Utilizing data taken from CMS hospice claims, the latest Facts and Figures report from the National Hospice and Palliative Care Organization (NHPCO) found that while 1.43 million Medicare beneficiaries were enrolled in hospice care for one day or more in 2016, 27.9% were enrolled for seven days or fewer. Overall, more than half of the total number of all beneficiaries received hospice services for one month or less.
Typically, hospice is considered when a physician determines that an individual has a life prognosis of six months or less. What kind of true aid and comfort can we as medical providers offer in only one week’s time?
As a teaching facility, MorseLife has integrated an academic approach throughout Palm Beach Hospice and Palliative Care with a mission to contribute to best practices within the industry. Below, I offer five areas in which hospice providers can be of more service to our patients and their loved ones:
Outreach and education: I doubt that when Dr. Elizabeth Kübler-Ross introduced her concept of the five stages of grief she thought the process of denial, anger, bargaining, depression and acceptance should be completed in seven days or less. Families need to better understand the philosophy behind hospice and the services available to them. Outreach can be made through medical providers, houses of worship, community lectures and symposia.
Respect the setting: According to the NHPCO report, more days of hospice care were provided in private residences than acute care hospitals, nursing homes, skilled nursing facilities, assisted living facilities and hospice inpatient facilities combined. As medical providers, we are most practiced and comfortable providing services in a healthcare setting. In hospice, the patients’ comfort level is more important than our own and we must respect that we are being invited into their home where they feel safest and in which their loved ones may continue to reside with memories of this period.
People managers: Hospice patients and their families have access to an interdisciplinary team (registered nurse, social worker, home health aide, hospice volunteer and chaplain) yet, once again, too often providers stick to a care team hierarchy and bureaucracy. At Palm Beach Hospice and Palliative Care, we have created a model in which registered nurse case managers serve a small number of patients and are an immediate point of contact by phone, email or text.
Sustaining caring connections: NHPCO found that the majority of volunteer time was for direct patient care (42.7%) compared against clinical support (29.9%) and non-clinical care (27.4%). That’s on the right track and medical professionals need to value those without medical degrees who offer a lifetime of experience, deep compassion and the utmost respect to patients and their families.
Moving beyond bereavement support: Offering primary caregivers a respite while their loved one is alive then, afterward, providing greeting cards, phone calls, visits and support groups is not enough. If we can expand the hospice care window from a week to six months or more, patients and families will have more time to come to closure and make meaningful memories. For those patient whose conditions allow, we will be working with them and their families to create lasting tributes.
Hospice offers compassionate care to its patients and has a profound effect on those they leave behind. Hospice providers need to give it their all because there is literally no time to waste.
