Washington To Cut Hospice Funding?

Gov. Christine Gregoire plans to eliminate all Medicaid funding for adult Hospice care in Washington state as of Jan. 1. This cut is supposed to save the state budget $4.6 million.

The savings from the elimination of hospice end-of-life care for the most needy of our neighbors totally ignores the increased costs which Medicaid will endure from those individuals who will wind up in hospital emergency rooms and will be charging Medicaid for all of their medications which Hospice would have paid for.

The sentiments here, from a Port Orchard Independent article by Jim Pledger, are being shared by many as Washington moves to eliminate Medicaid funding for hospice care. With study after study proving that hospice care saves thousands of dollars per patient, while simultaneously improving quality of life, why would you wish to eliminate a major source of funding and, as a result, ultimately cost the state more money than was saved?

Rise in Hospice Care Lowers Costs

Another study has been released exploring the connections between the increased use of hospice care and lowered health care expenses. This one was focused on heart failure patients, who traditionally encounter major expenses in their later months. A couple of quotes, from MedPage Today:

The retrospective U.S. study, encompassing almost 230,000 Medicare heart failure patients, found the use of hospice during the last six months of life jumped from 19% in 2000 to 38% in 2007, reported Lesley H. Curtis, PhD, of Duke University, and colleagues.

and...

The shift toward hospice and palliative care may actually be saving money, they speculated.

"Increasing the availability of alternative venues of care, such as long-term care and home care, may be effective in further reducing hospitalizations and containing costs," Kaul and colleagues wrote.

Financially, emotionally, and physically beneficial, hospice care helps patients to understand their choices and make informed decisions about what is right for them and their loved ones when their time is precious.

Hospice Care Saves

A flood of studies showing the benefits of hospice care to both patients and state finances has been hitting the news reels recently as experts prove what we have known for years. A quote from a Reuters article regarding one such study, authored by Dr. Jonathan Bergman of UCLA:

In his study, Bergman and his colleagues found that while hospice enrollment among dying prostate cancer patients jumped from around 30 percent in 1992 to over 60 percent in 2005, the timing of when they entered hospice didn't change. One-quarter of patients were in hospice for seven days or less, which is "too brief to maximize the benefit of enrollment," the researchers write. Another 10 percent outlived the six-month hospice care guideline.

Bergman and his team did find that hospice patients were about 20 percent less likely to receive high-intensity care, for example admission to the intensive care unit, two or more emergency department visits, or cardiopulmonary resuscitation. They also received fewer imaging tests, which are costly and are known to have no benefit for dying prostate cancer patients.

As we've seen in many of these studies, the effectiveness of hospice care is being limited by the fact that many patients wait far too long to enroll. While even a short stay can greatly increase comfort levels, a week or less is truly too short of a time to create ideal results.

Men Wait Too Long for Hospice

A new study by UCLA researchers has found that, while more than half of all men dying of prostrate cancer do use hospice care, most wait far too long to enroll, thereby missing out on many potential benefits. A quote from their press release, published on NewsWise.com:

For hospice care to be most effective, patients should be enrolled for several weeks prior to their deaths. However, the study found most men enrolled just one to two weeks before they died, said Dr. Mark Litwin, a professor of urology and public health, a Jonsson Cancer Center researcher and senior author of the study.

“It’s important that we maximize quality of life when quantity of life cannot be changed,” Litwin said. “Most men are being referred to hospice too late and that timing hasn’t changed in the last 20 years, which is unfortunate. As cancer specialists, we should offer these patients the best quality of life that we can, and that often means offering them the best quality of death that we can give them.”

While thinking used to be that preserving life at all costs was a doctor's goal, it is recognized that, when the inevitable is at hand, it is often healthier for both patient and family to simply be as comfortable as possible so they can enjoy their time together.

Uganda Seeks Hospice Care

While palliative and hospice care have a strong foothold in the U.S., other countries are not so lucky. A quote, from the Uganda Pulse:

As Uganda joined the rest of the world to celebrate World Hospice and Palliative Care day on Saturday, health service providers and communities have been advised to promote public information and advocacy for palliative care services around the country.

Speaking at the celebrations in Kampala on Saturday evening, the Commissioner, Clinical services in the Ministry of Health, Dr. Jacinto Amandua revealed that the people with HIV/AIDS, cancer, sickle cells and heart problems, among other diseases, are not receiving palliative care that could help them live much longer.

With such serious health problems in the country, the potential benefits from hospice and palliative care are enormous. Not only do these services help humans live better lives, but they save large amounts of money normally spent on intensive and unnecessary hospital care.

Growing Numbers Seek Hospice Care

Hospice care enrollment continues to rise as public recognizes the advantages

In the past, physicians didn't specialize in helping people deal with their final days of life. Instead, they often focused purely on survival, even if a patient was terminally ill.

Over the last four decades, the hospice movement has greatly changed how people die in the United States. Specially trained physicians, nurses and caregivers now devote themselves to helping dying patients find what they are looking for — freedom from pain, nausea, worry and spiritual angst.

Hospice care isn't universally accepted among patients or doctors some of whom push until the very end of life for a cure or remission of illness and avoid the issue of impending death. That hasn't stopped the more than 70 percent of eligible San Diego County residents from going into hospice care, according to the state.

This quote, from a Voice of San Diego article, is another testament to the recent growth and success of hospice care. Thanks to years of efforts, we have progressed from a small offshoot of the medical field to having a plethora of medical professionals and scientific studies supporting the fact that, for many, hospice is the most effective way to care for those nearing the end of their lives. Seeking care and comfort, not only physical but also mental and spiritual, the percentage of those seeking hospice care will likely continue to increase as the subject grabs more public attention.

Politics Hinder Hospice Education

Unfortunate politics cause public to miss out on information about hospice care

Palliative and hospice care have gained more interest from the public in recent years as personal stories and concrete statistics made clear the many benefits of this specialized care. Unfortunately, politics hindered the progression this year, as this quote from a WickedLocal article by Richard Griffin explains:

Surely, few single phrases harmed Americans this year more than did the coinage “death panels.” This label, a thoroughly deceptive ploy fashioned for political reasons, led leaders in Congress to cut out of the health reform bill one of its finest features.

That plan was to pay doctors for explaining treatment to terminally ill patients who needed to know about palliative care, hospice services and other alternatives to medical/surgical intervention.

The opponents of this legislation managed to twist the meaning of the proposal to make it seem like a way of getting rid of sick older people.

The sort of education intended to be provided by the plan is exactly what helps people to make informed decisions about alternatives to the traditional intensive hospital-based medical care. Hopefully, with the subject continuing to attract more attention, future legislation will make this education available to all.