When is it Time for Hospice?

Hospice brings compassion, dignity and hope to people nearing life’s end

(Alexandria, Va) – There is a point when cure is no longer possible for someone with a life-limiting illness, but that does not mean a patient and family must abandon all hope. Through hospice care, there is still hope for a peaceful death; hope to spend final months, weeks or days free of pain; and hope for quality time with loved ones in the familiar surroundings of home.

“While there isn’t one specific point in an illness when a person should ask about hospice care, many hospice professionals would suggest that a person think about hospice long before he or she is in a medical crisis,” advises J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “In fact, learning about palliative care and hospice as options is something that should happen early in the course of a serious illness and not just in the final days.”

Hospices utilize a team of professionals and trained volunteers to provide expert medical care, pain-and-symptom management, and emotional and spiritual support to patients and family caregivers. All care is tailored to the patient’s needs and wishes.

Hospice helps patients and families focus on living as fully as possible.

“Hospice professionals can be important resources for patients and families, they can help a person figure out what goals are important and help them get their arms around the fact that their life may be coming to a close,” noted Schumacher.

Considered to be the model for high-quality, compassionate care for people nearing the end of life, hospice offers the services and support that Americans want when coping with life-limiting illness.

Last year, hospice cared for more than 1.56 million patients in the US. NHPCO estimates that 41.6 percent of all deaths in the US were under the care of a hospice program last year.

Facts about hospice:

• Most hospice care is provided in the home. Care is also provided in nursing homes, assisted living facilities, and hospice centers
• Hospice care is fully covered by Medicare, private insurance, and by Medicaid in most states.
• Hospice care is not just for people with cancer. Hospices serve those with advanced Alzheimer’s disease, heart disease, lung disease, HIV/AIDS – anyone who is facing a life-limiting illness.
• The hospice benefit pays for medications and medical equipment related to the illness.
• Hospice care is available as long as a doctor believes the patient is eligible.
• Hospice care can include complementary therapies, such as music and art, to bring additional comfort.
• Hospice’s offer grief support to the family following the death of a loved one.

“Ideally, a patient would receive hospice care for the final months of life – not just the final days,” stated Schumacher. “One of the most common sentiments from families who have been helped by hospice care is that they wish they had known about hospice sooner.”

A recent report from the Dartmouth Atlas Project looking at care for patients with advanced cancer at the end of life identified gaps between patient wishes and care received. This highlights the need for people to learn about all options available for care.

Additional research published in the Journal of Pain and Symptom Management found that Medicare beneficiaries who received hospice care lived on average 29 days longer than those who did not opt for hospice near the end of life.

For more information, contact your local hospice, visit NHPCO’s Caring Connections website at caringinfo.org, or call the HelpLine at 1-800-658-8898.

Dartmouth Atlas Report Identifies Gap between Patient Wishes and Care Received

NHPCO Commends Dartmouth Atlas Project and Calls on Hospitals to Increase Access to Hospice Care

(Alexandria, Va) – A new report released today from the Dartmouth Atlas Project showing that individuals in some areas of the country are far less likely to receive comfort care in accordance with their wishes and has drawn the attention of the nation’s hospice and palliative care community.

This first-ever report from the Dartmouth Atlas Project on cancer care at the end of life, found that across the US, about 29 percent of patients with advanced cancer died in a hospital between 2003 and 2007. And in 50 academic medical centers, fewer than half of these patients received hospice care.

Furthermore, the study authors state that many patients are aggressively treated with curative therapies they may not want, and, “for frail elderly patients, and any patient with advanced cancer, these treatments have limited or no benefit.”

“The Dartmouth Atlas Project is to be commended for undertaking this thorough examination of end-of-life care for Medicare beneficiaries with advance cancer,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “While the findings of variation in care are not necessarily a surprise, one of the key messages that I take away from this report is the critical need for hospitals and all healthcare professionals to ensure that all patients are informed earlier about the course of an illness and the range of options available – options that include hospice and palliative care.”

