Hospice care on the rise, but misconceptions persist

More patients are receiving hospice care as the elderly population steadily increases, but many people still have misconceptions about the service, hospice administrators in Columbia say.

“A lot of people think that you just go on hospice a few days or couple of weeks and then die,” said Deb Barger, director of clinical services at Preferred Hospice. “We don’t give up on people. We actively treat their symptoms and support them even though we may not be treating the disease itself.”

Ray Kriner, administrator of Preferred Hospice, added, “Just because someone is in a hospice does not mean that they are necessarily dying right now. Many families are in denial and not aware of all of our services.” Awareness is especially important with the oldest members of the baby boomer generation now in their 60s.

In 2006, 26,599 patients received hospice care in Missouri, up almost 13 percent from 2005, according to the Missouri Hospice and Palliative Care Association. All but 2 percent of these received services in their homes.

Kriner said the local demand for hospice care has risen in the last five years. “You might say we have a higher turnover; we are admitting more people to hospice and of course we have the other side of that.”

But hospice care is still underutilized. Only a third of Americans die while under hospice care, according to a Harvard Medical School study, despite the fact that hospice, care is often free through Medicare entitlements.

For a patient to receive hospice care under Medicare, two physicians must say that the person is likely to die of his or her disease within six months. Some patients with end-stage lung diseases exceed that six-month period because their diseases are managed, but they still remain eligible. As people become more aware of available services, they will use hospice care more, Kriner said.

Doctors may be another reason hospice is used by only a small percentage of dying patients. “A lot of times, doctors do not think of hospice until they have absolutely no other treatment they can imagine to offer, and by that time the quality of life is in the bucket,” Barger said.

Hospice providers offer no quiet, dimly lit rooms where patients live out their last days. In fact, no in-patient facilities exist in Columbia.

Friendship House in Jefferson City, which supplies the area’s only on-site hospice care, is closing on Feb. 15 after being open 10 years. The administrators said costs were rising rapidly and donations were declining.

Hospices such as Preferred act, rather, as a clearinghouse for medical and support services. Most patients are managed in their homes or at skilled-care facilities, such as nursing homes.

Preferred Hospice’s staff of 22 full-time employees includes nurses, aides and social workers who serve a 60-square-mile area in Central Missouri. Thirty volunteers work with the staff and patients, providing emotional support to patients and caregivers, assisting in the office and offering bereavement help. Companionship provided by volunteers is an important aspect of hospice care. Efforts are made to match gender, interests and age.

Some patients receive hospice services for several months before they die, and a few remain active. A favorite activity of some patients is taking their oxygen tanks and wheelchairs to gamble on the casino boat in Boonville, said Barger.

“Not a very therapeutic environment, but that is what they want to do,” she said.

Preferred Hospice maintains a “census” of 60 patients per month, a number that’s often in flux. “Sometimes you lose 10 and admit 15,” Barger said.

Hospice care is an entitlement under the Medicare Hospice benefit, which generally pays 100 percent for medication, equipment, supplies and hospice team services. Social workers help people negotiate with government agencies, Barger said.

In addition to Medicare Part A, hospice is paid for by private insurance or private funds. Payment is on a per-diem basis and varies according to whether the locations are rural or urban and whether the patient is receiving inpatient care or home care.

Routine home care costs about $120 a day, including nursing visits, equipment and medications related to the disease.

“Most hospices have a philosophy that nobody is denied hospice care based on ability to pay. We sometimes get patients too young to get Medicare or who don’t have private insurance. If they have a need and meet the hospice criteria, they are still admitted,” Barger said. “Our biggest challenge is making people understand that we are not giving up.”

Another challenge is trying to educate families about unnecessary medical interventions at the end of loved ones’ lives. “We tell people it is always your right to call 911, but what we hope to do is make families comfortable enough with the end-of-life process so they don’t call 911,” Barger said. Hospice workers discourage artificial feeding and resuscitation of hospice patients, she said, because such measures usually don’t prolong lives or improve their quality.

Most hospice patients have signed a do-not-resuscitate form before arriving at a hospice, said Kriner.

“Everybody has this storybook idea of CPR being like it is on [the television show] ER. They resuscitate them and then have these great conversations, and the patient walks out of the hospital,” Barger said. “But when you have someone terminally ill and you do any kind of resuscitations measure, typically you are exposing them to more discomfort and temporary prolonging of the inevitable.”

Hospices in Columbia

Preferred Hospice of Missouri
1900 N. Providence Road
499-4540

Option Care/Missouri River
1410 Heriford Drive
814-7100

Boone Hospital Home Care
3315 Berrywood Drive
875-0555

Community Hospices of America
800 Hwy. 63 North
443-8360