Why is hospice care underused in the U.S.?

home care omahaWhile the number of people turning to hospice care may be growing in the United States, people suffering from terminal illness still face many barriers when trying to access end-of-life palliative care. And it’s not just because patients and/or their families are afraid of coming to terms with death. Medical journal Health Affairs conducted a nation-wide survey of nearly 600 hospices, which revealed there are other factors at play as well. The results showed that 78 percent of hospices had “at least one enrollment policy that may restrict access to care for patients with potentially high-cost medical care needs” like chemotherapy and tube feeding, according to Health Affairs.

Dr. Melissa Aldridge Carlson, lead author of the study and a geriatrics and palliative care researcher at Mount Sinai School of Medicine, told The New York Times that the results show there’s a barrier for people who may want hospice care but can’t receive it due to current Medicare requirements. And while this made sense a couple decades ago when Medicare first developed regulations that require patients to stop curative treatments upon entering hospice, advances in medicine have outpaced such regulations and currently blur the line between palliative and curative treatments, according to Aldridge Carlson.

The survey also showed hospices that are small, for-profit and in certain regions of the country consistently reported more limited enrollment policies than non-profit hospices. This is likely due to Medicare regulations, making it too expensive for many operations to care for a terminally ill patient’s high-cost care needs.

In the end, the study suggests Medicare’s hospice requirements be revised to better meet the needs of patients receiving modern medical treatments.

2011 U.S. hospice stats (via nhpco.org)

    • Nearly 1.7 million patients received hospice services.


    • The median length of hospice service was 19.1 days.


    • 66.4% of patients received hospice care at home.


    • Only 21.9% of patients received care in a hospice inpatient facility.


    • Currently there are more than 5,300 hospices in operation in the United States, including the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.


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