Texas Tech University Health Sciences Center
Growth and Changes in Hospice Care

Growth and Changes in Hospice Care

I favor the hospice movement in our country. The U.S. actually wasn’t the first to think of what we now call hospice care. The term can be traced to medieval times when it referred to a place of shelter for weary or ill travelers.  In more modern times, is was popularized by Cicely Saunders, M.D., when she started a hospice for the dying in England. Later, Saunders introduced the idea of specialized care for the dying to the U.S. during a 1963 visit to Yale University.

I have had experience working with hospice throughout my career, and have even served on two hospice boards. These were not paid positions, but something that I was pleased to volunteer to do. One of the hospices is here in Lubbock. The other one is the largest not-for-profit in the Dallas-Fort Worth area for which I was chair of the finance committee and worked with professional staff on matters such as budgets, billing and trying to get accounts paid on time. Texas Tech Physicians has faculty members who are involved in providing professional services to area hospices and the patients they serve. So, I still get involved on the periphery with hospices during contract times.

When I was more actively involved with a hospice, the case managers would often tell us that patients didn't get admitted to hospice care soon enough. In other words, patients who had a very short time to live were admitted so late that there was little that staff could do for them in terms of services. Hospice patients may be in private homes, hospitals, inpatient hospice facilities or nursing homes. The doctors, nurses, social workers and chaplains I know really want to help the patients and their families as they are compassionate people. Helping is difficult if limited to two or three days with the patient.

Now, there is a new situation where many patients are enrolled in hospice care for more than 1,000 days over three or four calendar years. This is interesting, because hospice was initially designed for people who are likely to die within six months. Of course, no one can predict when a person will die with absolute certainty. It seems more people are being admitted into hospice care for an array of ailments, including dementia, which can take years to progress. Historically, about 37 percent of hospice patients had cancer, which hasn’t changed. But, the percentage of hospice patients with dementia has increased from 12 to 15 percent.

I personally haven’t processed how I feel about this emerging trend. Of course, it's not all hospice patients that have these long admissions. The average patient is under hospice care for 88 days, but that is up from the 54-day average a few years ago.  On one hand, I'm glad that patients are being served. On the other hand, I wonder if hospice care is the most appropriate setting for someone who may suffer from dementia or some other condition, which could last for years. My sense of compassion wants those individuals to receive all the care that they need. I would be tempted to say it doesn't matter what the type of care is called, as long as the person is receiving needed services. But, Medicare, which covers a great deal of the cost of hospice care in our country, is concerned about this question.  This means it’s one more thing to figure out in our complicated health care delivery system.