Category Archives: Hospice value

Being Mortal


Dr. Atul Gawande has written several books and articles about modern medicine. His new book Being Mortal encourages the medical community—and the rest of us—to examine the way we face the end of our lives.

He writes of his own medical training: “I learned about a lot of things in medical school, but mortality wasn’t one of them. Our textbooks had almost nothing on aging or frailty or dying. How the process unfolds, how people experience the end of their lives, and how it affects those around them seemed beside the point.

The way we saw it, and the way our professors saw it, the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”

He writes about a revelation he had early in his medical career: “Within a few years… I encountered patients forced to confront the realities of decline and mortality, and it did not take long to realize how unready I was to help them.”

A story about a cancer patient who chose a difficult surgery over comfort care ends with Dr. Gawande writing: “What strikes me most is not how bad his decision was but how much we all avoided talking honestly about the choice before him… The chances that he could return to anything like the life he had even a few weeks earlier were zero. But admitting this and helping him cope with it seemed beyond us. We offered no acknowledgment or comfort or guidance.

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.”

He writes about his daughter’s piano teacher Peg and her terminal illness: “I suggested that Peg try hospice. It’d at least let her get home, I said, and might help her more than she knew.

The hospice team put a hospital bed on the first floor so she wouldn’t have to navigate the stairs, organized a plan for bathing and dressing, adjusted her pain medications until they were right. Her anxieties plummeted as the challenges came under control.”

Dr. Gawande offered this comment regarding end-of-life: “People want to share memories, pass on wisdoms and keepsakes, connect with loved ones, and to make some last contributions to the world. These moments are among life’s most important, for both the dying and those left behind. And the way we in medicine deny people these moments, out of obtuseness and neglect, should be cause for our unending shame.”

One online reviewer said: “This book should be required reading for all physicians.”

Another wrote: “I’ve asked my wife to read the book so that we can discuss the final chapter in our own lives and make better plans on how to preserve the things we value for as long as we can. Making these decisions will force us to answer such questions as when is it time to say “enough is enough” to medical care.”

Being Mortal by Dr. Atul Gawande brings important end of life issues and questions to the table. The fact that they are written by a leading Boston surgeon who also teaches at the Harvard School of Medicine means that these thoughts will reach the eyes and ears of many members of the U.S. and world medical community.

(For questions about hospice care in metro St. Louis, call us at Hope Hospice at 314-984-9800.)

Gail Sheehy on Being a Caregiver

If you find yourself suddenly the caregiver for a parent, a spouse, a partner, a sibling, you may be overwhelmed. Not only are there many new responsibilities, there is much mystery that lies ahead. Where do you go for help? Who can tell you what to do in this new role?

One source of useful guidance is the 2010 book Passages in Caregiving: Turning Chaos into Confidence by Gail Sheehy. She is the author of the 1976 book Passages, which helps define several phases of adult life. She now describes herself as “author, journalist, lecturer, advocate for caregivers.”

In Passages in Caregiving, she writes about the episodes in her husband Clay Felker’s slow demise. He died in 2008, seventeen years after his first cancer diagnosis. She writes about things she learned from personal experience, as well as insight she gathered from talking to other caregivers.

In the book, she identifies eight distinct “turnings,” starting with “shock and mobilization” and ending with “the long goodbye.”

Among her tips to caregivers is encouragement to take charge of the situation. She writes to caregivers: “How you handle this crisis will shape how you feel about yourself and almost certainly will change you in ways that follow you to the end of your days.”

She also tells caregivers, “We cannot do it alone. No one can.” She writes: “We need to grow a network of family, friends and veteran caregivers to help us understand what we’re going through and pitch in wherever they can.”

Of hospice care, Sheehy writes: “Caregivers often receive the most cherished benefit of hospice care. They and other family members almost universally express gratitude for being guided and supported through the mysteries of the dying process.”

As we at Hope Hospice tell patients and caregivers, every situation is different. But there are common elements that exist in most end-of-life experiences. Similarly, your caregiving experience will be different from that of Gail Sheehy. But by having walked that path, she is able to share her story (as well as those of other caregivers) in a way that can provide you a better idea of how to proceed.

If you are a caregiver and have questions about hospice care, call us at Hope Hospice at 314-984-9800.

(Passages in Caregiving is available from Amazon in a print edition and e-book. The Kindle version comes with several videos on the topic. It is also available in local libraries.)

Hospice Care Saves Money for Medicare

The results of a recent study published by Health Affairs, a journal of health policy and research, show that hospice provides significant cost reductions for patient care. This is great news for taxpayers because of the large portion of health care in the US that is funded by Medicare.

Of course, we have known all along about the savings that hospice care delivers. This finding just makes it official.

Earlier findings had indicated that, on average, significant savings to Medicare occurred only when a patient was receiving hospice care for at least 53 days before dying. The new figures reveal that shorter terms can also reduce average costs.

