Numerous studies show that most Americans want to die at home, surrounded by family and friends. But most patients still die in hospitals or chronic care facilities. • This troubling disparity has multiple causes, but as a hospice physician, I believe a major factor is that only about 40 percent of Medicare patients in the United States are receiving hospice care when they die. • There are many reasons for this, but an important one is that a lot of people don't fully understand what hospice is and how it works. • The hospice movement has grown enormously over the past 40 years. About 1.5 million Americans a year receive hospice care at their homes, in hospitals and in special hospice facilities. In my work, I hear many misconceptions over and over. So I have written a series of three articles for the Tampa Bay Times that I hope will help patients and physicians better understand hospice. • Today, I'll start by looking at who is eligible for hospice care.
MISCONCEPTION: Only patients with terminal cancer are eligible for hospice.
TRUTH: Any patient with a terminal condition and a prognosis of less than six months is eligible. In the 1970s, most hospice patients had cancer. Since then, this demographic has changed. In 2009, only 40 percent of hospice patients had cancer. Today, most hospice patients have chronic conditions, such as congestive heart failure, chronic obstructive pulmonary disease or Alzheimer's.
MISCONCEPTION: Hospice referral should be reserved for when the patient is about to die.
TRUTH: Many patients, their families and physicians are well aware of the wonderful care provided by hospice, especially when death is imminent. But hospice can also be of great value to both patients and families early in the dying process, months before the patient begins to decline significantly.
Long before death is imminent, hospice can help patients and families with emotional, spiritual, social, financial and legal issues. Furthermore, studies show that grieving families are better able to cope with the loss of a loved one if hospice had been involved for at least two months before the patient's death. For example, family members who have used hospice services are statistically less likely to suffer clinical depression after their loss.
But when a patient comes to hospice only when death is imminent, the opportunity to help families with nonmedical issues is diminished or even lost entirely. That's why we recommend that patients who want hospice care ask their physicians about hospice referral early, as soon as possible after their terminal illness is diagnosed.
MISCONCEPTION: Once admitted to hospice, patients cannot change their minds and seek aggressive treatment of their disease.
TRUTH: Patients may discontinue hospice, for any reason, at any time. They can even leave hospice care and later decide to come back, provided they remain eligible with a terminal illness having a prognosis of six months or less.
NEXT TIME: The rights and privileges of hospice patients
Dr. Gary McCarragher received his medical training at McGill University and the University of Ottawa and was a gastroenterologist in Brooksville for 18 years before going to work for Hospice and Palliative Physician Services, which contracts with HPH Hospice in Pasco, Hernando and Citrus counties. Follow him on Facebook and Twitter (drgarymac), or at www.garymccarragher.com.