“Hospice is extremely beneficial, not only for the patients themselves – to manage pain and symptoms of their illness – but also for families and caregivers because of the added emotional support of the hospice team,” Mastrojohn said.
Shifting to home-based palliative care
Steve Pantilat, MD, director of the UCSF Palliative Care Program, said that advances in treatment for terminal diagnosis may be partly to blame, but also part of the solution.
When Congress first created a Medicare hospice benefit in 1982, the focus was on cancer patients. Today, NHPCO figures show cancer accounts for just 27 percent of Medicare hospice enrollment.
“The challenges of late enrollment often have to do with the breadth of treatments available to people, particularly with new chemotherapeutic agents, for example, that are less toxic or taken orally,” Pantilat said. “It means that people are often involved in disease-oriented treatment until very late in their disease process.”
Hospital-based palliative care programs have increased in response to late enrollment. According to the Center to Advance Palliative Care, from 2000 to 2016, hospital-based palliative care programs increased by 178 percent.
Pantilat believes that improving home hospice begins with hospices developing palliative care programs. “It's basically the same philosophy of care – improving the quality of life for people with serious illness – but not under the Medicare-hospice benefit,” he said.