In this article journalist Ben Hallman investigates concerns that American for profit hospices market their services inaccurately to person’s requiring care and their families, push to register them for the hospice program even when they do not meet the criteria, provide care that is inappropriate, and hasten death….. I could spend a day responding to this article.

A few brief points, and I welcome your thoughts:

The U.S. hospice industry has quadrupled in size since 2000. Nearly half of all Medicare patients who die now do so as a hospice patient — twice as many as in 2000, government data shows.

My thought: GREAT! Way to go! We are moving forward!

 Since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud.

Ugh! I hate it when an organization that represents the care that I care so deeply about either provides unethical care or is perceived as doing so.

Hospices bill by the day, and stays at for-profits are substantially longer than at nonprofits (105 days versus 69 days). …..In 2009, for-profit hospices charged Medicare 29 percent more per patient than nonprofits, according to the inspector general for the health service.

Looks suspicious.

Earlier referrals! Great news! In my world, we work to prevent late referrals and short stays! We do not want to admit people on their death bed. We want to provide care earlier in the disease process and provide support for the last months. We want to help prepare the dying person and the family, and provide the beautiful care that we are so good at providing.

The increase length of stay is more likely to reflect the fact that hospice has extended their service to people dying with non cancer diagnosis. Serving those with any chronic life limiting disease has it’s own challenges. It is very difficult to prognosticate for people with chronic illness. If we wait until time of death is certain before we refer people to hospice, we will be filling out their death certificates instead of transitioning them to hospice care. It is estimated that half of people dying with chronic illness will not know the week before they die that they will be dead by the end of the week. This is very different than dying with a steady more predictable decline.

Regarding the increase in costs… I am sure that more money was spent on hospice care, but I wonder how much less money was spent in the Intensive Care Unit.  When people receive palliative care, and/or hospice care, they spend less time or no time in the ICU and the Emergency Department.

It is a challenge to provide excellent hospice palliative care in any system. It is a challenge to build a healthy, interprofessional team that is educated, skilled and compassionate. It is a challenge to keep the person and their family at the center of care, to complete impeccable assessments addressing common issues, to share information in a way that helps the dying person and the family understand what is happening… and then to provide them the support to make informed decisions… to develop a care plan and then to provide the care.

To do this in Canada with financial restraint is incredibly difficult. To do this in the United States is beyond me.

Ben Hallman shares a number of stories. In the stories I see the possibility of fraud. I also see the challenge of helping the person and the family understand the disease process and help them prepare for death.