The Scope of Hospice Care

Kudos for getting the facts right. This concise, well-written article helped educate readers on the benefits of earlier admissions, the full scope of hospice care, Medicare coverage, and other important information ["A Spreading Appreciation for the Benefits of Hospice Care," December 15-22]. But there is a long way to go to get people to realize that hospice is not a facility; it's a philosophy. I especially appreciate the article's subhead, "Putting terminally ill patients at ease in their final months." As reported, referrals to hospice tend to come unnecessarily late: The average time in hospice is just 20 days. By emphasizing that hospice care is appropriate for the final months, not just the final days or hours, this story may help patients and families seek the wonderful support of hospice care sooner. All you need to do is see one family in crisis who finally finds hospice to know that the hospices in this country are one of our most valuable assets.

Martha Vetter, Transcend Marketing Group, Holland, Ohio

You failed to say that in-home hospice does not provide 24-hour care and that a primary caregiver must be designated in order to receive in home care. This is an ongoing misconception. As for assistance with actual patient care, we had nurse's aides who came for one hour, three times a week. A licensed nurse came every other week, but somebody was always on call to field questions and come to the house on an as needed basis. Weekends found us essentially alone. I must add that we were given lists of agencies whose personnel we could hire if we needed extra hands. This being said, the entire hospice experience was a positive one. Each team was a very compassionate group. It takes an exceptional individual to love another human being enough to help guide and navigate the often choppy waters of the final journey. The hospice philosophy assures that peace and comfort are of the essence. I can think of no greater gift to give a person during their last days.

Bernadette Peter, Richmond, Ky.

We had the wonderful support of Hospice of the Valley here in Phoenix twice during my mom's battle with Alzheimer's. Its support was invaluable. I could have never cared for my mom in the comfort of her own home if it were not for its help and support. Hospice of the Valley was faithful, dedicated, and very informative. I can't say enough good things about it! The full staff of caregivers, nurses, and personal doctor was always on hand to answer questions and offer services such as bathing, companion activities, much-needed supplies, and regular checkups. They were very helpful in informing me of what to expect and symptoms to watch for. I was so thankful to be able to care for her in her home without having to transfer her to a facility. It was a huge blessing.

Comment by Nancy LaCasse of AZ

I believe the hospice article was technically correct; however, it really did not point out the true benefits of hospice. My wife, Kathy, died of breast cancer at the age of 56 in 2002. She was in a residential hospice for 12 weeks. She died in peace and comfort and was pain free. I was able to spend quality time with her, along with our family and friends. In her honor, I built The Kathy Hospice, in West Bend, Wis., adjacent to the new St. Joseph's Hospital. It opened in 2006 and has eight beds, and we have served more than 350 patients and their families. The hospice has been filled, and we have a waiting list. Hospice care is for all diseases and ages. While the article talks of seniors, we have had patients in their 30s. Hospice care relieves the stresses and strains of dying and allows everyone to be at peace and celebrate a person's life before he or she enters the next life.

Ronald Komas, West Bend, Wis.

"A Spreading Appreciation for the Benefits of Hospice Care" missed an important twist in the hospice story pertaining to in-patient versus out-patient hospice. The Medicare requirements for admission to in-patient hospice are now exceedingly stringent and are in no way as liberal as those for out-patient hospice. For a hospice to be paid by Centers for Medicare and Medicaid Services, the in-patient hospice must be managing an acute symptom such as uncontrolled pain, uncontrolled seizures, or severe, unmanageable agitation, which cannot be managed in the home setting. Failure to comply results in continued audits and delayed payment, if payment is rendered at all. This creates a severe problem for the staff at in-patient hospices. For many reasons, hospitals and families are looking for manageably inexpensive ways to place patients or family members who otherwise would remain in expensive hospital beds or nursing homes. Many families cannot or won't take the time or effort to care for the patients at home, because they would miss time at work or disrupt home life. The excellent quality of care makes in-patient hospices the perfect location to place them in their view, except that most of these patients do not meet the CMS admission guidelines. Both hospitals and the families will do whatever it takes to get the patients into an in-patient hospice, so often their situation is misrepresented at the time of hospice evaluation. The net result is that the hospices, out of compassion, keep the patient in the in-patient unit but only bill the payer at substantially lower, out-patient rates. Consequently, most of these facilities lose money and are probably in jeopardy. Ironically, many of the in-patient units in a nearby city are considering closing because they cannot fill the beds with patients who meet the CMS admission criteria but have to staff at levels that meet CMS care guidelines, a real catch 22.

William Thoms, M.D., Kingston, Ga.