Hospice Care in The United States - Hospice Demographic

Hospice Demographic

In order to qualify for hospice care, a patient must have certification from two physicians that he or she has less than six months to live if his or her disease runs its natural course; usually the patient's primary physician and the Hospice Medical Director will provide this certification. Patients can and do stay on hospice longer than six months, and as long as the hospice team continues to certify with supporting evidence that the patient is terminal, insurance companies will usually continue to pay for hospice care.

Many physicians are slow to refer to hospice care, waiting until they are absolutely certain of a terminal prognosis. Some physicians believe that the patient must have a six-month prognosis or less to receive hospice care, while others are overly optimistic in their assessment of prognosis, presuming treatment will be more effective than it is. As a result, the majority of patients are referred to hospice in the very end-stages of their diseases. The average length of stay in hospice before a patient dies was 26 days in 1994, but only 19 days in 1998. Although these numbers have since increased, the term of care continues to be underutilized, with an average length of stay in 2004 of 57 days and a median length of 22 days. 33% of hospice patients admitted in 2004 died within seven days of admission. Such late admission is inconsistent with the process of hospice, which requires time for patients and family members to develop relationships with the hospice team.

A misperception regarding hospice is that only individuals suffering from cancer or AIDS can receive hospice care. Hospice in the United States did evolve around the model of cancer care, with its predictable pattern of deterioration, and according to 2002's The Case Against Assisted Suicide: For the Right to End-of-life Care, "60% of hospice patients have cancer and many of the rest have AIDS". However, patients can be on hospice for cancer, end-stage heart and lung diseases, stroke, renal failure, Alzheimers or many other conditions. Any diagnosis that would be an acceptable cause of death on a death certificate is, if expected to be terminal, an acceptable diagnosis for hospice care.