Update on Hospice Care-Part III

(8/4/15)- Medicare will be testing a new pilot program that is designed to affect the health-care of about 150,000 Medicare patients over the next four years that will allow patients with terminal illnesses to receive hospice care, but still see doctors and get medical treatments, like chemotherapy or hospitalization, intended to fight their illness.

This test program is based on research that shows that these patients end up with better quality-of-life styles than would otherwise be the case.

(9/23/00)- The General Accounting Office (GAO), an investigative arm of the federal government issued a report on the use of hospice care programs. It indicated that the use of this service has more than doubled in the last decade. The hospice benefit is designed to ease patients pain and suffering, avoids aggressive efforts to cure a disease and provides nursing and psychological care to eligible patients who are certified by physicians that they are likely to die within 6 months. These services can be done in the patients home or at hospice center. Patients can be recertified after the six months. This is the message sent by Nancy Ann Min DeParle, the Administrator of the Health Care Financing Administration, which runs Medicare. She was attempting to clear up "a disturbing misperception" as to the idea that patients will lose coverage and be hit with severe financial penalties if they stay in a hospice for more than 6 months. She wrote: "Let me be clear: In no way are hospice beneficiaries restricted to six months of coverage as long as they meet the eligibility requirement."

In its report, the GAO indicated that 28% of all Medicare beneficiaries in the hospice program received an average of 59 days of hospice care in 1998, down from an average of 74 days in 1992. Patients with diseases other than cancer accounted for the sharpest reductions in use of these services, despite increasing their numbers to 43% of the total receiving care. William J. Scanlon, the director for health care studies at the GAO is quoted as saying " Although Medicare beneficiaries are receiving hospice services, they are, on the average, receiving fewer days of care than did the beneficiaries in the past."

Presently, Medicare provides financial aid for over 39 million people who are elderly or disabled. The number receiving hospice care in 1998 was 358,949 up from 143,110 in 1992. These numbers are expected to increase unless there is some dramatic medical breakthrough. Funding for the hospice program will be a problem. It is one of the reasons that the Senate Special Committee on Aging, chaired by Senator Charles E. Grassley is holding hearings (See our Article Helpful Web Sites for the address of the Committee). The NY Times issue of September 18, 2000 quoted Senator Grassley as saying: "Too few people use the hospice benefit for too little time. That has to change." He is expected to call for additional funds for hospice providers and explore whether the Medicare rules need further clarification to alleviate patient's fears about being burdened with financial responsibilities if they stay for more than 6 months.

The hospice service, which can provide doctorsí services, nursing care, the services of home health aides, medical supplies and equipment, and pain-control medication in the patient's home is a necessary program. It relieves some of the pressure on family members and provides the patient a comfortable, familiar environment at the end of life. We have observed it first hand in a family in Denver, Colorado where three trials of chemotherapy and radiation therapy did nothing for the inoperable lung cancer in a 70 year old male who had stopped smoking 17 years ago. The family, through the treating doctor, opted for hospice care at home. The doctor will manage the palliative care but no heroic measures will be undertaken. In emergencies, the family will call the hospice care, not 911. They will make every attempt to make the patient comfortable and pain-free and await what will happen. Patient and family are relieved and accepting of this decision. This end of life planning decision was not easy to make, but given all options, has provided the patient and family peace of mind.

Funding for this program is also tied in with funding for drug costs for the elderly. Increase in these costs has put financial burdens on hospice services, which has meant budget cuts for total services. President Clintonís legislative proposal to provide $1 billion in grants to states over five years to improve the quality of care and ease staffing shortages will go a long way in curing this problem. It is now up to our Congress to act.

For our other Article on Hospices See:

Hospice Care Benefits-Part I
Incurable Disease and Hospice Care-Part II



Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated August 4, 2015

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