Patients enrolled for one to seven days before dying saved Medicare an average of $2,650. Patients on hospice for eight to 14 days resulted in savings of $5,040. And those who were hospice patients for 15 to 30 days before death led to an average savings of $6,430 compared to hospital and other medical costs.

Multiply those figures by the number of deaths that occur annually in the US. The result is savings well into the billions. With our state and nation facing multiple fiscal challenges, it is reassuring to note that ours is a portion of the health care arena where we can make a difference.

At Hope Hospice, our top objectives are patient comfort and symptom control. The care we provide comes from a team of participants. In addition to our medical team (doctors, nurses, home health aides), patients and caregivers receive support from our social worker, our chaplains and our massage therapist. This means that while our work is less costly than hospital visits, the services we deliver to patients are extensive and thorough.

How can you help? Spread the word. As Americans learn more about hospice, they embrace it in greater numbers. As patient numbers grow for hospices around the country, the savings to our nation’s Medicare budget also increase.

For information about Hope Hospice or hospice care in general, visit our website or call our office at 314-984-9800.




Is The Hospice Message Getting Through?

Are people gradually becoming more aware of hospice? Does it seem that when hospice is mentioned in a conversation, someone usually says, “Yes, my mother (or other loved one) was on hospice. Those people did such a great job!” Or, “The hospice nurses made sure that my uncle was not in pain during his final days.”

Does it seem lately that when someone talks about hospice, they are better informed? Has the general public learned that the great majority of hospice care is performed in private residences and in nursing homes, not at in-patient hospice facilities? Do they know that hospice care is covered by Medicare, Medicaid and most private insurers? Do they know that hospice is not just doctors and nurses, but other teams members as well? Increasingly, the answers are yes.

How has this jump in hospice awareness and knowledge happened?

  1. More people are using hospice. Growth in hospice care organizations and in numbers of hospice patients has increased dramatically in St. Louis and across America in the last five years. As hospice delivers care to more patients, the family members and friends of those patients tell others about the work and the compassion of hospice personnel.
  2. Media members are more willing to do stories about hospice care and hospice patients. Some outlets are still looking primarily for lighter content beyond their hard news coverage. But as more media people learn what hospice is and what it does, they are more eager to tell the story. Even though hospice deals with people who are expected to die, hospice work is not all gloom and doom—a fact that media members are figuring out.
  3. The internet has, over the past decade and a half, delivered enormous amounts of information about hospice care. By utilizing hospice agency websites and blogs (such as this one), a person can obtain useful facts and opinions about hospice care and its value.
  4. The medical community, which is obliged to constantly gain knowledge about its specialty fields and general medical issues, has learned more about hospice. Sometimes this is because patients and patient families have asked doctors specific questions about hospice.

Hope Hospice knows that there is much work yet to be done in informing Americans about hospice and its value. We can’t stop now. But we can take just a moment and rejoice in the fact that efforts to inform people about hospice are moving ahead.


The Cost of Dying

A front-page article in Sunday’s (6/24/12) St. Louis Post-Dispatch told the shocking story of a local woman who spent six months in and out of hospitals and care facilities, obtaining treatments for the various maladies that led to her eventual death. The story pointed out the total bill for her medical care was $1.16 million dollars!

Shouldn’t there have been some mention of hospice as a less costly alternative to in-patient hospital care?

The article was timed to run just before the expected Supreme Court decision on “Obamacare.” The article contained a good deal of timely, important information. And the writer, Jim Doyle, may have wanted to focus primarily on the specific issue of spiraling costs of hospital stays and services.

As “Sixty Minutes” pointed out in a segment titled “The Cost of Dying” that aired in 2009, huge amounts are spent on treatments that are often unsuccessful.

We are blessed in St. Louis with some of the best medical personnel and facilities in the US and we applaud their great work. But, as the Post-Dispatch story and the “60 Minutes” piece point out, the costs of care for elderly patients are skyrocketing. Should there be more discussion of hospice care in doctors’ offices AND in media coverage of the healthcare? We think so.

Many patients and families have found hospice care preferable to going in and out of the hospital, with cost not even considered as a factor in those feelings. But the truth is hospice care is less costly than hospital stays.

Had the woman in the Post-Dispatch story been in hospice care, her final months may have been more comfortable for her than described in the article. The story mentions that she spent only 22 nights at home during her six months of treatment. Had she been a hospice patient, she could have, presumably, spent every night in her own home.

The real value of hospice care to the patient is the pain management that hospice provides. The real value of hospice care to those of us who fund Medicare is the efficiency and less costly expense of hospice care.











Hospice Costs: The Rest of the Story

Legendary broadcaster Paul Harvey delivered a popular feature called “The Rest of the Story.” He would hook listeners with a catchy opening, provide some vague details and then reveal an often surprising ending. His concluding line was always: “And now you know… the rest of the story!”

