Questions in Hospice Care

According to a research by the Post, one in six hospices in the United States did not provide crisis care to their dying patients this year. “The lack of such care,” had written Post reporters Peter Whoriskey and Dan Keating, “suggests that some hospice care outfits are stinting on medical care, according to hospital professionals. Inspection and issue information, meanwhile, illustrate the discomfort of sufferers who have been left without proper care.” And, indeed, Whoriskey and Keating offer some experiences about failures, starting with 85-year-old Ying Tai Choi, a Tampa, Florida, woman whose nurse abandoned her an hour before she died.

Hospice-CareWhat gives the Post’s research value beyond its immediate impact, though, is that the document submitted the data source it used to carry out its reporting. The Post says it examined Medical health insurance payments information for more than 2,500 hospice care companies as well as “an internal Medical health insurance count of medical care in sufferers near death and examined complaint records at hundreds of hospices.” By showing its work, the document has provided valuable leads for follow-up experiences by news organizations across the country. According to the data source, 16 percent of 43 hospice care facilities serving 22,865 sufferers in Massachusetts reported providing no crisis care this year. That percentage is right around the national average, though it is higher than any other New England state.

Under Medical health insurance guidelines, a hospice must be able to offer crisis care to its critically ill sufferers, which the Post tells us, is “either ongoing medical care at home or an inpatient bed at a hospital.” The Post is careful to point out that the mere fact that a service did not offer crisis care in a given year is not evidence that there’s anything wrong. It’s possible that none of its sufferers needed it. A further explanation: The lack of crisis care does not necessarily indicate a breach of the guidelines. But hospital professionals say it is unlikely that larger hospices had no sufferers who required such care. In other words, the data source provides questions, not answers, precisely the information news companies’ need for follow-up reports at the local level. Investigative reporting is expensive and time-intensive. The Post’s hospice care story provides reporters with a great jump start.

Care and Dignity in Hospice Care

The end of life should be lived with as much convenience and joy as each day before. It is a moment when the discomfort from a serious illness is replaced with feelings of love from close relatives and care providers. Hospice care neither speeds up nor postpones death. It is about enhancing time people share together. “Patients and their loved ones as well as doctors, choose hospice for many reasons and the key word is choice, placing the decisions in the hands of patients and close relatives,” says community liaison, Kristen Lorenz. “We see our services as a gift of physical, emotional and spiritual support with care and dignity.”

hospice_careWhat is hospice care? It’s a philosophy of modern care for the control of signs associated with an individual’s diagnosed medical problem. The care is provided occasionally and as needed wherever the individual lives, including someone’s house, assisted living facility, long-term care center or hospital. “We try to emphasize that getting hospice care does not mean giving up hope,” says Lorenz. “We change the focus to one of making the most of life. The goal is to recover the essence of life through pain management and management of symptoms, so family members can remember special periods and create even more of them.”

According to Lorenz, only some Americans eligible for hospice care coverage take advantage of the benefit, 27% to be exact. Of that getting hospice care, the average time frame is only 9.6 days. Such proper care is 100% covered by Medicare Part A, State health programs and Veterans Administration benefits based upon an individual’s diagnosis and life span. While most often utilized for those with six months or less to live, there are times when it is available for longer. “It’s truly remarkable that so few utilize one of the best entitlements we are provided,” she adds.


Hospice Care and Oncology Patients

Why do doctors have such difficulties adopting hospice care and using it to benefit sufferers, particularly oncology patients? The Dartmouth Atlas Project recently revealed that the amount of melanoma sufferers who are passed on to a hospice program in the last 3 days of life increased by 31% from 2003 to 2007. The total share of melanoma sufferers even getting hospice care was only about 61%. David Goodman, co-principal investigator for Dartmouth Atlas said more sufferers are being admitted to hospice care in the last 3 days of life “when it’s too late to offer much comfort” and that “many sufferers are getting more competitive in-patient care and less effective hospice care.”

Holding Hands with Elderly PatientThere are many wonderful oncologists who take pleasure in looking after for their sufferers until the very end. But there are growing concerns with the doctors who do not utilize hospice care properly and once they do refer the individual, they don’t want to be involved with the care anymore. For example, the Dartmouth Atlas study mentioned the unsuitable use of feeding pipes in dying sufferers. We are all aware, or should be, that feeding pipes do not make dying melanoma sufferers live a longer time, cure injuries, put on weight, or reduce aspiration. They more likely cause aspiration, diarrhea and feeling sick. But family members and doctors continue to force PEG pipes on sufferers without asking them their desires and without full disclosure of the threats and lack of advantages.

It is a natural procedure to quit taking in nutritional value that can no more offer the advantages they did in a recuperative state. Offer food without pressure and never make the individual feel accountable for not eating. It can be challenging for family members to watch as a loved one stops eating and in our community, they often expect the individual to pass away very quickly when they don’t eat or drink. Patients can be kept completely comfortable, but for families, it is a difficult vigil.