When patients enter the dusk of their sunset years, they need peace, support, and care. It can be a trying time for patients and family alike — but with hospice, the burden weighs a little easier. According to one report published in the BMJ’s Supportive and Palliative Care, patients who enroll in hospice during their final six months of life tend to experience better satisfaction with treatment, improved pain control, fewer days spent in the hospital, a better quality of care, and lower rates of hospital and intensive care mortality.
Hospice’s benefits can be particularly valuable to patients who suffer from complex or painful terminal conditions that require intensive, round-the-clock care. As researchers for one study shared in the Journal of Clinical Oncology wrote in 2017, “Patients with advanced cancer often experience pain, dyspnea, and distress at the end of life (EOL), and use intensive, hospital-based services near death […] Hospice offers an alternative, patient-centered model of care focused on relieving suffering, and often delivers services within the home environment.”
However, many people do not receive hospice services as much as they should — or even realize that hospice support is an option. In 2012, researchers at the University of Iowa found that 60% of patients who passed away at a studied teaching hospital qualified for hospice enrollment during the year before their terminal admission. However, only 14% were offered the option to enter hospice services during pre-terminal discussions. In some cases, this shortfall led to a notable downturn in patient comfort and care satisfaction. Researchers found that patients who spent three or fewer days in hospice were significantly less likely to die in their preferred place (e.g., at home, in a care facility) than those who began receiving hospice care 30 or more days before their passing.
The degree of comfort and reassurance a pre-terminal patient enjoys, too, can hinge on their access to end-of-life care. Patients not enrolled in hospice often need to make emergency trips to the hospital during their final weeks. The frequent travel and uncertainty can place unnecessary stress on the patient and family alike — and lead to suboptimal care. Multiple reports have indicated that terminal patients who receive primarily hospital-based care often experience poorly-treated physical symptoms and receive treatments that are either unwanted or inconsistent with their stated care goals.
Moreover, non-hospice end-of-life care can place a heavy financial burden on families. The expense numbers are shocking; according to Medicare data, 5% of Americans accounted for 50% of healthcare spending, with costs predominately accrued in hospitals during the last year of life. The continuity of hospice care ensures that terminal patients experience fewer expensive emergent situations and experience more affordable, consistent care in their final weeks.
Expanding patient access to and knowledge of hospice services would solve the lion’s share of our problems with end-of-life care. When families coordinate a hospice-centric end-of-life plan, they ensure that their loved one enjoys better-coordinated, high-quality, and lower-cost care at a time when it matters most. Currently, the median length of stay for hospice care rests at around 17 days, rather than the month or more that researchers recommend for a truly comfortable and supportive transition. Whenever possible, clinicians and insurers should work to ensure that terminal patients have the care and support they need during their final weeks.
Hospice can provide peace and support when terminally-ill patients need it most — it falls to those of us in the medical sector to ensure they have it.