End of “Abandon All Hope” Hospice Model?

When I was researching my book on bioethics, Culture of Death: The Assault on Medical Ethics in America, the late Dame Cecily Saunders honored me with a 30 minute interview at her St.Christopher’s Hospice. For those who may not know, Dame Cecily–the creator of the modern hospice movement–was one of the most important medical humanitarians of the 20th century.

I asked for her impression of hospice in the USA. She said not enough people accessed the services here.

I asked her why she thought that was so: Medicare had made a huge mistake, she said, by requiring patients to forego all life-extending treatment as a condition of receiving hospice care. “It’s like saying, ‘Abandon hope all ye who enter here,” she told me, shaking her head.

Now, Medicare might finally be seeing the light. A new pilot program will allow patients to receive both treatment and hospice. From the Reuters story:

A new program from the Centers for Medicare and Medicaid Services may remove a barrier that makes patients hesitate to opt for hospice care near the end of life. Until now, to receive hospice care, patients had to agree to forego any further attempts at curative treatments. The new Medicare Care Choices Model will soon offer an option for Medicare beneficiaries to receive palliative care services from certain hospices while still receiving treatment from curative care providers…

Don Schumacher, president of the National Hospice and Palliative Care Organization (NHPCO), said this model may change the future of end-of-life care. “One of the biggest sadnesses and regrets in hospice is that patients are admitted and die within a very short time,” he said, underscoring that too many are not enrolled long enough to realize benefits.

According to the NHPCO, the median length of hospice service in 2011 was 19 days. One benefit of receiving hospice care sooner might be that symptoms could be addressed before they become difficult to control, said Szmuilowicz. “It’s a lot easier to stay on top of somebody’s pain than catch up to it.”

As a former hospice volunteer, I can attest that the problem usually isn’t going into hospice too soon, but too late.

I have been very critical of this administration’s health care policies. But they sure hit a home run with this one. Bravo.

(For my obituary tribute to Dame Cecily, hit this link.)