Hospice Limits?
You may recall Art Buchwald, the humorist who wrote a book about his hospice experiences. Too Soon to Say Goodbye: I Don’t Know Where I’m Going. I Don’t Even Know Why I’m Here chronicles his experiences in hospice, where he lived much longer than he, or his doctors, expected: “[f’]inally, after five months of having “a swell time — the best time of my life,” Mr. Buchwald checked himself out of hospice to resume an ordinary life of a famous old funny man.”
As elder law profs, we know about hospice, what is provided and what Medicare pays. I guess we shouldn’t be surprised to learn that Mr. Buchwald wasn’t the only person in hospice to live longer than the prognosis. The New Old Age Blog recently ran a story from Paula Span, Bounced from Hospice about an increase in patients who were discharged from hospice. According to the article, there are several reasons why this may happen, which may roughly be summarized as including more oversight by CMS , patients who maintain or even improve, albeit temporarily, and, not surprisingly, dwindling budgets. As we know, death doesn’t occur on a schedule, so even someone certified for hospice can live longer than the prognosis. Ms. Span cites to a Washington Post story about the role of for-profit hospices,”[t]he Post attributed much of the jump in discharges to the way for-profit hospices have come to dominate the field, enrolling ineligible seniors for long stays to bolster corporate bottom lines, then dumping them to evade Medicare sanctions…” Ms. Span reports that the National Hospice & Palliative Care Organization keeps information and stats on discharges, and the article notes that 2/3 of discharges come from hospices and 1/3 from the patients. NHPCO has great resources on their website, including their 2013 report, NHPCO’s Facts and Figures: Hospice Care in America (2013 Edition). One interesting figure on page 5 of the report is that the “median… length of service in 2012 was 18.7 days [with] the average length of service… 71.8 [days]”. (citations omitted). NHPCO offered a response to the Washington Post article.
Ms. Span offers:
I worry about families who have agonized about the decision and finally called for help, then feel betrayed when hospice withdraws, even though their relatives can regain hospice care when they decline further. They shouldn’t get caught in this crossfire…Was this really the intent of the 1983 hospice Medicare benefit – to have dying older people moved off and on the rolls, to have families receive crucial support and then lose it, depending on whether someone’s weight has stabilized for a few weeks?
It makes me think of a yo-yo, which is great and entertaining as a toy, but never a good way to go through life’s experiences especially when that experience is dying.