Despite multiple studies citing its advantages, two-thirds of patients in the US with serious illnesses don’t opt for palliative care, according to a 2018 study published in the Journal of Pain and Symptom Management. 

Hospice care shares the same outlook, in that the majority of Americans who could benefit from it don’t take advantage of its services. 

Palliative care, hospice care, and their benefits

Palliative care is specialized medical care that focuses on enhancing a person’s quality of life while receiving treatment for a serious illness, such as heart failure, cancer, or dementia. 

Hospice care, on the other hand, aims at elevating a patient’s quality of life and ensuring they receive care and comfort toward their final days of life. Both types of care comprise teams of doctors, nurses, doulas, and other medical professionals. 

Multiple studies, some tracing a decade ago, show that both palliative and hospice care produce excellent outcomes in patient and family satisfaction, improved symptom management, and healthcare cost reduction.

So why aren’t many Americans who could benefit greatly from palliative or hospice care still not on it?

Why Americans are missing out

A paper published in the National Library of Medicine found that Medicare’s beneficiaries spent only about 12% to 15% of the days of their last year of life under hospice care.

The author noted that though there may be various reasons why an individual may not undergo hospice care services, he also explained that such reasons include:

• Difficulties in acknowledging mortality among patients, their families, and physicians
• And, increasingly challenging and highly variable prognostic determinations for most of the leading causes of death 

The two reasons are interrelated. Medicare is the payer for most hospice care in the US. To qualify for hospice support, Medicare requires certification of a prognosis of six months or less. 

During hospice admission, Medicare also requires two physicians to predict that a patient is more likely to die within the next six months, based on clinical status. 

In the event that the patient outlives their expected prognosis, hospices may also be penalized once a thorough retrospective review by the Centers for Medicare and Medicaid Services and its payer contractors has been processed. 

The financial and legal repercussions of reviews and audits make certifying physicians and agencies fearful and hesitant to take patients under care, contributing to delaying or limiting a patient’s access to hospice care. 

On Americans missing out on enjoying palliative care, some physicians root the problem in finances. Since palliative care teams require health and hospital systems to make upfront investments, some don’t dare to do so since the ROI for such can actually be negative.

Another reason is some physician’s reticence in recommending palliative care to patients, which may stem from misunderstanding, confusing the service with hospice care. 

Effective legislation and proper education about palliative and hospice care are needed to shift the current status wherein these specialized forms of care are enjoyed only by the minority and not the majority of individuals who need them most. 

While waiting for such to materialize, you can begin to communicate about availing palliative or hospice care services with your loved ones who may soon need them. Open the discussion to all concerned family members who need to be involved in the decision-making and responsibility-sharing processes to ensure that your loved ones’ final days will be as comfortable and easy as possible.