As health care reform proposals continue to strive for choice, quality of care, and reduction of healthcare costs, hospice advocates have an opening to shout out, “This is what hospice is all about!”  Choice, quality of care, quality of life, and reduction of healthcare costs are all consistent with the realities of hospice.
 
When facing a life-limiting condition, there comes a point when the patient and family must decide to pursue attempting to cure an illness, even when a cure is unlikely, or to choose a better quality of life achieved with hospice care and symptom management through the final stages of life.
 
A difficult decision to make even in the best of circumstances, it is made more difficult by the lack of information and by common misperceptions about hospice care.
 
Even healthcare professionals aren’t fully aware of what hospice care is about.  One Delaware Hospice nurse said, “After some time, I realized I was being more helpful to my patients and their families as a hospice nurse than I had been in any other nursing role.  As a hospice nurse, you’re able to do what you always thought you would do as a nurse—providing care and comfort.”
 
The fact that hospice encompasses the entire family is not common knowledge.  In addition to meeting the patient’s physical needs, an intra-disciplinary team explores and tries to meet the emotional, spiritual and practical needs of all family members closely involved with the patient.  That team typically includes a nurse, certified nursing assistant, social worker, chaplain and a volunteer.
 
One family wrote of their gratitude for their father’s hospice care:  “When we first started this adventure, we had no idea what to expect.  Cancer was unfamiliar to us.  We had no knowledge of how to care for a terminally ill person.  We just wanted to honor my dad’s wish not to pursue aggressive treatment for his cancer and we wanted the end of his life to come gently, filled with love and compassion, in the comfort of home.  And with your support and compassion, we know that wish was fulfilled.”
 
Ultimately and predictably, the quality of life experienced by patients and families in hospice programs far exceeds that of those who didn’t.  That, in and of itself, would make hospice a preferred choice for end-of-life.  In the economic terms of reducing healthcare costs, hospice care would also be the choice.
 
John Keyserling, Vice President of Public Policy for the Alliance for Care at the End-of-life, reported to Erin Burnett in an interview on CNBC that research has shown an inverse relationship at end-of-life between the amount of money spent and patient and family’s satisfaction with services.  You spend less in a hospice setting as opposed to acute interventions in acute care settings, and patients and families are more pleased with services and the end-of-life experience. (http://www.cnbc.com/id/15840232?video=1200483943&play=1).
 
The fact that hospice care decreases healthcare costs has been reported by several formal studies, including a Duke University Study which reported that costs were reduced for non-cancer patients through 154 days of care.  Likewise, costs were reduced for cancer patients on hospice through 233 days of care.
 
Medicare expenditures could be significantly reduced.  In 2007, 38.8% of deaths in the U.S. were under hospice care, and the average length of days in hospice was 67.4 days.  The National Hospice and Palliative Care Organization (NHPCO) estimates that for every hospice patient, two more could benefit from hospice.
 
Looking at Medicare costs overall, 27% of Medicare costs occur in the final year of life.  Last year, Medicare’s budget was $477 billion; for patients in their last year of life, $143 billion; and for the last month of life, $47 billion.
 
Families, who have chosen hospice for their end-of-life care, clearly feel that they made the right choice according to NHPCO’s Family Evaluation of Hospice Care Survey.  Nationally, 98% of families responding to this survey were willing to recommend hospice care to others, while 100% of Delaware Hospice families were willing to recommend hospice.  Their choices of hospice care not only brought a better quality of life at a critical time, but a reduced healthcare cost as well.
 
All organizations supported through Medicare will most likely be confronted with the possibility of cuts to their reimbursements.  However, there exists great potential to reduce healthcare costs in the U.S. with increased utilization of hospice care as an end-of-life option.
 
Any future healthcare reform legislation would serve the public well to include provisions for protecting hospice care as well as encouraging the exchange of information between patients and their physicians regarding end-of-life care.

For more information about Delaware Hospice’s programs and services, upcoming events, or employment opportunities, call 800-838-9800 or visit our website, www.delawarehospice.org.