Getting More With Hospice: It’s about TIME. It’s about TEAM.

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A CONCERNING TREND

Hospice care is a specialized form of medical care aimed at providing comfort and support to patients in their final phases of life. Recognized as an integral part of health care, hospice care improves quality of life and preserves the dignity of patients in their last days. Despite this, late referrals to hospice care continue to negatively impact patient and their families.

Patients become eligible for hospice when they receive a terminal prognosis of 6 months or less to live, yet, *half of hospice patients benefit only 17 days or less from hospice care before death. Reports from across the healthcare industry indicate that many patients are referred to hospice care too late, sometimes only a few days before their death. Such late admissions do not allow sufficient time for the patient and their family to fully benefit from the comprehensive support that hospice care can provide, including physical, emotional, and spiritual care.

NATIONAL HOSPICE L.O.S.

*According to NHPCO (National Hospice and Palliative Care Organization) National 2023 Facts and Figures; for Medicare decedents enrolled in hospice in 2021

THE IMPACT OF LATE-REFERRED HOSPICE

The impact of late-referred hospice patients is significant and multifaceted. From the patient’s perspective, late referrals can result in inadequate symptom management and diminished quality of life. Late hospice referrals can leave patients and families feeling overwhelmed, underprepared, and riddled with regret about not opting for hospice care sooner.

From a healthcare provider’s perspective, late referrals can result in increased hospital readmissions, higher healthcare costs, and decreased patient satisfaction. Late hospice referrals may also increase the emotional burden on healthcare providers who may have to manage complex end-of-life issues in a very condensed time frame.

Early integration allows providers to conduct comprehensive assessments, allowing for the effective management of symptoms and the delivery of tailored care plans. This proactive approach not only addresses the physical aspects of a patient’s condition but also attends to the emotional, social, and spiritual dimensions of their well-being.

NEGATIVE IMPACT OF LATE REFERRALS

FOR PATIENTS:

  • Poor symptom management
  • Diminished quality of life

FOR FAMILIES

  • Feeling overwhelmed and under-prepared
  • Low satisfaction for service
  • Feeling regret for not knowing about benefit earlier

FOR PROVIDERS/CAREGIVERS:

  • Increased hospital readmissions
  • Higher healthcare costs
  • Low patient satisfaction
  • Increased emotional burden

WHAT’S CAUSING LATE REFERRALS?

Because hospice is a decision often made by committee (patient, provider, and family), unnecessary delays of an appropriate and timely hospice referral can be caused be each member of that committee. In general, lack of knowledge, confusion, disagreement, and difficulty accepting hospice combine to create a problematic barrier to timely care.

Many hold misconceptions that receiving hospice is akin to giving up. This resistance is fueled by a deep-seated difficulty in confronting end-of-life decisions and an underlying fear that opting for hospice signifies an expedited end rather than a focus on quality of life. Misunderstandings about costs of hospice care and insurance coverage often reinforce this resistance, with many believing inaccurately that hospice services are beyond their financial circumstances. Additionally, family members often believe they will lose control of their loved one’s care, mistakenly believing the patient’s current doctors and providers will no longer be part of the day-to-day decision making and care.

TOP BARRIERS FOR TIMELY REFERRALS

  • Lack of knowledge and benefits for patients, providers, and families
  • Difficulty with acceptance
  • Inaccurate perception of high costs and/or insurance coverage
  • Overestimating survivability, and disagreement among providers
  • Inaccurate perception of transition of care and/or losing control of care management
  • Confusion about hospice vs. palliative care

Clinically, especially with cancer diagnoses—the condition with the highest propensity for late hospice admissions—there is often discordance in the perceived prognosis between specialists, general practitioners, and the patient’s understanding, leading to an overestimation of survivability. Consequently, patients and their loved ones hold on to unrealistic expectations and postpone hospice care, missing out on the comprehensive support for symptom management, emotional, and spiritual needs that hospice teams adeptly provide.

HOW DO WE HELP PATIENTS GET THE MOST OUT OF END-OF-LIFE CARE—AND LIFE?

HOSPICE AND PALLIATIVE FAST FACTS

TOP HOSPICE REFERRED CONDITIONS

  • Neurological Disease (Alzheimer’s, Dementia, etc.)
  • COPD/Heart Failure
  • Cardiovascular Disease and Stroke
  • Cancer
  • Liver, Kidney, and Lung Disease
  • ALS
  • AIDS

HOSPICE BASICS

  • Eligible with terminal diagnosis of 6 months or less
  • Curative treatment ceases

PALLIATIVE CARE BASICS

  • Eligible with chronic disease diagnosis
  • Curative treatment continues

Healthcare practitioners play the most critical part in helping terminal patients transition to hospice at the right time. Patients and their caregivers must understand their options and prepare for the future, and providers must prioritize clear and compassionate communication about the goals and advantages of hospice care.

