Casey Corbin: With end-of-life care, benefits outweigh any drawbacks

GUEST OPINION: HOSPICE

January 8, 2014 

In an article reprinted in the Idaho Statesman from The Washington Post, “Hospice boosts its bottom line,” (Dec. 28) the authors tell a story with very complex implications for patients and their families seeking quality care at the end of life. As the statewide coalition for advancing end-of-life care in Idaho, we are concerned that the overstated issues addressed in this article might deter families from the benefits of hospice care.

Hospice has a strong and established presence in Idaho with a mix of nonprofit and for-profit programs, all focused on providing the best care possible to their patients and families. For more than 30 years, Idahoans have depended upon this specialized segment of the health care continuum. With the aging of Americans nationwide, hospice, which originally focused on cancer patients, is now seeing a wider variety of illnesses at end-stage. Heart and lung disease, Parkinson’s, Alzheimer’s and other noncancer diagnoses now constitute more than 50 percent of hospice patients.

First, the coalition and its members fully support safeguards to ensure that only appropriate and eligible patients and their families elect the hospice Medicare benefit. The vast majority of hospices adhere to rules and regulations, and the article clearly demonstrates that there are checks and balances in place and working.

The article relied heavily on the “Average Length of Stay,” which at the national level is 85 days. However, this is not the real story for the average hospice patient and family. Average Length of Stay is not used by most oversight agencies because, as the Center for Disease Control states, “The distribution for average length of service is skewed; therefore, both the mean and median values are presented.” The median stay for hospice (50 percent of patients) is only 19 days; 63 percent of patients die within a month and 36 percent within a week of a hospice referral. Only 11 percent live beyond six months. Earlier referrals to hospice can be beneficial by: allowing for easier transitions as the patient’s condition changes over time; creating more confident family caregivers; and providing greater coordination of care and resources for patient and family.

More important, perhaps we are asking the wrong questions. Instead of focusing on patients remaining on hospice beyond six months, we should ask, “What are their alternatives?” Last year, 2,513,000 Americans died in one of two ways: 45 percent with hospice services and 55 percent without. The 45 percent avoided nonbeneficial treatments, most ICU stays and costly emergency room visits. Their families had far better bereavement outcomes, and the patient was able to have the best possible symptom management. Most patients died comfortably and with dignity at home.

The remaining 55 percent experienced the traditional health care system, which included all of the things that most hospice patients avoided and none of the family and bereavement services. Looking at the cold hard fact of per-patient cost to the American taxpayer, one cannot deny the wonders of hospice. The average cost for a hospice patient in their last six months was $13,000. The average cost to Medicare for a nonhospice patient in their last six months was $101,000, nearly tenfold. Both groups died within six months, but one group enjoyed the many benefits of compassionate care through hospice.

As we face the oncoming tidal wave of an aging America, it is important to recognize that by choosing hospice as early as appropriately possible, the family, the patient and even the American taxpayer benefits.

Casey Corbin, of Boise, is director of The Idaho Quality of Life Coalition.

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