What Could Prevent Or Delay Receiving Hospice Care?
Following are some of the reasons that prevent or delay patients from receiving hospice care:
- Your doctor may not be knowledgeable about hospice care.
- A report in the New York Times indicated that a surprising number of doctors and hospital nurses, although somewhat familiar with hospice care, did not fully understand its potential benefits or the requirements for hospice care. As a result, many of these doctors did not mention hospice care as an option to their patients.
Reluctance to talk
- Patients and / or their doctors may be reluctant to talk about death and end-of-life issues.
Misconceived giving up
- Some people may view the decision to discontinue curative treatment as a sign of giving up. In reality, hospice care is designed to provide high quality end-of-life care.
- There is always reason to have hope - even if it is only hope for a pain free day.
Predicting life expectancy
A doctor may have difficulty in accurately predicting a life expectancy.
- An accurate prediction is difficult. Every individual is different and so is every situation.
- A prediction can be particularly difficult for people diagnosed with a chronic progressive illness such as emphysema, MS, ALS, and heart disease.
- A doctor may be reluctant to provide an estimated life expectancy in writing as is required in the admission process for hospice care, even though doctors are not penalized if their prediction of life expectancy proves incorrect.
- Some hospice agencies may be able to assist with this evaluation.
Disclosing life expectancy
- Many doctors are hesitant to provide patients with information about life expectancy.
- Doctors are sometimes overly optimistic in their predictions. This results in the continuation of aggressive treatment long after it is effective. A study conducted by doctors at the University of Chicago Medical Center and reported in the Annals of Internal Medicine, involved interviews with 258 area doctors who referred cancer patients to hospice programs. The study revealed the following: in 23% of cases doctors would not give patients an estimate of life expectancy, even when asked; 40% said they would knowingly give an inaccurate estimate, usually providing a more positive estimate; and only 37% said they would provide their best estimate for those patients who asked.
A supposed burden
- Some people may actually feel greater comfort in the more structured hospital setting, where health professionals continually monitor their symptoms around the clock. These same individuals may feel that their home care would prove too great a burden on their family and loved ones.
- Geographical boundaries can be a problem for people residing in rural areas. Home hospice agencies generally have travel limits, and are unable to provide care for people living outside of those boundaries.
- Alternatives might include staying with friends or relatives who live within the treatment area, or obtaining care at the nearest in-patient hospice facility.
Home care may be a problem
Home care may be a problem in the following situations:
- Some patients may have complex medical needs, which do not make home hospice care a viable alternative.
- Not all patients have the family/friend support team necessary to provide day-to-day home hospice care. Many potential hospice patients and their spouses / friends are elderly, and may find providing the necessary duties required of home care too physically demanding. Often family and friends may reside in different parts of the country.
In either of these situations, inpatient hospice care may be an option.