How about this for an attention getting headline? “Government Spending More Than $12 Billion On Hospice Care.”

In 2011, ABC News reported that the amount Medicare pays hospice care organizations had increased 53% from 2005 to 2009. The main reason, says the report, is the number of patients using hospice also increased significantly.

The amount that Medicare paid hospices in 2009 was over $12 billion dollars, according to the ABC News report. That’s billion with a “B.” That’s a lot of money. That’s a figure that gets attention.

ABC News, to its credit, goes on in the report to explain what hospice care is, then quotes Robert Field, a health management professor from Drexel University in Philadelphia. He says that hospice care “is used more and more because it’s worked out for many people.”

The story also quotes the Don Schumacher, head of the National Hospice and Palliative Care Organization, who makes the excellent point that “hospice still saves the government money.”

The ABC report concluded with two telling quotes:

“For every patient admitted to hospice, it saves approximately $2,250 compared to patients with similar illnesses not admitted to hospice care,” said Schumacher.

“The fact that the government is spending more on hospice care might be a good thing,” said Field. “That could be money we’re not spending on long-term care or hospital care.”

Yes, Medicare spending on hospice care has increased because more people are using hospice. More people are using hospice because more people know about it and have been told about its benefits. Because more people are using hospice instead of spending time in hospitals, hospice is actually saving the government money!

And now you know…

….the rest of the story!




More On The Cost/Value Of Hospice

An amazing statistic appeared in a recent New York Times op-ed column. According to writer Susan Jacoby, “A third of the Medicare budget is now spent in the last year of life, and a third of that goes for care in the last month.” The column also states “the average hospital stay costs Medicare over $6,000 a day.”

Those are startling numbers. If you have recently filed taxes, you may have noted on your W-2 form the significant amount of your 2011 income that went directly to Medicare. (And that amount is not deductible.) Whatever the amount, you would probably have preferred to have that money in your own pocket.

Consider the amount of money that could be saved by Medicare (and we whose contributions fund it) if those who are dying in hospitals chose to die at home, under hospice care.

Another note regarding the massive hospital bills that are accumulated by those who prefer to die connected to tubes and monitors in a hospital: families are often obliged to pay some of the costs that are not covered by Medicare, including the tab for certain drugs. Whereas patients on hospice care are not obliged to make additional payments to the hospice agency.

How do you know if your loved one would prefer to spend his or her last weeks and months in the comfort of home? (As opposed to being in a hospital.) You ask. And you ask early in the dying process, when the patient still has a grip on reality.

These conversations can be difficult to get started. But once the topic is addressed, you may discover that your loved one has thoughts and desires that have never been voiced. And, like with many such dialogues we conduct in our lives, they often turn out to be much less uncomfortable than anticipated.

Hospice care is a money-saver for Medicare when compared to the cost of hospital in-patient care. Hospice care can also be a money-saver for families of patients whose hospitalization coverage is less than complete. But the main concern of families and health care providers should be patient comfort. That is always the top priority of Hope Hospice staff and administrators.

To learn more about hospice and all the elements of care provided, call Hope Hospice at 314-984-9800. Or click on

The Value of Hospice Care

Here is an excerpt from the Wikipedia article on Hospice:

“Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four hour/seven day a week access to care and support for loved ones following a death.

Hospice care is also covered by Medicaid and most private insurance plans.”

This information is one of the most important elements of the hospice story. When a patient is referred to Hope Hospice of St. Louis, our representatives share details about the care we provide. After we list the many aspects of our patient care, the question is asked, “How much will this cost?”

Upon learning that the costs of hospice care are covered by Medicare/Medicaid/private insurance, there is frequently an audible sigh of relief from the patient and/or family members.

When you consider that hospice care includes much more than visits by nurses and home health aides, the value of hospice care becomes obvious. Addressing a patient’s emotional, spiritual and social needs, as well as physical/medical needs, allows hospice to play a huge role in a patient’s end-of-life process. The support and assistance offered to the patient’s family—before and after the patient’s death—also contribute to the value of hospice care.

Patients and families should take advantage of any hospice service that is offered. At Hope Hospice of St. Louis, we are proactive in making patients and families aware of all we can do. A conversation with one of our chaplains can be comforting. Advice from our social worker can help in dealing with a variety of issues. Our massage therapist can provide relief from pain and general stress relief.

Based on comments we regularly receive from families following a patient’s death, we are gratified to learn the real value of our work. We are frequently told that being able to spend those final weeks and months at home—with hospice care—made things easier for the patient. We hear about patient and family appreciation for our high levels of compassion and concern.

One of the greatest values of hospice care is the knowledge that, following the patient’s death, family members will not receive an invoice for services rendered. That can provide genuine peace of mind for all concerned.