Hospice and Some New Statistics From the Census

Hospice and Some New Statistics From the Census

The Hospice Experience

If a Hospice nurse has been in your home, you have had the devastating experience of having someone you love declared “terminal”.  These wonderful people are there to assist the family with the care of someone who will be passing from this life at home, with their loved ones around them.

A new report says that more people are dying at home than in hospitals.  That’s the good news.  33.5 percent of Medicare beneficiaries died at home in 2009, 10 percent more than in 2000. Only about 24.6 percent died in the hospital in 2009, down one-quarter from 2000, while the percentage of people dying in nursing homes was little changed. At the same time, about 42 percent died in hospice care in 2009, nearly twice the percentage in 2000.

There is another part to this story.  During the same time period, the number of transfers between care facilities in the last 90 days of life increased from 2 to 3. Ten percent faced a care transition in their last three days in 2000, but 14 percent were moved in 2009. While 24 percent of those who died used the ICU in 2000, 29 percent received intensive care in 2009. More than 11 percent had three or more hospitalizations in the last 90 days of their life.

Although the statistics show these patients spent less time in the hospital, they spent more time in the ICU.  Sadly, dementia patients spent more time in the ICU as well.

Hospice use increased, but 28% were in their care for 3 days or less.

To explain some of this, let me get personal.

My first mother-in-law died in the hospital.  As she laid in be dying, and unconscious from painkillers, the family was only allowed to see her two people at a time.  I never understood the reasoning behind the rule, but that’s the way it was.  This was in March of 1973.  If Hospice existed then, we didn’t know about it.

My own mother was declared terminally ill in July 2001.  At the end of July, my son who lived here in Reno, and my daughter who resides in Florida, decided to visit her together one last time.  The doctor said she could die in a couple of weeks, or live as long as several months.  We left her, knowing we’d never see her again.  The only person to care for her was my uncle, her younger brother, but he was already in his early 70’s.  I made arrangements for Hospice to assist my uncle.  They took care of her until she passed in early October.  She died as she wished, in her own apartment in Idaho.

My last two encounters were in 2010.  My wife’s mother, and her stepfather were both diagnosed with lung cancer.  There was hope for my mother-in-law that chemotherapy and radiation might save her.  But my father-in-law was in stage four.  He went through chemotherapy, hoping to prolong his life.  He simply became too ill to enjoy it.  When his time was near, Hospice came to care for him.  His body fought for life, and he lived for a couple of weeks.

My mother-in-law won her battle, so we thought.  When she fainted one evening, and hit her head, she was back in the hospital.  Tests were run, and it was decided that her cancer had metastasized to her Pancreas.  Hospice met with us at the hospital.  She was discharged, and passed away in 3 days.

All four had been heavy smokers.

The statistics only show changes in the number of transfers of Medicare patients.  There were no statistics from Medicare Advantage as of yet.

There were also no studies of totally different reasons for being hospitalized.  For instance:  If a man was hospitalized because of an automobile accident, was discharged, and then suffered a heart attack, and died in the ICU, he would be part of the transfer cases.

The article in the Journal of American Medicine Association pointed out that most people don’t die that way, they die of chronic disease, such as heart or lung disease, and dementia.  What the statistics showed, is that we have a lot more to learn about ‘end of life’ care.

James Turnage

Columnist-The Guardian Express

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