Perspective               

Hospice Care is Underutilized

Hospice care is one of Medicare's hidden treasures. It is an ideal way to give terminally ill patients and their families the at-home care they need in their last days. Despite its excellent benefits, a recent report shows that terminally ill patients are spending fewer of their final days in hospices.

According to officials at the Health Care Financing Administration, the Medicare hospice benefit is meeting its intended expectations and the needs of its patients. It offers doctor services, nursing care, physical and occupational therapy, home health aide services, and short term-care in the hospital. Hospice care also provides drugs for symptom control and pain relief as well as inpatient respite care. To be eligible for the hospice benefit, a doctor must certify that the patient is terminally ill and has less than six months to live.

The number of older Americans with Medicare taking advantage of hospice care has grown dramatically during the past decade. Nearly 360,000 people with Medicare enrolled in hospice care in 1998, more than twice the number that used it in 1992. However, a recent report demonstrated that people are getting less hospice care today and spending two weeks less in hospices in 1998 than in 1992. People are choosing to enroll in hospice care at a time closer to death; half of Medicare hospice users are enrolled for 19 or less days, and service periods of one week or less is becoming very common.

Why is hospice care declining? Officials say that many doctors are confused by the Medicare hospice rules. Many hospice managers also complain of fraud scrutiny if they let their patients stay long. Doctor preferences and individual patient choice may also contribute to the length of hospice care. To read the report, go to www.gao.gov. To learn more about hospice care, call 1-800-MEDICARE and ask for the brochure called "Medicare Hospice Benefits."

_________________________________