NHPCO Statement: Debunking Hospice Myths Propagated by Recent News Story
For Immediate Release
June 21, 2023
(Alexandria, VA) – The National Hospice and Palliative Care Organization (NHPCO) published the following statement in response to a recent NBC News story on HCA Healthcare hospitals, suggesting that HCA hospitals may be inappropriately pushing patients toward hospice care. NHPCO is not in a position to comment on HCA specifically. On behalf of our member hospices NHPCO has raised concerns about hospitals pressuring hospices to admit patients in the last hours of life. In a recent comment letter, NHPCO included examples of hospital pressures on hospices and recommended that the Centers for Medicare & Medicaid Services (CMS) or its contractors “should publish specific and accessible guidance about the hospital mortality metric specifically for hospitals and hospices.”
The choice for end-of-life care is deeply personal and should be made by patients, in consultation with loved ones and medical personnel, with a thorough understanding of the prognosis, the various care options available, and the implications of each of those options.
Unfortunately, the NBC report works against the goal of public understanding of healthcare options by perpetuating myths about hospice. NHPCO seeks to clear up three of those myths here:
Myth: To discuss end-of-life needs or care is to “play God.”
Reality: Research consistently shows the vast majority of Americans would prefer to die at home. Yet, a large number don’t get that opportunity, because many medical professionals and systems are not adept at putting patient goals at the center of the care plan. Additionally, one of the main comments hospices receive from patients’ families is, “We only wish we had chosen hospice earlier.” Though the NBC News article never says directly that medical professionals should avoid talking with patients about end-of-life care options, it certainly risks putting a damper on those already very limited conversations, when in fact patients would benefit from the opposite. As a country, we should help medical professionals and facilities improve their capabilities for frank, open conversations with patients and their loved ones about prognosis and care options. By having those conversations effectively, and making referrals to community-based palliative care or hospice earlier, our health system could help more people spend their final days, weeks, or months at home, surrounded by loved ones, and achieving their goals. That is not playing God, it is giving patients what they deserve: complete information and the ability to make choices for themselves.
Myth: After entering end-of-life care, “patients don’t typically live long.”
Reality: The median length of stay in hospice care is 17 days and the average lifetime length of stay is 92.1 days, according to the Medicare Payment Advisory Commission. By sharing information about his personal end-of-life journey, former President Carter has helped Americans understand this reality. President Carter entered hospice care in February 2023 and as of today has been on hospice for more than 4 months. To qualify for hospice under Medicare, a patient must have a prognosis of six months or less to live if the disease runs its normal course. Some patients can and do outlive their prognosis, and in those cases the patient can be recertified for continued hospice care. Study after study after study have shown that hospice patients tend to live longer than patients with similar diagnoses who do not choose hospice care. Research also shows that hospice care—at any length of stay—benefits patients, family members, and caregivers, including increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress.
Myth: “Patients in hospice typically receive only pain medication.”
Reality: While pain management and symptom control are core to hospice care, patients are offered so much more. By definition, statute, and regulation, hospices provide interdisciplinary care driven by patient goals. Hospice patients receive care from a team that includes doctors, nurses, hospice aides, social workers, spiritual care providers, bereavement care professionals, and trained volunteers. Many hospices also supplement those requirements with support from additional experts, such as speech, physical, occupational, music, or art therapists, and/or end-of-life doulas.
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org