“Last Minute” Hospice Referrals

I came across a perceptive article by Harvy Lipman in the Bergen (NJ) Record.  His point is that referrals to hospice are often equated with loss of hope for recovery and, therefore, are put off as long as possible — even until the day of death.

The hospice system is designed to manage terminal patients at home whenever possible, controlling their pain and improving their quality of life, while also offering a team of social workers, volunteers and chaplains to help both patient and family deal with the emotional toll. Those relationships, hospice experts say, need to be nurtured over as much time as possible.

But too often patients aren’t even referred to hospice until their conditions have deteriorated to the point where their families can no longer manage. And at that point, that quality of care becomes difficult, if not impossible.

“The average amount of time people spend in our hospice is only 17 to 21 days,” Megerman said. “In the last three weeks of someone’s life it’s hard for us to provide all our services.”

Delayed entry into hospice is an issue across the state, but especially so in North Jersey, said Kris MacMillan, director of Valley Hospice — an arm of the Valley Health System which serves patients in Bergen and Passaic counties.

“In 2010, the average length of time patients spent in hospice care in New Jersey was 64 days,” MacMillan noted. “The national average was 71 days. Our average was 46 days.”

Lipman goes on to observe that doctors are reluctant to “abandon” their patients to the hospice care team and are even more reluctant to have a conversation with those patients about approaching death . But, when they do, the results can be positive: A NJ doctor interviewed by Lipman asserted that “Patients who enter hospice actually live longer and have a better quality of life. And their families recover faster.”

What can be done about this situation?  I’ll offer some thoughts in my next post.