Hospice Care Not Widely Available Across US

Even though most of us don’t talk much about it, almost everyone would like to leave this life in a pain-free, peaceful, dignified manner. And dignity at the time of death is exactly what every hospice strives to achieve. It’s their main mission and the industry has flourished, especially in the last twenty years. Unfortunately, hospice care facilities are not readily available across a wide swath of the nation.

A recent study conducted by the University of Michigan (UM) reveals that about a third of the US population does indeed employ hospice care, in one form or another, at the time of death but the service is tightly clustered in just a few areas of the US - the northeastern and upper midwestern states bordering the Great Lakes and California.

The remainder of the country, particularly the Plains states, the South, Florida, and Texas have few, if any, hospice services available. The (UM) study suggests demographics and access to private health care plays a role.

On a per-county average, hospices number 2.1 per county across the country. Unfortunately, they aren’t that evenly distributed. Some counties have no hospices while others may have as many as 125.

The National Hospice and Palliative Care Organization identifies the need for one hospice for every 60-mile radius but this measure is even more unbalanced than the per-county count. Some 60-mile zones have no hospices while others contain 280.

Hospices tend to be clustered in areas where household incomes exceed $100,000 or where more residents complete a high school education. Only 70% of hospice care is covered by Medicare and most private insurance policies don’t cover it at all. Most families face out-of-pocket expenses when a family member receives hospice care and many hospices rely on charitable donations and volunteers to stay in business. The ability to pay the out-of-pocket expenses, charitable donations, and volunteerism are more common in areas of affluence.

In areas heavily populated by the elderly, the number of hospices is low, probably due to the population’s reliance on Medicare for medical expenses. People in rural areas and of certain ethnicities also seem reluctant to utilize hospice services.

Education level and experience with hospice services are also cited as reasons why care is clustered the way it is. Maria Silveira, MD, MPH, who presented the findings of the study to the Society for General Internal Medicine last Friday, feels that familiarity and physician referrals would generate more interest in areas currently under-served by hospice care. Silveira is an assistant professor of internal medicine at UM’s Medical School and is a member of the Veterans Administration (VA) Ann Arbor Healthcare System’s Health Service Research & Development (VA HSR&D) Center of Excellence.

Silveira calls upon the Medicare program to subsidize the cost of building facilities in under-served areas and to increase the cost and number of hospice services they cover. She also feels that private donations should also be encouraged so that hospice coverage is extended beyond the areas now covered and into the areas where more facilities are needed.

Hospice services can dramatically improve the quality of life for many patients and is available in designated hospice facilities, in the patient’s home, and in many hospitals, nursing homes, and long-term care facilities.

Hospice services provide compassionate care to patients of all ages who are facing death due to injury or illness. In addition to medical care and pain management, they offer emotional and spiritual support, including grief counseling, to patients and their loved ones.

The University of Michigan and the VA HSR&D Center of Excellence provided funding for Silveira’s study.

Filed under: Cancer, Elderly Care, Family, Hospice Care, Medical Research, Medicare