Healthcare Professionals Blog

A recent New York Times article fretted about the possibility that “For-Profits May Be Cherry-Picking Hospice Patients” (http://www.nytimes.com/aponline/2011/02/01/health/AP-US-MED-Hospices-Profit.html?_r=3&ref=health).   The concern was that for-profit hospices, which have been found to have longer lengths of stay and higher numbers of patients who survive for an extended period on hospice than do nonprofit hospices, are selecting the “easier,” less-costly patients to make a greater return on the daily Medicare reimbursement of $143 per day.

Reading further, however, it turns out that the “easier” patients in question are the frail elderly with dementia.  When I read this the entire story looked different to me.
Dementia is an illness which can last for decades, and take our loved ones from us piece by piece, often leaving a functional body long after the person in that body has lost the ability to interact or communicate as she once did.  It is frightening, disorienting, and often undignified, as the abilities to navigate, calculate, speak, and ultimately toilet, eat, and bathe are lost.
Despite all this, people with dementia have low rates of hospice use compared to cancer patients or even to heart failure patients (another group that under-utilizes hospice).  Dementia is not thought of as a terminal disease, and many dementia patients spend the last year or two of life shuttling back and forth to the hospital to treat pneumonias, urinary tract infections, psychosis, or broken bones, or to have feeding tubes inserted when they “won’t eat.”  The additional suffering they undergo is considerable, because of their inability to communicate pain, discomfort, or shortness of breath.  And caring for them is anything but “easy;” just ask their loved ones.
Thank goodness, I thought, that someone is providing the care these patients need.  The ability of hospice to ease the burden on these patients and their families cannot be underestimated.

Dr. Jonathan Weinkle