Staying in Hospice Proves Healthier

New study demonstrates the gap between hospice care and traditional care

Studies that prove the effectiveness of hospice are a favorite topic on this blog, and a new one, described here in a quote from an About.com article by RN Angela Morrow, has some telling figures comparing patients who continue or discontinue hospice care:

Cancer patients who disenroll from hospice care  -- meaning they had signed up for, then decided to discontinue, hospice care -- are more likely to be readmitted to the hospital and die there.  A study published in the October 1, 2010 issue of Journal of Clinical Oncology, "Impact of Hospice Disenrollment on Healthcare Use and Medical Expenditures for Patients with Caner", found that:
 

• 33.9% of patients who disenrolled in hospice care were admitted to an emergency department, compared to only 3.1% of hospice patients
      
• 39.8% of disenrolled patients were admitted to the hospital compared to only 1.6% of hospice patients
      
• Disenrolled cancer patients spent an average of 19.3 days hospitalized, hospice patients only spent an average of 6.7 days
   
• 9.6% of disenrolled patients died in the hospital while only 0.2% of hospice patients did
   
• The costs of caring for a disenrolled patient were nearly five times higher than caring for patients who remained on hospice

With such a large difference in all categories, hospice care seems the clear choice for comfort and ease of living at the end of life.

Golf for Charity

Hospice Care Corporation's Dr. D.R. Davis Golf Classic was the subject of more local news coverage, this time from WBOY 12 TV. Here's a sample:

Sunday's fundraiser helps pay for patients who can't pay for care or don't have insurance.

"It's a win-win situation for us, as we raise needed money for our inpatient unit and to take care of patients in North central West Virginia. We're in 12 counties and there's a lot of people that need our help," Cynthia Woodward of Hospice Care Corporation said.

Many thanks to WBOY 12 TV, coverage like this is immensely helpful in spreading the word about ways to help the nonprofit Hospice Care Corporation continue its good work.

HCC Golf Tournament

The Hospice Care Corporation's 22nd annual DR. D.R. Davis Golf Tournament this past weekend received some nice coverage from WDTV. A quote:

Sponsors said this tournament is definitely a worthy cause. "It's a tough thing to have happen in your family," said Steve Decker, the market president at Wes Banco, and a sponsor for the event, "but to have somebody there in a time if need is very important."

This tournament raised more than $10,000 for the 12 Hospice Care Facilities around North Central West Virginia.

The nonprofit Hospice Care Corp. holds several fundraisers in the Western Virginia area throughout the year to help finance its facilities and services, for information stay tuned to this blog or check out the HCC website, http://www.hospicecarecorp.org/.

Choosing Between Hospice Care & Palliative Care - An in Depth Look at Your Options

