Column: Debunking hospice myths

by Mary K. Spengler

While more than 1.5 million Americans die each year in hospice care, accounting for nearly 60 percent of all deaths in the U.S., according to the most recent data, many other Americans eligible for these services did not elect them because of the stigma, fears, and misinformation linked to the end-of-life care. Conversely, hospices nationwide report consistently that patients and families wish they elected hospice sooner.

To help make an informed decision about end-of-life care, here is a list of hospice myths debunked and dispelled.

Myth: Hospice is a place.

Reality: Hospice care usually takes place in the comfort of an individual”™s home, but can be provided in any environment in which a person lives, including a nursing home or assisted living facility.

Myth: Hospice is only for cancer patients.

Reality: More than 50 percent of hospice patients nationwide have a diagnosis other than cancer. Hospice cares for people with any serious or life-limiting illness, including: heart disease, cancer, Lou Gehrig”™s disease, cirrhosis, emphysema, kidney disease, AIDS and Alzheimer”™s disease, among others.

Myth: Hospice is just for the patient.

Reality: Hospice focuses on comfort, dignity and emotional support of the patient as well as family members and caregivers.

Myth: Once you choose hospice care, there”™s no turning back to traditional medical treatment.

Reality: Patients are free to leave a hospice program at any time for any reason without penalty. If a patient”™s condition improves or the disease goes into remission, he or she can be discharged from hospice and return to aggressive, curative measures. If a discharged patient wants to return to hospice care, Medicare, Medicaid and most private insurance companies and heath management organizations (HMOs) will allow readmission if he or she meets the medical eligibility criteria.

Myth: If you choose hospice care, you won”™t get other medical care and can no longer receive care from a primary care physician.

Reality: While the hospice team will provide all aspects of care for the illness that qualifies you for hospice services, you are still free to seek treatment for unrelated illnesses or conditions. For example, if you are receiving hospice care for heart disease, you can still get treatment for a broken bone. Hospice also works closely with your primary physician and considers the continuation of the patient-physician relationship to be the highest priority.

Myth: After six months, patients are no longer eligible to receive hospice care through Medicare and other insurances.

Reality: According to the Medicare hospice program, services may be provided to terminally ill Medicare beneficiaries with a life expectancy of six months or less. However, if the patient lives beyond the initial six months, Medicare, Medicaid, and many other private and commercial insurances will continue to cover hospice services as long as the patient meets hospice criteria of having a terminal prognosis and is recertified with a limited life expectancy of six months or less by the hospice medical director.

Myth: All hospices are the same.

Reality: All licensed hospice programs must provide certain services, but the range of support services and programs may differ. Like other medical care providers, the business models differ. Additionally, hospice programs and operating styles may vary from state-to-state depending on laws and regulations, and some programs are not-for-profit and some hospices are for-profit.

Myth: To be eligible for hospice care, a patient must already be bedridden.

Reality: Hospice care is appropriate at the time of the terminal prognosis, regardless of the patient”™s physical condition. Many of the patients served through hospice continue to lead productive and rewarding lives.

Myth: Hospice care is expensive.

Reality: Most people over 65 years of age may have Medicare insurance. Medicare is not the only insurance that provides coverage for hospice care. Medicare covers hospice services and there is little out of pocket expense. However, most private plans, HMOs and other health care organizations include hospice care as a benefit. Additionally, through community contributions, memorial donations, and foundation gifts, many hospice programs are able to provide patients who lack insurance with free services. Other programs charge patients in accordance with their ability to pay.

Mary K. Spengler is executive director of Hospice & Palliative Care of Westchester in White Plains, which provides end-of-life care to people with any life-limiting illness who reside in Westchester County. She can be reached at 914-682-1484.