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While Hospice Care Is Growing, Not All Have Access

Hospice care should be available to anyone that needs it

A study has shown that only one third of Americans are actually receiving hospice care leaving the majority of those that need it without the care they need and deserve in their last few months. The study was conducted by colleagues from the University of Michigan using data from Medicare and 2000 Census data.

The study shows that while wealthier areas and people with higher education levels are getting access to hospice care, people from low income families and lesser education levels are actually less likely to have access to hospice care and so are areas where a large proportion of the population is aged over 65. Those with incomes over $100,000 have better access to hospice care as do those whose education reached at least HSD (High School Diploma) level.

A CNA (Certified Nursing Assistant) working in a hospice in Maryland says that one of the most important parts of her job is to make the last few months of a patient’s life the most comfortable that it can be while one of her favorite parts of the job is “helping families get prepared”. Hospice care should be available to anybody regardless of their economic or educational background.

Dr. Maria J. Silveira who was the lead researcher on the study and is an assistant professor of internal medicine at Michigan University explains that hospices must exist as a charity before Medicare will pay for their services. It is this requirement that has meant hospice access has become limited to people in poorer areas. Medicare needs to support hospices that are for-profit to allow more to be set up in poorer communities, without them having to exist as a charity and rely on voluntary donations.

Dr. Silveira thinks that although Medicare reimbursement is sufficient for hospice care within the home, it is probably too low for care received “in-hospice” and that it should be higher to allow hospices to make money.

The study showed that access to hospice care varied from region to region with the availability being higher in the Northeast, upper Midwest and the majority of California. Access lessened in regions along the Mississippi River, the Rocky Mountains and the Southwest. Areas with the lowest availability were in the South – Texas, Florida and the Plains states.

Surprisingly and totally against the grain is that the study found that access to hospice care was actually reduced the older you were.

Some experts have since commented on this study explaining that the findings may not be totally accurate as the data used was from the year 2000 and since then access to hospice care has improved. Notably in the grown in “for-profit” hospices. There are more hospices now that do not rely on charitable donations to keep running, pointed out the president and CEO of the National Hospice & Palliative Care Organization, Donald Schumacher. In fact, between 2000 and 2009 the number of hospices increased by around 50% with for-profit hospices making up the majority. However, it is acknowledged that improvements are still required in terms of hospice care availability in poorer and rural regions.

Medicare reimbursement is based on a daily rate which, as of 2011, is approximately $652 a day for in-hospice care and $147 a day for hospice care received within the home.