by Allen Jesson

Recently I wrote an article for family members of patients who could benefit from hospice care and/or palliative care, in which I discussed the factors that physicians must consider in referring hospice or palliative care options to their patients. In this article, I will explore the topic in greater depth, discussing the similarities as well as the differences between the two primary options: hospital-based palliative care and traditional hospice-based palliative care. Hospital-Based Palliative Care Hospital-based palliative care comes into play following a patient's hospital admission, and prior to discharge. For example, if the physician orders chemotherapy, it could be administered in the hospital-but not by the hospice-as chemotherapy is considered a therapy (and precludes hospice admission). It is important to remember that hospitals are acute facilities that strive to restore patients to optimum function. Very simply, this means that they focus on therapeutic, rehabilitative measures. When that is not a viable option due to a patient's terminal or life-limiting disease, the hospital-based palliative care team can assist the physician in structuring a plan of care that strives to maximize quality of life while managing pain and symptoms. In this situation, the palliative care team might suggest an early hospice referral, as the patient would be leaving the hospital setting. Generally, while the patient's doctor and the hospital-based palliative care team make the referral, the patient and family also participate in the decision, so that the outcome best benefits and supports the patient's desires. The physician must be confident the hospital-based palliative care team incorporates holistic care at its very base, including ensuring the patient's physical comfort, providing emotional and psychological support, and supporting shared decision-making. In addition, the patient's physicians should also be confident that the hospital-based palliative care team coordinates the care across different care settings and involves the patient and family as appropriate. A candid prognostic dialogue is paramount, as communication bridges the gap between the patient's needs and the physician's expertise. What to Expect from Hospital-Based Palliative Care The physician should expect the following from the hospital-based palliative care team: Evidence-based symptom palliation and psychological support Shared decision-making that supports both the patient and the family or caregiver Dignity and respect regarding the patient's cultural values Practical, financial and legal assistance for patients and families Coordination of care across the health care setting that helps patients move from one setting to another (e.g., from hospital to home) in a seamless fashion The hospital-based palliative care team can work closely with the local hospice agency once patients have completed all therapies and have a prognosis of six months or less. I have found that when working with physicians, patients and families who are considering hospice care in the last months, everyone appreciates a coordinated health care approach, which helps guide the patient to navigate the system, providing appropriate care at each stage. A hospice nurse on the hospital-based palliative team can advise as to when the patient would benefit more from hospice services, and advocate for the patient and his or her family regarding those services. Hospice-Based Palliative Care Patients who are not hospitalized or are currently undergoing therapy can still access the expertise of the hospice nurse regarding pain and system management. Many hospices provide limited support to patients who are not yet eligible for hospice care or are not emotionally ready for hospice. These are non-reimbursed services that hospices provide as community outreach. Medicare stipulates all curative measures must be exhausted, and all therapies completed, before patients access hospice care benefits. So an early hospice referral from the hospital-based palliative team for these services can establish, and foster, a caring relationship with the case manager and the patient before any hospice care is actually needed. Establishing this relationship and making an early hospice referral helps alleviate fears on the part of the patient and family, and allows for a rapport to develop should the patient access hospice services at a later date. How to Choose a Quality Hospice Agency Physicians who determine it is time for a hospice referral due to patient preference and disease trajectory may wonder how to select a competent hospice organization. Not all hospices are created equal: some are very good, and some are truly excellent. But, like choosing a hospital-based palliative care team, there are guidelines for determining high-quality hospice programs. To begin with, the physician can ask: Is the hospice accredited or certified through a national organization? Are staff members certified in hospice and palliative care medicine? Does each team member use a standardized assessment tool? Does each patient have one case manager and social worker assigned to them? How does the program monitor and improve its quality of care? Most hospice agencies are Medicare certified, as Medicare is the primary source of reimbursement for patient hospice care. But if the hospice is Joint Commission Certified, it is held to a higher standard and level of accountability. The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) is an independent governing body that oversees hospitals and nursing homes. By voluntarily participating in this outside review and evaluation process, in addition to the mandated (federal) Medicare and state Department of Health annual reporting, a hospice demonstrates a commitment to quality care, continuous improvement and public accountability for the care and service of terminally ill patients and their families. When a hospice agency has this certification, both physician and patient can rest assured they have chosen a truly excellent hospice whose guiding principles focus on delivering competent, compassionate, and coordinated care.

Please visit the Gilbert Guide for the very best in Palliative Care and for more information about Hospice.

A New Way

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

This quote from an article in The New Yorker eloquently describes the struggle currently going on in our health care system. Although many hold on to expensive and uncomfortable medical care far after its usefulness has passed, piling more stress on themselves and their families in the process, hospice care has repeatedly been proven to address the real concerns of dying patients.

Hospital and Hospice

Recent changes to President Obama's health care bill have once again eliminated the possibility of patients receiving both hospital and hospice care simultaneously, a decision that, if it remains unchanged, will hurt the lives of many. A post on The Times Record's blog explains:

Since Reagan-era changes to Medicare reimbursement, seniors haven’t been able to choose hospice unless they give up hospital visits. It was thought that it would be too expensive to offer both.

But it’s not true. A 2004 experiment by Aetna allowed patients to choose both hospital and hospice care. The results contradicted expectations.

Two-thirds of patients chose hospice, rather than the one-third now typical. And hospice participants returned to the hospital far less often, even though they could. They lived just as long as those more frequently hospitalized, and, with certain diseases, longer. Moreover, family members were far less likely to suffer from depression after the patient’s death.

Overall costs were more than 25 percent lower – a huge difference, given that nearly one-third of Medicare spending occurs in the last six months of seniors’ lives.

There have been many studies confirming the same thing, patients who are under hospice care receive far more benefits from their standard hospital care as well because with their mind at ease they are free to do what is best for their body. Add to that the lightened burden on the families of those involved and you see that hospital and hospice care need not cancel each other out, but can instead work hand in hand effectively.

Palliative Care Extends Life

In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.

The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

This quote, from a NY Times article, is yet another affirmation of a fact that we already know - hospice care improves and extends a patient's final months. Citing a three-year study done on patients with fast growing lung cancer, the article states that those receiving some sort of palliative care immediately after diagnosis managed to live three months longer than the group receiving standard care while reporting less depression and happier lives with fewer worries about problems caused by their illness.