Hospice report

A Keck School of Medicine student learns about hospice care during a role-playing exercise. An actor plays the role of the dying patient. (Los Angeles Times / August 7, 2014)

If there’s one aspect of healthcare that Americans rate highly, it’s hospice, which provides services for people who have a limited time to live and have decided to forgo drastic attempts to cure their illnesses. Satisfaction rates have been almost universally high; in hospice service, patients find that healthcare providers, even the doctors, spend real time with them. Their desires are respected. Attention is paid to their comfort and dignity.

But in recent years, with increased insurance coverage for hospice, much of the growth in hospice has been among for-profit companies and, according to a report in the Washington Post, the results don’t look good.

Research shows that at many hospices, close to one in three people are leaving while still alive, a sign that either they are dissatisfied with the care they are receiving, or they were enrolled when they weren’t dying, which would mean the hospice was drawing in unqualified patients to boost its revenue.

There were signs that hospices were intentionally prodding people toward leaving when their care became more expensive, the Post story says. One in four of those who left hospice alive entered a hospital within 30 days.

In 2000, the Post notes, only 30% of hospices were for-profit; by 2012, that rate had doubled. And at small for-profit hospices, the rate of people leaving while still alive is twice that of nonprofit hospices.

The growth of the for-profit sector in hospice shouldn’t have to mean losing the quality of care, but it apparently has in too many cases. That also means the diminishment of one of the kindest, most humane and cost-effective services among our nation’s healthcare offerings.

But what’s especially sad is that this is happening just as hospice, which was once seen as “giving up” on life, has gained so much traction among Americans. According to “Changing the Way We Die,” a 2013 book on hospice care, 44% of American deaths take place in hospice. More people have been embracing the idea of leaving life in a state of comfort and peace, without a desperate, terribly uncomfortable and almost always doomed effort at heroic lifesaving. It would be a shame to lose the value in this way of death. 

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