Advantages and Disadvantages of Hospice Care

What are the advantages and disadvantages if you or a loved one enters hospice care? Hospice services are a specialized form of medical care that seeks to provide comfort and maintain a patient's quality of life (to the greatest extent possible) for those facing a life-limiting illness, disease or terminal condition.

While this care generally attempts to provide holistic comfort and dignity as death approaches, hospice might or might not be the right choice for you or a loved one depending on your unique needs and/or situation. Here are some of the possible advantages and disadvantages of hospice care that you should consider.

Advantages

• Hospice includes comprehensive, interdisciplinary care from a team of professionals and hospice volunteers. This care can involve physicians, case manager nurses, home health aids, certified medical social workers, chaplains and trained hospice volunteers to meet the needs of the patient and his or her family members or personal caregivers.
• Care is available 24 hours a day, including weekends and holidays. Patients and their family members or personal caregivers always have access to hospice professionals when they need assistance.
• Choosing hospice usually results in a reduction in your out-of-pocket expenses for medications, durable medical equipment, and medical supplies. Medicare, Medicaid and/or your private insurance typically cover the cost of these necessary items for hospice patients.
• When a patient is truly ready for comfort care, choosing hospice care can also mean avoiding unwanted hospitalizations, medical treatments, and procedures. The goal of the entire hospice team is to support the wishes of the patient and his or her family members and personal caregivers while helping them achieve their goals for care.

Disadvantages

A potentially significant disadvantage of choosing hospice care might arise because of the restrictions placed on the various aspects of treatment. Under the Medicare hospice benefit, a hospice receives a flat per-day amount of money from which all medical expenses must be paid. This can result in several difficulties, such as:

• Denial of some diagnostic tests, such as blood work and X-rays. Even if requested by the patient's attending physician, the cost of these tests still becomes the financial responsibility of the hospice agency. Because these tests are expensive and might not always prove beneficial, hospice agencies often will not approve them.
• Hospitalization is discouraged once a patient enters hospice care. While the Medicare hospice benefit does contain provisions for short-term hospital stays (called inpatient care) for symptom management, the criteria for admission and coverage for specific treatments are poorly defined.
• Participation in experimental treatments or clinical trials is not allowed because they are considered life-prolonging. In addition, other treatments or procedures considered life-prolonging nasogastric or "feeding" tube, might not be covered.

Making Your Decision About Hospice Care

The pros and cons of entering hospice can vary for you or a loved one depending on your unique needs and/or situation. Unfortunately, some patients aren't even referred to hospice until they are very close to death and therefore miss out on much of what hospice could have offered them. Because many misconceptions about hospice exist, as well as a general lack of awareness of its benefits and services, many patients fail to enter hospice at all, which leads to the underutilization of this specialized form of medical care.