The likelihood that a Medicare patient with advanced cancer will die with the support of hospice care, or in the hospital without hospice, varies markedly depending on where he or she lives and receives care. The percent of cancer patients dying in a hospital varied threefold among patients receiving most of their care at academic medical centers.

“It’s important to recognize that this report is not a negative comment on care in our nation’s hospitals or among academic medical centers, rather, it’s a much needed reminder that healthcare professionals must work to help patients and families understand where the course of their illness may take them. And, when cure is not possible, it is our duty to offer the robust benefits that the hospice team can provide,” added Schumacher.

Hospice care provides coordinated care delivered by a team of interdisciplinary professionals that are trained to address the special needs a person has at the end of life. The hospice team provides pain and symptom relief as well as emotional and spiritual support for the patient and the family.

More than 1.56 million Americans received care from the nation’s hospices last year. However, 34 percent of patients died or were discharged in seven days or less – too short a time to take full advantage of all of the services available under hospice, including support for family caregivers.

“In more than 30 years of running hospice programs, the most frequent comment I would hear from patients and families was why they didn’t learn about hospice care earlier,” Schumacher noted.

For several years, NHPCO’s Caring Connections has been providing healthcare professionals and consumers with information about care options and caregiving when facing serious or life-limiting illness. Information to help patients and family caregivers understand the benefits of hospice care, speak with physicians about care, or learn about advance care planning is available free of charge from NHPCO’s Caring Connections at www.CaringInfo.org or by calling the HelpLine at 1-800-658-8898.

-###-

The Dartmouth Atlas Project is run by the Dartmouth Institute for Health Policy and Clinical Practice and principally funded by the Robert Wood Johnson Foundation. A link to the full study can be found at www.dartmouthatlas.org.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO’s mission is to lead and mobilize social change for improved care at the end of life, www.nhpco.org.

Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

Schumacher Quoted in Oncology Times

NHPCO's Don Schumacher is quoted in an article in Oncology Times, "Helping Prevent Suicide in Cancer Patients," (September 25, 2010 issue). The article by Robert Carlson begins:

"Oncologists who say they've never had a patient commit suicide simply might not know. The patient who doesn't return for treatment or reportedly died of an accidental drug overdose could have decided, in their suffering, that life was not worth living."

Dr. Schumacher offers some insight from his 30 years of running a hospice program. This is an informative article for oncologists and other healthcare providers.

Read the article online! What are you thoughts?

Research Shows Patients May Live Longer with Hospice and Palliative Care

NHPCO Reminds People They Can Ask Physicians for Palliative Care

(Alexandria, Va) – A new study released by the New England Journal of Medicine found that among patients with non-small-cell lung cancer, those who received palliative care lived, on average, almost two months longer than those who received standard care. Researchers also found that the patients receiving palliative care reported a higher quality of life through the final course of their illness.

The goals of palliative care are to improve the quality of a seriously ill person’s life and to support that person and their family during and after treatment. Sharing the same philosophy of hospice care which is usually provided in the final months of life, palliative care may be provided at any stage during a serious or life-limiting illness.

Researchers also found that when patients received palliative care services, they were also more likely to elect hospice services.

"With earlier referral to a hospice program, patients may receive care that results in better management of symptoms, leading to stabilization of their condition and prolonged survival," wrote the authors of the study released Wednesday in the New England Journal of Medicine.

This new study adds to the body of evidence showing that many patients live longer with hospice and palliative care.

A 2007 study that looked at Medicare beneficiaries with some of the most common diagnoses leading to death, found that patients who received hospice services lived on average, 29 days longer than those who did not receive hospice care. This study, published in the Journal of Pain and Symptom Management (March 2007) looked at 4,493 terminally ill patients with either congestive heart failure or cancer of the breast, colon, lung, pancreas, or prostate.

