The largest non-profit group representing hospice care is advising relatives to discuss end of life treatment during holiday get togethers.

45-50% of Medicare decedents in Missouri are enrolled in hospice at the time of death.

Image courtesy – the National Hospice and Palliative Care Organization

The National Hospice and Palliative Care Organization (NHPCO) says the service enables patients and families to focus on living, despite having a life-limiting illness.

The group’s President, Edo Banach, says the assistance can help those with a terminal condition continue to live life to its fullest.  “When you accept that we’re mortal, and you make decisions, not necessarily based on curing, but really on living, you can live a fulfilled, more comfortable life,” said Banach.

A study published in the Journal of Pain and Symptom Management showed that some people under hospice care live longer than those who don’t receive the service.   It also showed that in some cases, costs are lower for patients who choose hospice care than for those who do not.  The pattern persisted across most of the diseases studied.

Another study published in the same journal found that for certain well-defined terminally ill populations, patients who choose hospice care live an average of 29 days longer than similar patients who do not choose hospice.

Banach says in some cases, patients live beyond their coverage for hospice care.  “Some people are no longer eligible for hospice, because hospice has that effect,” said Banach.  “That’s not a bad result.  When folks are comfortable and they’re less stressed, sometimes they do live longer and certainly happier lives.”

J. Donald Schumacher, former NHPCO president and CEO, thinks there’s a misperception that people have thrown in the towel when they turn to hospice care.

“There’s an inaccurate perception among the American public that hospice means you’ve given up,” said Schumacher. “Those of us who have worked in the field have seen firsthand how hospice can improve the quality of and indeed prolong the lives of people receiving care. Benefits of hospice have been reinforced by positive stories like that of Art Buchwald who seemed to thrive under the care of hospice.”

Art Buchwald was a writer and humorist at the Washington Post, who experienced improving health during a hospice stay.  He checked out after 5 months and continued to live for a time before his kidneys failed at age 81.

About 32,000 Missouri patients received hospice care from 120 providers in 2016.  The service is generally utilized in the last six months of life, although most people receive the care for 20 days.

Banach says it’s important to plan ahead for end of life treatment.  “If we leave these things up to chance, what happens is folks, by and large, end up dying in a hospital.  They end up hooked up to machines.  They end up in an ambulance.”

According to the American Cancer Society, home hospice care usually costs less than care in hospitals or nursing homes because less high-cost technology is used, and family and friends typically provide most of the care.  The service is normally covered by Medicare or Medicaid, as well as by most private insurance plans and managed care organizations.

There are conditions that keep people from entering hospice care.  For one, Medicare requires patients who opt for the service to discontinue life prolonging treatments, and the coverage that pays for it.  Only comfort care is covered through the hospice benefit.

The NHPCO describes hospice care as a team approach for medical care and pain management, as well as emotional and spiritual support which is tailored to the patient’s needs and wishes.

The organization notes that family members typically serve as the primary caregivers, and sometimes help make decisions for the terminally ill person. Members of the hospice staff, who are on-call 24-hours a day, will make regular visits to assess the patient and provide additional services.

Palliative service brings comfort care to people earlier in the course of a serious illness.  It differs from hospice care in that it’s normally administered in a hospital or nursing home where a palliative care team is present.