I get asked the same question over and over again. How can you say someone lives on hospice longer? Isn’t hospice to help people die, and don’t they just die within a few days?
What most patients and families don’t understand is that hospice is an entitlement of Medicare (think like social security). It is a service set up by Medicare to take care of patients as they decline. It is not meant for those who are actively dying (yes, those patients can be taken care of on hospice also), but geared more towards those who are starting their final decline. The reason hospice has so many benefits is exactly for this reason. Why would someone who is actively dying need an entire team? A nurse and a physician can take care of this patient optimally without the rest of the team in the final moments. Medicare requires an entire team because hospice is not meant for the last few days or weeks. It’s meant to help the patient and family reduce suffering months/years before they pass away.
Medicare guidelines are very clear. Hospice is meant for those patients who have 6 months or less to live, as determined by a doctor, WITHOUT intervention if the disease was to run it’s normal course. The key aspect is that in hospice, WE INTERVENE! ALL THE TIME. We treat infections, we treat UTIs, Pneumonia, skin infections, provide wound care, etc. We treat COPD, CHF, hypothyroidism, depression, GERD, hypertension, diabetes, heart disease, pain, nausea, vomiting, diarrhea, shortness of breath, etc. You name it we take care of it. The list goes on and on. These interventions/treatment modifications and adjustment of medications allow for improvement in symptoms, better quality of life, and most importantly less pain and suffering. This equates to a LONGER life. Think about it, if you are taken care of , your symptoms are managed, you are happier, you are being monitored closer, and things being taken care of faster; you are likely to live longer.
Look at it this way, if you have someone who is declining with no support, how do you think they are going to do? If the doctor sees them every month (if you can get in that frequently) and any time they need more support they have to go to the urgent care, to the ER or hospital. Studies have shown, the more patients visit the hospital, the more likely their disease process is progressing and the higher changes of something happening to shorten the patient’s life. But on the other hand this same patient, while on hospice, can get a nurse who visits him/her 2-3 times a week, gets a Social Worker to help coordinate care, a Spiritual Care Advisor to help alleviate patient and family anxiety, nurse aides who help keep the patient clean, monitor for skin breakdown, as well as an entire office whose function is to reduce suffering. With all this support, infections are picked up faster, skin breakdown is detected earlier, equipment needs are identified sooner, and patient and family communication is taking place continuously. Who do you think is going to do better, and more importantly LIVE LONGER?
Now, I am not saying we treat everything. Each patient and family is unique and each patient and family has their own thresholds of where they want treatment and where they don’t. Some want a UTI to be treated, some don’t. This is where the constant communication that occurs allows optimal care of the patient and family regardless of the path they choose. Just because we decide not to use antibiotics, doesn’t mean we don’t treat. There are other things we can do to make sure that the patient is comfortable, and most importantly not suffering.
One of the least used benefits in our healthcare system is the hospice benefit. It is because of the misconception that surrounds the word hospice and individual ideas of what hospice care means. Medicare is making physician services, nursing care, social work care, spiritual counselors, nursing aide visits, medications, DME equipment, bereavement support for after the patient passes away, and an entire IDT (interdisciplinary team) focused on taking care of a patient available to patients. Families and patients as well as physicians need to be better aware of services that are available, and think outside of the box, to allow our patients to live longer, healthier, and happier even though they have a terminal condition that will eventually take their life.