Millions choosing hospice for end-of-life care at home
When doctors told Matt Oldham's mother, Edna, last May that she had end-stage chronic obstructive pulmonary disease, they suggested hospice, something a growing number of terminally ill patients are choosing for end-of-life care. "She was able to pass away in the home she loved," says Oldham of San Antonio, who was by her side.
More than 1.5 million people received hospice care in 2009, up from 950,000 in 2003, according to the most recent industry data. And while some receive end-of-life care at a nursing home or a designated hospice facility, about 90 percent of hospice patient deaths occur at home, says J. Donald Schumacher, president and chief executive of the National Hospice and Palliative Care Organization. "The research has shown that the home is where they want to be," he says.
Wherever it's provided, hospice focuses on making patients comfortable. Clinicians, counselors and clergy provide pain medicine, medical equipment, mental health services and religious rites to patients and grief counseling for loved ones. "They not only look after the person [who's ill], they look after you," says Oldham, who hired highly rated Odyssey HealthCare of San Antonio to care for his mother.
But not everyone given six months or less to live by a doctor is willing to forgo curative treatment, a Medicare requirement to qualify for hospice coverage. "That is a significant barrier to hospice use," says Susan E. Hickman, a geriatric psychologist and end-of-life planning expert, located in Indianapolis.
Starting in 2012, the federal health law requires Medicare to launch up to 15 pilot projects to test the cost-effectiveness of covering hospice and curative treatments simultaneously and some private insurers, like Aetna, already do so. Those covered for hospice and their families usually pay little to nothing out of pocket - insurers pay hospices about $145 per day on average, and patients don't get billed if care costs more.
Still, experts suggest asking about plan particulars in advance. Medicare patients wanting to continue treatment can get palliative care, which reflects hospice's interdisciplinary approach to pain management, but there's no guarantee they'll receive the same intensive, end-of-life services covered by a hospice benefit.
Experts say that's all the more reason to make end-of-life wishes known. Hickman advises having the conversation before a crisis occurs if possible, and communicate preferences to doctors and nurses, too.
Member Penny Decker's father, Frank Morrone, made it clear he didn't want to be in the hospital. In the two weeks leading up to his death in February 2010, highly rated Hospice of the Comforter in Altamonte Springs, Fla., anticipated the family's every need, Decker says, putting her father at ease and consoling her mother in their home. "I think it's the kindest thing that you can do for a loved one - to allow them to leave the world with the dignity they deserve and not in a cold sterile hospital," Decker says.