Hospice care: Limited end-of-life care fails to take into account such care may prolong life
Dr. Byock (R)
Hospice care useMedicare patients who died in 2012 and received hospice care:
But experts here say the real problem, in New Hampshire and elsewhere, is that most terminally ill patients and their families are coming into hospice too late.
But nearly half - 47 percent - of patients were in hospice fewer than 30 days, and 28 percent received care for less than a week.
Byock, whose latest book about end-of-life care is "The Best Care Possible," sees irony in the scrutiny of hospices where patients have outlived the six-month period that federal law defines for such care.
After a San Diego hospice went bankrupt last year after a government audit found problems with its Medicare billing practices, Byock worries about a chilling effect on physicians who may postpone referring their patients to hospice care.
Access to hospice care varies sharply among New Hampshire counties. In Coos County, 24 percent of Medicare patients who died in 2012 received hospice care, while 47.3 percent of patients in Merrimack County and 44 percent in Hillsborough County did so, according to Cordt T. Kassner of Hospice Analytics in Colorado, who analyzes Medicare and other data to promote better access to end-of-life care.
By definition, hospice provides support and care for people in the last phases of an incurable illness "so that they may live as fully and as comfortably as possible," according to the National Hospice and Palliative Care Organization. That includes physical, social, spiritual and emotional care for patients and their families during the dying process and bereavement period.
NHHPCO's McDermott said she sees two divergent trends in hospice care today. For one, as patients live longer with chronic illnesses, "It gets harder to predict when the end is."
"And conversely," she said, "the medical community waits too long to offer hospice, or the family doesn't think they're ready."
Last year, three individuals were discharged from the hospice house and 29 were discharged from home hospice care, Andrade said. But that doesn't mean they were not appropriate patients for the program to begin with, she said. "It was because they were stabilized."
When her mother was dying 13 years ago, Andrade said, no one ever suggested hospice care to the family.
"At the time, I knew nothing about hospice, and nobody came to that hospital room to say anything about hospice," she said.
In 1981, when Congress passed Medicare regulations, it set a time limit of six months for hospice care, Byock noted. "But the median length of stay has been falling progressively since that time," he said. It's now under 19 days nationally.
For more: nhhpco.org, and dyingwell.org
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