Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=220360
Story Retrieval Date: 9/22/2014 9:19:10 PM CST
More than 44 percent of Americans with less than six months to live choose hospice care, and 97 percent of those people choose home hospice care, according to a recent study conducted by the National Hospice and Palliative Care Organization.
Hospice care is designed to focus on comfort and quality of life, rather than a cure, for dying patients. The proportion of dying patients who used hospice care rose from 21.6 percent in 2000 to 42.2 percent in 2009.
While most of us prefer to avoid the topic, how we choose to spend our final days could quite literally be a matter of life and death. Planning ahead can be crucial to making hospice care available as soon as someone needs it.
“There are studies to the effect that show if you are in hospice care your life expectancy is longer than if you are not in hospice care,” Chicago hospice nurse Steve Wren said.
The New England Journal of Medicine published a 2010 study on terminally ill lung cancer patients that showed those receiving palliative care had a better quality of life and lived an average of three months longer than those who did not seek palliative care.
Palliative care focuses on relieving a patient’s suffering in all disease stages, and it often goes hand in hand with hospice care. It includes a team of medical professionals addressing physical, emotional, spiritual, and social concerns for patients suffering from a serious illness.
Terminal illness sometimes gives people the freedom to go off medications and remove some of the symptoms and side effects.
Wren said that, in many cases when patients are taken off medications they are on for conditions such as high cholesterol to osteoporosis, the patient improves. “You have a 90 year old who is taking a mass amount of medications, you go through that list and you say, do we really need to be worrying about osteoporosis with someone who has terminal colon cancer? Probably not.” Wren said.
Journey Care Hospice in Barrington is a nonprofit hospice care that provides inpatient 24-hour care. Communications Specialist Lisa Encarnacion said the decision for a patient to elect inpatient hospice care is “basically based on the doctor recommendation and around the clock care is required.”
Hospice is covered by insurance. The national hospice organization reports that the percentage of hospice patients covered by Medicare's hospice benefit versus other payment sources was 84.1 percent in 2011.
The Medicare Payment Advisory Commission reported that Medicare spending for hospice has increased from $2.9 billion in 2000 to $13 billion in 2010. Medicare costs associated with home care are significantly lower than inpatient hospice. The Center for Medicare and Medicaid services published 2013 daily hospice payment rates of $153.65 for home care and $682.59 for inpatient care.
An independent study conducted by Duke University revealed that home hospice saves Medicare over $2,300 per patient on average.
A 2009 study by the Health Services Research and Development Service reported that the final 30 days of life accounted for 78 percent of a person’s lifetime healthcare costs. Those who had end-of-life discussions, including the decision to seek hospice care, consumed costs 35 percent lower than those who did not.
The Journal of the American Medical Association published the study that also concluded that 80 percent of those terminally ill would prefer to die at home. However, it is unclear whether home care has an impact on a patient’s longevity over inpatient hospice, according to the study.
A European study conducted by Rand comparing home hospice to inpatient hospice concluded that prognosis is not affected by place of care. However, Wren disagrees. “In my experience they do tend to live a little bit longer and a little bit more comfortably inpatient,” Wren said.
Whether or not those in the end stages of life choose to die at home or an inpatient setting, having the discussion can provide peace of mind to family members, Wren said. “I think you are going to see more people making good end of life choices and that they talk about what they want those choices to be,” he added.