Regular, multidisciplinary case discussions among healthcare providers can align perceptions of a patient’s prognosis and encourage timely referrals. Integrating hospice discussions as a routine component of patient care plans can normalize and destigmatize the transition, and enable families to appreciate the focus on quality of life rather than an imminent end. Early involvement of hospice teams in the care trajectory can also demonstrate the tangible benefits of hospice care, making the decision to transition easier when the time comes.

Most importantly, providers should know the key points, differentiation, and timelines for hospice and palliative care.

Patients become eligible for and can be referred to hospice the moment they receive a prognosis of six months of less to live. Palliative care—a service for patients still utilizing curative treatment—is eligible for patients the moment they are diagnosed with a chronic disease. Providers can help patients and caregivers make the best decisions by recognizing the signs of symptom progression and the appropriate time to refer to palliative or hospice care, and by educating and preparing patients and caregivers about the service.

The chart below illustrates a general guideline for referring to hospice and/or palliative care.

Disease and symptom progression graph

The decision to refer to hospice is, and should always be, a joint decision with providers, caregivers, families, and the individual facing the terminal prognosis most of all. Timely agreement can only occur when everyone involved is aware of these factors and the benefits of the services.

KNOW YOUR HOSPICE BENEFITS

In order to enter hospice treatment, a patient must first be diagnosed by a physician to have a likelihood of living for six months or less. Patients are then treated for comfort and not for a cure. Because of this, the most common misconception about hospice for patients and their families is that entering hospice means giving up on life. But hospice doesn’t mean giving up—hospice means getting more.

Patients in hospice—and their families—receive personalized care and support wherever they call home. It’s a specialized type of care designed to support the most difficult times in patients’ and families’ lives, and help guide them through complicated decisions with expertise, experience, and deep compassion. In short, hospice means calling in reinforcements for the journey ahead, and making the most of your time together.

The main advantages of hospice for patients, providers, and caregivers include:

  • Preserving Dignity and Independence
  • Medication Reconciliation and Comfort-focus
  • Pain Management Expertise
  • Comprehensive Medical Equipment and Supply Management
  • Professional Skilled Nursing Care
  • Dietary Counseling
  • Physical, Occupational or Speech Therapy if needed
  • Emotional and Spiritual Support
  • Short-term Inpatient and Respite Care Options
  • Education and Assistance with End-of-Life Planning
  • Financial Relief from Rehospitalizations
  • Bereavement Support

TOP HOSPICE MYTHS

  • Hospice means giving up.
  • You need a doctor’s referral to receive hospice care
  • Hospice means the patient no longer has a say in their care
  • Once you are in hospice you stay in hospice
  • Hospice is expensive
  • Hospice only provides support for the patient
  • Hospice and Palliative Care are the same
  • Hospice patients must sign a “Do Not Resuscitate” order
  • Hospice can only be provided for six months
  • Hospice is only for cancer patients
  • Hospice care ends with the patient
  • Hospice is a place

The interdisciplinary hospice team of medical director, registered nurse, hospice aides, medical social worker, spiritual care coordinator, specially trained volunteers, registered dietitian, bereavement coordinator and more coordinates efforts on behalf of the patient and family in collaboration with the patient’s providers to develop a plan of care tailored to each patient’s needs and situation. Hospice is a comprehensive approach tailored to support and collaborate with patients, providers, and families during the complex end-of-life process. Understanding the extensive benefits of hospice care and the committed team of hospice professionals is essential for doctors advising patients and families making difficult healthcare decisions.

CHOOSING MCLAREN AS YOUR PARTNER

For more than 30 years, McLaren Hospice has supported the physical, emotional, and spiritual needs of thousands through their most difficult moments. For McLaren, hospice means making the most of your time with your loved ones. Whether during a short-term hospital stay or wherever patients call home—including in an assisted living facility (ALF), skilled nursing facility (SNF), adult foster care home (AFC), McLaren Hospice provides comfort, support and dignity to those with a life-limiting illness.

McLaren Hospice, Palliative Care, and Home Care is a nonprofit, Medicare-certified, Blue Cross-approved, and CHAP accredited (Community Health Accreditation Program) provider, top performer in quality scores, and proud supporter of our Veteran community with a Three Star designation from the “We Honor Veterans” program in recognition of our dedication.

If you are considering hospice for a patient, McLaren can help your patient get on service fast to maximize the full benefits of hospice care. Get more with McLaren by clicking the button to refer or call (800) 862-3132 today.