Sooner Is Better: Hospice Care for Patients With Advanced Illness
By Dr. Andy Arwari, MD, Medical Director - Miami-Dade and Monroe Counties, VITAS Healthcare
While hospice is considered a medical intervention, it is, more precisely, a fully funded federal benefit intended for patients with advanced illness. As part of an entitlement program that patients pay into, it is a benefit they can use—and tap into sooner.
If patients do, they receive the holistic care that a physician alone cannot provide. With hospice, an interdisciplinary team works together to deliver coordinated care. A social worker helps patients with their social needs while a chaplain assists with spiritual care. Nurses and physicians address the patient’s ongoing pain relief, yet the entire approach is team-based and comprehensive.
Hospice: A Federal Benefit Under Medicare Part A
The origins of hospice as a community-based service began in the 1960s, when Dr. Cicely Saunders founded St. Christopher’s Hospice in London. The facility paired expert symptom relief with physical, social, spiritual, and psychological care to meet the needs of patients and their families.
This model evolved in the US, and the federal hospice benefit under Medicare Part A became permanent in 1985.1 Payroll taxes dually paid by employees and employers help fund this, and individuals eligible at 65 for Medicare Part A are entitled to access this benefit. Hospice is also covered by most insurance and Medicaid.
Yet so many are not aware of it. Over 48% of Medicare decedents do not access their hospice benefit.2 As a physician, it is my civic duty to inform patients of the enhanced care they can receive. Patients and their families are often surprised—they tell me that hospice services seem too good to be true.
Hospice Is for the Living
Currently, more than one-third of patients live less than seven days in hospice. Because of this shortened time frame, these patients miss months of care and support which would have enhanced their quality of life.
Many later ask: How come I didn’t know about this before?
Hospice is for the living, not just for the dying. It enables advanced illness patients to be comfortable wherever they are—at home, in assisted living, a nursing home, or a hospital setting. Hospice also supplies durable medical equipment, such as wheelchairs and commodes, which other medical plans may not cover, making it a financial benefit as well.
Physicians use a six-month projected life span to determine hospice eligibility. Yet, if a patient is still in the end-stage of disease at six months, they can renew hospice care at two-month intervals. The team will monitor the patient daily. If the patient has stabilized, the hospice may discharge them. More likely, the patient will re-certify as they continue to decline.
Educate Your Patients
Ultimately, a patient decides if they want to use the hospice benefit. Their physician can help them determine eligibility. As a physician myself, I want to understand ways to support a patient. If I have a struggling patient and medical treatments are no longer working, I want to provide my patient with the quality of life they desire.
For example, a cardiologist referred an advanced heart disease patient to hospice care. She spent several months receiving coordinated care. During this time, her family learned more about the disease process while a team of experts supported this patient. Her family thanked the team for their level of care. Many later ask: How come I didn’t know about this before?
It is our duty to inform patients and families so that hospice becomes an integrated part of healthcare. When patients near the end of life, the physician becomes less significant than a chaplain or social worker. I have never had a family member express any regrets about choosing hospice.
Offer the Option Sooner
When selecting a hospice provider, look for the level of engagement between team members and the patient and family. The attention a patient receives in hospice should increase. It takes an expert team to help navigate the emotions arising during this stage of life. In hospice, families become part of the care plan.
The pathway of serious illness is not unique. Diseases progress the same anywhere in the world. Yet, the US is the only country to have a fully funded hospice benefit through Medicare Part A. We must share this with our patients. It breaks my heart to see patients suffer.
If we have a holistic approach for providing compassionate care, it is our responsibility to offer this solution sooner.
1History of Hospice. (2021). The National Hospice and Palliative Care Organization.
22021 Edition: Hospice Facts and Figures. Alexandria, VA: National Hospice and Palliative Care Organization. www.nhpco.org/factsfigures.