In an earlier study looking at patients with 16 of the most common terminal diagnoses, researchers found that hospice patients lived longer. On average, this ranged from 20 days for those with a diagnosis of gallbladder cancer to 69 days for the cohort of breast cancer patients (JPSM, September 2004).

“There’s an inaccurate perception among the American public that hospice means you’ve given up,” said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. “Those of us who have worked in the field have seen firsthand how hospice and palliative care can improve the quality of and indeed prolong the lives of people receiving care.”

NHPCO encourages all families who are diagnosed with a serious illness to ask their healthcare providers about hospice and palliative care services.

“The time to learn about these services is before a person is in a medical crisis. Patients and families must learn about these options of care as soon as possible,” Schumacher added.

Both hospice and palliative care focus on helping a person with a serious or life-limiting illness by addressing issues causing physical or emotional pain, or suffering. Hospice and other palliative care providers have teams of people working together to provide care.

More information about hospice and palliative care is available online at caringinfo.org or by calling the HelpLine at 800-658-8898.

-###-

Contact:
Jon Radulovic
NHPCO, Vice President of Communications
Ph: 703-837-3139
jradulovic@nhpco.org

Costs of Care at EOL

Discussions About End-of-Life Care Reduce Healthcare Costs in Last Week of Life

NHPCO Encourages Dialog between Patients and Physicians

(Alexandria, Va) – Patients with advanced cancer who reported talking about their end-of-life wishes with their physicians had significantly lower healthcare costs in the last week of life. Researchers found that these conversations between patients and physicians led to fewer cases of aggressive care, which saved money and resulted in a far more peaceful death for patients.

The study in the March 9 issue of Archives of Internal Medicine suggests a tangible benefit to advance care planning discussions with physicians – lower costs and reduced utilization of aggressive care, including admission to the Intensive Care Unit.

Thirty percent of Medicare’s annual costs are spent on the five percent of beneficiaries who will die in a given year. Additionally, about one-third of those dollars spent in the last year of life are spent in the last month.

“Discussions about care at the end of life result in a higher quality of life for patients – and cost the healthcare system less money, that is something that hospice and palliative care providers have long known” said J. Donald Schumacher, president and CEO of National Hospice and Palliative Care Organization.

A 2007 study out of Duke University found hospice saves Medicare about $2,300 per beneficiary that receives hospice care.

Researchers in this recent survey looking at costs in the last week of life indicate that if 50 percent of people had a discussion with their physician about end-of-life care preferences, the cost difference in a year could be more than $76 million dollars.

Study participants who discussed end-of-life care preferences were more likely to be referred to hospice sooner than those who did not.

“In fact, patients who received less invasive or aggressive treatments lived as long as patients who did not, indicating that attempts to prolong life in end-stage cancer patients might be futile,” noted Schumacher.

Research published in the Journal of Pain and Symptom Management (March 2007) found that Medicare beneficiaries who opted for hospice care at the end of life lived on average 29 days longer than similar patients who did not take advantage of hospice.

NHPCO has been a longtime advocate for people having frank discussions about the care they would want – primarily to ensure that a person’s wishes are honored and that they experience the highest quality of life possible.

“An important time to talk to your doctor about the kind of care you would want at the end of your life is not when you’re days away from death but much earlier in the course of an illness,” said Schumacher.

“In fact, I cannot stress the importance of advance care planning for all people. Taking time, right now, to have these discussions with family and loved ones can be very important in making sure wishes are honored should a medical crisis come along,” added Schumacher.

Last year, more than 1.4 million Americans with life-limiting illness received the quality care from the nation’s 4,700 hospice care providers.

Information on care at the end of life, starting these important conversations with loved ones and care providers, and state specific advance directive forms, are all available free-of-charge on NHPCO’s Caring Connections Web site, www.caringinfo.org, or from the Helpline at 800-658-8898.

-###-

For more information visit, http://www.nhpco.org