Hospice centers provide valuable end-of-life care for those facing terminal illness.
So, why aren’t more people using these centers for longer stays?
Established in 1982, the Medicare hospice benefit (MHB) gives recipients access to high-quality care near the end of their lives.
But, research in the Journal of the American Geriatrics Society states that those who utilize the service often do so too late. Most people are in hospice care for an average of only 12 days. Why aren’t they entering hospice sooner?
The study included 562 individuals, all aged 70 and older with an average age of nearly 87 years. Only 43 percent entered hospice services during their last year of life.
Researchers found that for half of the study participants their duration of hospice care was less than 13 days.
The authors say underutilization of hospice care can create a burden for healthcare workers, and result in patient suffering.
The reason people don’t more readily choose hospice is frequently complex.
One reason is diagnosis. Originally designed for those with end-stage cancer, more and more people have begun seeking hospice care through the Hospice Medicare Benefit for noncancer-related ailments.
The problem is that other issues, such as frailty and dementia, may be harder to discern when determining an individual’s eligibility for hospice care.
Cancer tends to have the most predictable course. Meaning it is generally easier to predict when someone with cancer is in the last six months of life. The challenge is even greater for the elderly since many die from a combination of different conditions.
The most common conditions leading to death were frailty and organ failure, not cancer. However, hospice acceptance rates for frailty were the lowest, and for cancer the highest.
Duration of stay is another problem. People wait until the last possible moment to enter hospice. Many pass just hours or days following admission because they were actively dying at the time of admission.
The median of 12.5 days spent in hospice indicates that even when individuals do utilize hospice, it is at the last possible moment. When patients are so near to death at admission, it’s difficult for hospice providers to improve comfort and quality of life.
While this research helps to highlight the underutilization of hospice care, it does not provide crystal clear answers why.
Hospice care also represents a difficult dilemma for families, which may help explain why duration of stay is so low.
Many view putting a loved one in hospice care as a sign of defeat. People entering hospice and dying quickly following admission, reinforces this opinion.
But, according to recent studies, patients may actually live longer in hospice care when they are admitted earlier and there is time to get their pain and symptoms controlled.
This is why hospice providers encourage those who need hospice care to get enrolled sooner, rather than waiting until the last moment.