As hospices have become more successful at servicing those who are dying they have encountered more people who do not fit the requirements of this model. Many people are willing to discontinue seeking curative treatment even when the chances for effective treatment are minimal. The MHB eligibility is based on a belief that we can accurately predict six month mortality in most cases. Unfortunately we are not able toaccurately predict death within six months for most individual patients. Thus there are many people who will not qualify for the MHB In addition for anyone to make use of any kind of end-of-life program there must be an endstage to the disease condition. For a significant number of people who die there is no endstage; there is a sudden decline and death. (3)
When people who are suddenly disabled or near the end of life must enter a caring environment, whether in their home, a relative’s home, nursing home, or hospital they are often subjected to something called an assessment. It is usually defined as a process that determines which problems are most prominent; it may be formal or informal and may be completed by relatives or professionals. From this assessment, a plan of care is developed to address and alleviate those problems. (1) When the dying accept hospice care they give up curative treatment. Instead hospice helps them to live out their final days alert and pain free. Early hospices represented a revolt against traditional medicine, which is seen as failing the terminally ill by giving them futile, but aggressive treatment. If someone was dying, a hospice volunteer went to the person’s home to do whatever is need, from emptying catheters to providing companionship. When hospices started in the mid-1970, no one was billed for these services. Funding came from charitable contributions. The hospice of the Florida Suncoast was started in 1975 by volunteers, who worked from a one-bedroom house with donated wheelchairs and walkers stacked in a bathtub.
In 1983 Medicare began to reimburse for hospice care, allowing hospices to serve far more people. Medicare fundsfueled a fourfold increase in patients served, from around 100,000 in 1983 to nearly 400,000 today. The Medicaid reimbursement enabled hospices to offer more sophisticated care that included skilled nursing and physical therapy. And it seemed like a goodbet for taxpayers. For every dollar spent on hospice patients in the last year of life, Medicare saves 1.52. But the savings are less certain after six months of care.
Medicare involvement steered hospice away from its roots as a movement that relied primarily on volunteers. Today only 30 percent of hospices are independent community organizations, and most are division of hospitals, home care agencies, or regional hospice chains. The availability of Medicare funding led to the...