Hospice group's point: People hurt themselves by delaying the service

The hospice community has long held that older, terminally ill adults and their families wait too long to take advantage of a Medicare-funded service that many appreciate once they have it, and the newest report on the topic continues to make that case.

About 28 percent of the people utilizing hospice in 2015 did so for seven days or less, and another 13 percent for just two weeks, according to the Facts and Figures: Hospice Care in America report from the National Hospice and Palliative Care Organization.

The median length of hospice use — where equal numbers of people were above and below the time span — was 23 days. Advocates for hospice use in the past have said that people wait too long to tap the service because they cling to unrealistic notions of treatment and recovery, or they may simply be uneducated about what the benefit provides to a patient and family.

Typically, hospice care is provided by a team of nurses, aides and social workers on intermittent visits to a patient’s home, where they provide some direct care but also advise and assist family members who perform the bulk of work to keep a loved one comfortable. 

“The hospice interdisciplinary team is ideally suited to provide care and support to patients and family caregivers throughout the last months of life, not just the last days,” said Edo Banach, president of the national hospice organization. “We need to continue reaching out to patients, family caregivers and other health care professionals to help them understand all the benefits that hospice care brings, particularly when provided in a timely fashion as part of a continuum of care.”

Minorities, in particular, have resisted heavy use of hospice services, in which the focus is on comfort and pain management  — as opposed to curing disease — for those expected to have no more than six months remaining. Among hospice patients in 2015, about 87 percent were Caucasian, 8 percent African-American, 2 percent Hispanic and 1 percent Asian.

Among all patients using hospice, about 44 percent died at home; 32 percent in a nursing home or assisted living; 15 percent in a hospice residential unit; and 8 percent in a hospital.

The report said 46 percent of Medicare beneficiaries who died made use of hospice for at least a day. Where the service was once primarily thought of for cancer patients, many people use it today while dying from other diseases. While cancer remains the most common disease responsible for the death of hospice patients, it is a diagnosis for only about 28 percent of them.

Gary Rotstein: grotstein@post-gazette.com or 412-263-1255.


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