Balancing costs and quality of life with hospice care

Hospice care can lead to substantial cost savings for the U.S. Medicare program, providing both financial benefits and improved patient outcomes. This is based on the research conducted by MIT scholars.

The study examines the expansion of profit-driven hospices and the Medicare hospice program, which offers comfort over curative treatments. However, concerns have arisen about potential overutilization of hospice services, particularly among Alzheimer’s and dementia patients, especially within the for-profit hospice sector due to financial incentives.

The research indicates that Medicare can save approximately $29,000 over the first five years after an Alzheimer’s or related dementia diagnosis for patients enrolled in for-profit hospice care. This highlights the cost-effectiveness of hospice care compared to traditional medical treatments.

The findings suggest that hospice care not only reduces costs but also enhances patient quality of life by focusing on comfort and emotional support rather than aggressive medical interventions. This approach is particularly beneficial for terminally ill patients and their families.

Ultimately, hospice care offers a valuable option for individuals facing the end of life, allowing them to avoid unnecessary medical procedures and prioritize their well-being.

Charting What More Hospice Access Means

The hospice movement began in the 1960s and gained traction in the U.S. during the 1970s, with Medicare formally covering hospice services in 1983. Since then, hospice care has become one of the best options for American patients seeking personalized nursing care in either a home environment or a residential facility setting.

This approach focuses on prioritizing comfort and quality of life over curative treatments for those with a life expectancy of six months or less. Overall, hospice care provides essential support to patients and families during difficult times.

However, concerns have arisen regarding aggressive marketing practices employed by some for-profit hospices. Some fraudulent operators target vulnerable populations, including residents in assisted living facilities or nursing homes, enrolling individuals who do not meet terminal illness criteria. This can lead to significant harm as patients may lose access to necessary curative treatments.

Research indicates that hospice enrollment can increase the five-year mortality rate by 8.6% while simultaneously reducing overall medical costs.

The reported increase in the five-year mortality rate upon hospice enrollment suggests that patients may experience a more natural progression of their illnesses when receiving hospice care. Rather than pursuing aggressive treatments that may prolong life without improving quality, hospice focuses on palliative care, which emphasizes symptom management and emotional support.

The average annual cost for hospice care per patient is approximately $29,205, which is a capped amount under Medicare regulations. This cap can lead to situations where patients do not receive adequate support or are prematurely discharged from hospice care.

Despite certain limitations inherent in the system, informed patients often view hospice care as a cost-effective option for end-of-life care. Informed patients who understand the benefits of hospice care are more likely to appreciate its value as a compassionate alternative to conventional treatments.

For individuals nearing the end of life, creating a plan for end-of-life care can make an enormous difference in ensuring that their wishes are honored and reducing anxiety.

Another vital aspect of end-of-life planning involves creating a living will, which documents an individual’s preferences regarding medical treatments and interventions. A living will includes include preferences regarding resuscitation efforts, decisions about the use of ventilators for breathing support, and choices about receiving food and fluids through artificial means.

A Physician Orders for Life-Sustaining Treatment (POLST) form is another important tool for individuals with serious illnesses. This doctor-ordered document outlines specific medical interventions that align with the patient’s wishes, such as refusing entry into the ER, avoiding hospital stays, and wanting life-sustaining care.

The Advance Health Care Directive

An Advance Health Care Directive (AHCD) is a legal document that allows individuals to outline their preferences for medical treatment in the event they become unable to communicate their wishes due to illness or incapacity.

It serves as a guide for healthcare providers and family members, detailing what they want or don’t want to happen.

An AHCD allows individuals to appoint a healthcare proxy or agent—a trusted person who will make medical decisions on their behalf if they are unable to do so. This representative should be someone who is willing and able to engage in discussions about healthcare choices.

Individuals are encouraged to complete an AHCD form as soon as possible, which is often available at no cost from various sources, including hospitals, legal aid organizations, and online resources. While there is no legally required format for an AHCD, it must be signed and witnessed according to state laws to ensure its validity.

The need for an attorney to complete an AHCD

In California, an AHCD does not require an attorney for completion. The law states that any kind of agreement or contract is considered legal in California if it has been signed by the party involved, bears the current day and month, and also carries the signatures of at least two qualified observers.

Specific witnessing regulations apply in skilled nursing facilities, where the participation of a patient advocate or ombudsman may be required to ensure compliance with state laws.

While legal representation is not mandatory, it may be advisable in certain situations such as if you have specific medical conditions or complex family dynamics that might complicate decision-making.

If you are a seasonal resident in another state, consulting an attorney familiar with both states’ laws can help ensure that your directive is valid and enforceable.

Legal advice can provide clarity and help draft a more comprehensive directive if you anticipate potential disputes among family members regarding your healthcare decisions.

Creating your Advance Health Care Directive

Creating an AHCD is an essential way to ensure your medical wishes are respected if you’re ever unable to communicate them.

Start by reflecting on your personal values and end-of-life goals. Think about what matters most to you, such as maintaining independence, preserving dignity, and managing pain. Also, consider your preferences for end-of-life care—whether you’d want aggressive treatments or would prefer comfort-focused care.

Once you have a sense of your values and goals, share them with your loved ones and healthcare providers. Have open, honest conversations with family and friends, and consult healthcare professionals to better understand possible medical scenarios and treatments.

Next, choose a healthcare agent—someone you trust to make medical decisions on your behalf if you’re unable to do so. This person should understand your values and be able to make tough decisions if needed.

To complete your AHCD, you can use pre-printed forms or templates as guides. Clearly outline your preferences for specific treatments like CPR, mechanical ventilation, and artificial nutrition and hydration.

After completing the directive, review it with your healthcare provider and healthcare agent to make sure it accurately reflects your wishes.

Finally, keep the original document in a safe place, and provide copies to your healthcare agent, primary care physician, and any alternate agents.

Planning for a dignified end may seem overwhelming, but it’s a compassionate way to ensure your healthcare wishes are honored.

This proactive approach not only respects your desires but also brings peace of mind to you and your family.