Understanding and Overcoming Hospice Myths

Hospice Fact

While hospice remains one of the most comprehensive benefits available to Medicare patients, many still do not use it! According to a report published by the National Hospice and Palliative Care Organization (NHPCO), only about 50% of eligible patients utilized the hospice benefit. This means half of the individuals who are eligible for hospice aren't receiving this care.

What Can We DO?

EDUCATE!!

Educating individuals about hospice is the key. An article issued by the NHPCO reiterated that research consistently shows most Americans would prefer to spend their remaining days at home. Yet, a larger number don't get that opportunity, because many medical professionals are not adept at having conversations with patients who may be eligible to receive hospice care. Families often state they wish they had chosen hospice sooner. As a country, we should help medical professionals and facilities improve their capabilities for frank, open conversations with patients and their loved ones about prognosis and care options. By having those conversations effectively and making referrals to community-based palliative care or hospice earlier, our health system could help more people spend their final days, weeks, or months at home, surrounded by loved ones, and achieving their goals.

MYTHS and FACTS

Myth

Hospice is only for the last days of life.

FACT

This myth will always be around unfortunately. Many of the referrals given to hospice are "late" referrals. This means the individual and family would have benefited from hospice care if the referral was made sooner. Receiving hospice care does not mean giving up hope or that death is imminent. The earlier an individual receives hospice care, the more opportunity there is to stabilize the medical condition and address other needs, therefore improving quality of life. While hospice care is generally focused on patients where life expectancy is six months or less, some individuals actually improve and may be discharged from hospice care. They can then be re-admitted later when it is necessary. As long as the patient meets the criteria, they may receive care for longer than six months.

MYTH

Hospice hastens death

FACT

While most hospice patients do pass away while they are in hospice care (this concept likely explains how this misconception came to be), hospice does not speed up death. In fact, those individuals who have chosen the hospice benefit may live longer than those who do not choose hospice services.

Many ask, "How can that be?"

Studies have shown that this may be because hospice care helps relieve pain and stress, provides symptom management, emotional and spiritual support, therefore improving quality of life allowing them to live more comfortably for longer periods of time. For example, a study published in the Journal of Pain and Symptom Management found that patients who received hospice care lived longer than those who did not. This study reviewed data from more than 44,000 terminally ill cancer and CHF patients and found that those who elected hospice lived an average of more than 29 days longer than those who did not receive services. Another study from the American College of Cardiology reported that patients on hospice used less health care, lived longer and were less likely to die in the hospital.

THE MORPHINE MYTH

Morphine stops breathing and speed up death

FACT

Among terminal lung disease patients, 95% report breathlessness as a symptom. Morphine opens the blood vessels allowing more blood circulation within the respiratory system. This makes it easier for the lungs to get the bad gases out and the good gases in. The patient becomes calm, their breathing slows down. A runner is a great example of how this works in healthy people. When they are running a race, they breathe hard and fast. The body requires more oxygen to fuel this burst of energy. When they finish the race, their body is fully oxygenated. Their breathing naturally slows down.

With morphine dilatating vessels and increasing oxygenation, it's like breathing while sleeping. Breathing slows down to match their body's demand, not stopping it.

If a patient dies shortly after receiving morphine, it may look like the morphine caused the death simply because of the timing. When in fact the morphine has only promoted the level of comfort needed. Many patients are unable to rest because of symptoms. Often suffering is holding back death. Remove the suffering and death can happen in its own timing.

MYTH

You need Medicare or Medicaid to receive hospice

FACT

There are many different payment options available for hospice care. Hospice is covered under the Medicare hospice benefit, Medicaid and most private insurance plans. However, with Hospice of the Blue Ridge, patients are not denied hospice care regardless of ability to pay.

MYTH

"For-Profit" and "Not-for-Profit" are the same

FACT

A for-profit hospice organization's goal is to provide care while providing an annual stakeholder profit share (or return on investment). This means that all financial decisions are made and measured by the need to deliver a profit along with the delivery of patient care.

Not-for-Profit hospice organizations, like Hospice and Home Care of the Blue Ridge, reinvest all proceeds to the hospice program to further enrich care to patients and their families. What does this mean? This means all financial decisions are made and measured by the need to deliver the highest quality care possible, patients who are underinsured or uninsured are never turned away for their inability to pay, and our mission is to provide quality care to those we serve and not to make a profit. We measure every financial decision by asking, "is this the right thing for the patient?" and not, "is this the right thing for the shareholder?"

MYTH

Facility patients don't need hospice.

FACT

Hospice is a service, not a place. Care is provided wherever a patient calls home. The location of the patient doesn't negate their need for specialized hospice services. In fact, the hospice team can help supplement the care that the facility provides. Residents enroll in hospice but continue to receive the same services from the facility, such as bathing, meals, medicines and staff support. When hospice is involved, the resident also receives the support of the hospice team. Much like a resident might receive therapy services in a nursing home, hospice is an additional service that specializes in care at the end of life. Hospice brings a whole team of workers to join the facility staff who all work to gather to meet the special needs of the patient. Hospice and nursing home staff collaborate on a plan that will meet the residents' and family's needs.