Kristin Donahue: Don’t wait until it’s too late
May 28, 2018
In recent years, hospice programs across the country have experienced an epidemic of late admissions. These are patients who are referred to hospice just a few days or hours before their deaths, and are in a state of acute medical, emotional and family crisis.
Waiting too long to enroll in hospice will diminish a patient's ability to enjoy both quality and quantity of life. Even though the Medicare hospice benefit is designed to cover the final six months of life, half of all hospice patients nationwide are enrolled less than three weeks before their deaths and 37 percent spend less than a week in hospice.
Some patients are referred so late that the hospice team must rush admission to see them before they die. This problem of late admissions has forced crisis management and hurried attempts to maximize quality of life in the few precious hours or days before the patient dies.
This crisis-management approach is in sharp contrast to the hospice ideal of building relationships, managing pain, facilitating meaningful emotional closure for significant relationships, and enabling a peaceful dying experience for the patient and grief support for loved ones. Both the patient and the family miss the full benefit of hospice care by waiting too long to access support. They also may not have time to address issues such as wills, end-of-life wishes and financial arrangements. Unaddressed concerns can magnify the natural fears and anxieties that patients and families experience.
Hospice of the Foothills professionals know from experience how much calmer the patient's dying process can be with support, making the final chapter of a patient's life comfortable, peaceful and satisfying, if time permits. That complaint is often echoed by bereaved family members in hospice grief support groups: "If only we had known about hospice sooner."
Why are hospice admissions delayed? Part of the answer lies in the widely held notion that a hospice referral is "giving up" — even though studies indicate that patients often live longer with symptom management. In fact, many hospice patients find the progression of their disease stabilizes.
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Physicians may also be reluctant to acknowledge the "failure" of their care and resist initiating difficult conversations with terminally ill patients, encouraging them to call hospice. Fortunately, anyone can initiate a hospice referral by calling Hospice of the Foothills for an eligibility assessment. If the patient does not yet meet the Medicare standards for hospice care, but are in need of palliative (comfort) care and support, a referral can be made to Foothills Palliative Care Consultants.
When a patient is referred late to hospice, just days or even hours before death, the burden of symptoms from the illness and the side effects of aggressive treatment likely have multiplied to the point that everything seems to be going wrong at once, both in the patient's physical condition and in the family dynamics (emotionally and spiritually).
Late referrals can disrupt the patient's care at a most stressful time, rather than allowing for a more orderly transition and a relationship of trust to develop between the hospice team and patient. In some cases, the crisis may land the patient in the hospital and even preclude the opportunity to die at home, which research has revealed is the preferred choice.
Hospice of the Foothills has been servicing the end-of-life needs in our community for the past 39 years. Our goal is to enable our patients to value each day and to live fully during their time remaining. We understand that it is important to make the end-of-life journey a gentle, loving and peaceful experience for our patients and their loved ones.
It's also important to mention hospices are not associated or connected. Some are nonprofit community run organizations, while others are for-profit franchise corporations. Hospice of the Foothills is pleased to have served our community as a nonprofit, community run hospice for the past 39 years. We rely on community support through monetary donations or Gift & Thrift store sales and do not bill our patients for care related to their terminal diagnosis.
For questions about the right time to access hospice or palliative care, call Hospice of the Foothills at 530-272-5739. Unlike other hospice providers, all of our services are provided locally. We are your friends and neighbors and we care about our community.
Kristin Donahue is the director of fund development at Hospice of the Foothills in Grass Valley.