogan, D.). Hospice care is the best solution for a patient’s desire to be at home during their final moments.

What is hospice?

Hospice is specialized care designed to provide support to patients and their loved ones during an advanced illness, traditionally serving patients whose life expectancy is six months or less. Hospice care focuses on comfort and quality of life, rather than finding a cure. Hospice is founded on the principle that death is a natural process, and it’s important to enable the patient to have an alert, pain-free life so that they may live each day as fully as possible (Community Hospice). As patient comfort is the ultimate goal of hospice, it’s no surprise that more than 90% of hospice care is received in the patient’s home (Harbor Hospice).

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iStock | Extended

There are many myths surrounding hospice care, with one of the most common being that hospice is a last resort for the patient; that it means all hope is lost. In actuality, hospice care helps provide the patient with the best quality of life and a sense of dignity and independence. Enrolling in hospice care doesn’t mean that the patient is guaranteed to be bedridden, or will become incoherent. Hospice can certainly represent something sad, as death is never easy, but it should be viewed as a positive experience for the patient and their family.

Helping patients and their families cope

Sometimes realizing that hospice care is the best solution for the patient can be toughest for the patient’s family. It’s common for family members to not be ready to say goodbye, or accept that their loved one isn’t benefiting from their traditional treatments any longer. Hospice is sensitive to these emotions, and they take pride in serving as a compassionate guide for patients and their families. Enrolling in hospice care can be an emotional decision, and usually a family member steps up to act as the primary caregiver, with support from a professional hospice team. Caregivers can become overwhelmed, stressed, and unsure about their day-to-day role and decision-making skills. Hospice organizations take the time to help caregivers understand, prepare for, and support each other through a final illness. This helps family members find peace in the situation. What’s more, patients receiving hospice care early experienced less depression, had better quality of life and survived 2.7 months longer than patients who waited to enroll in hospice care until they had a few weeks or days to live (Hogan, D.). The earlier patients and their families are educated on the role of hospice for end-of-life, the better.

Hospice care is truly a team effort. The typical hospice team includes the patient’s physician, a hospice doctor, a case manager, registered nurses and licensed practical nurses, a counselor, a dietician, therapist, pharmacologist, social workers, a minister, and various trained volunteers. Together, the hospice team will create a care plan tailored to the patient’s individual needs, and provides all the necessary palliative drugs and therapies, medical supplies, and equipment (Robinson, Segal, 2016).

iStock | Extended

iStock | Extended

A rise in chronic illness leads to increased spending

While the benefits of hospice expand to both the patient and their family, it’s also beneficial for the healthcare industry. As healthcare providers are challenged to improve outcomes and accept reimbursement cuts, hospice care is an important factor in how the healthcare industry can work together to increase efficiencies by collaborating on care plans for end-of-life patients. With the aging population growing exponentially, plus the rise in chronic illness, healthcare spending will be forced to increase. Medicare is the largest payer for hospice and end-of-life costs, and in 2009, spent $12 billion on hospice (Carollo, 2011).

Some facts from the National Association for Home Care & Hospice to consider:

  • By 2020, the number of people living with at least one chronic illness will increase to 157 million.
  • Approximately 68 percent of Medicare costs are related to patients with four or more chronic conditions, which are typical palliative care patients.
  • The costs of critical care for patients with chronic disease and multi-organ failure are exceedingly high. The top 5 percent of such patients account for nearly half of healthcare spending and the cost per capita for 1 percent of such patients is $90,000 compared with $236 per capita for the bottom 50 percent.

Hospice and the future of healthcare

Recent research has concluded that hospice can reduce overall healthcare costs, as it creates greater efficiencies and costs less than other care settings, which will be important as we see the rise in aging patients and chronic illnesses. One of the keys to helping more patients take advantage of hospice care may be increased communication and education.

A study from the Brookdale Department of Geriatric and Palliative Medicine at the Icahn School of Medicine at Mt. Sinari, supported by The National Hospice and Palliative Care Organization, found that hospice patients had significantly lower rates of hospital and intensive care use, hospital re-admissions, and in-hospital death when compared to the matched non-hospice patients. The study authors suggest that investment in the Medicare Hospice Benefit translates into savings overall for the Medicare system. For example, if 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million (NHPCO).

The Hospice Insider | HospiceFact

The Hospice Insider | HospiceFact

In another study, first published in JAMA (Seaman, 2014), researchers used data on roughly 40,000 Medicare patients with poor-prognosis cancers who died in 2011. Half of the group chose hospice, the other half did not. Much like the study from the Brookdale Department of Geriatric and Palliative Medicine, the patients who did not enroll in hospice had more hospitalizations, more stays in intensive care units, and more invasive procedures compared to the patients who were enrolled in hospice. Almost 75 percent of the patients not in hospice died in hospitals or nursing homes, with only 14 percent of the hospice patients. The services provided for non-hospice patients also proved to cost more. Patients who were enrolled in hospice for five to eight weeks had total costs of $56,986, compared to $74,890 for the patients not in hospice. Researchers suggest that many times patients don’t know that hospice is an option for them; the conversations and education are lacking. Additional collaboration between physicians and patients will help alleviate the communication gap. Increased collaboration across the healthcare continuum will help drive efficiencies in care.

Hospice is not something most people like to think about, but the reality is that hospice is likely to impact our lives in some capacity. It’s important for patients and family members alike to have conversations with physicians early to get adequate information on all options available to them, including hospice. Hospice care allows the patient to be as comfortable as possible, in the comfort of their home, versus the cold, stale environment of a hospital or nursing home. The patient, the patient’s family, and the healthcare industry all benefit from hospice care. Increased communication amongst healthcare professionals will enhance the care hospice patients receive and reduce overall healthcare costs.

Appearing originally on the DeVero blog by Robert Love.

Robert Love joined the home care and hospice community in 2001, straight out of graduate school in California. Since then, he’s ventured into the technology side, where he channels his passion for home care and hospice at DeVero

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