A recent article in the New York Times (“This was not the good death we were promised” published on 1/7/18) highlighted once again that not all hospices are the same in their prioritization of patient and family needs. Glossy brochures and service “extras” don’t substitute for being able to count on a highly trained healthcare professional to respond in times of crisis – which can be at any hour of the day or night. Cancer patients in particular have a less predictable disease course, and the potential for unanticipated symptoms arising in their final weeks.
Care Partners prides itself on having a nurse on-call 24 hours a day, 7 days a week. If needed, one of our physicians will also evaluate the situation and recommend a course of action – even at 3 am. We often visit patients more than once a week (potentially multiple times in one day if required) and we are in contact with the home at least four times in the first 48 hours after admission. There is never a time, including holidays, when our phone is not answered. We always do advance planning and coaching with our families, making sure that an adequate supply of medications is in the home, as well as specialty “kits” we have created for emergencies like seizures.
Hospice has the potential to help patients through a good death experience (see another New York Times article, “One last visit to see my patient” published on 9/25/17), but Medicare payment reforms are needed to insure that funds are available to cover services for patients with high needs. Currently hospice is the only type of care with flat reimbursement unrelated to patient acuity. As a result, for-profit agencies have fewer incentives to care for medically-complex patients with short stays, while non-profits whose mission is to provide exceptional care without exception are under pressure for incurring costs far above the daily rate they are paid.