HOSPICE CARE: Making an Informed Choice.

"Through understanding, recognition, and acceptance of hospice care, those diagnosed with a terminal illness have a favorable alternative when curative treatment no longer is an option."

Over the past 100 years, the 65-plus age group has increased twelvefold, with the 85-plus age group the fastest-growing population segment. The U.S. Census Bureau estimates that, by 2050, the 65-plus segment will double, reaching 67,000,000, or 21.8% of the U.S. population. With this graying of America, hospice care has become a $2,200,000,000 industry, playing a role in some of the most significant and cost-saving marketplace changes, including a rise in the number of mergers and acquisitions. This tremendous surge is a result of society recognizing the validity of palliative care as the chief option when curative treatment no longer is appropriate.

What is palliative care? For centuries, a hospice was a place of shelter for weakened and ill travelers to reside. Over the years, it evolved into a refuge where people could find care, comfort, and support during difficult times in their journey through life. Today, a simple summation of palliative care--also referred to as "end of life" or hospice care--is that it is designed to provide aggressive treatment of physical and emotional pain and symptoms for persons in the last phases of an incurable disease.

To raise awareness and understanding, as well as to clarify numerous misconceptions of hospice care, certain factors should be reviewed in order to make informed decisions. These include:

* What criteria are necessary to be eligible for hospice services?

* What services are available to the patient and family, and how does a patient acquire them?

* How do hospice services differ from those in a nursing home, home health, or assisted living setting?

* How does a patient pay for hospice services and what benefits are covered under Medicare, Medicaid, or private insurance?

In order to be eligible for hospice services, the following criteria must be established: The patient and his or her physician must decide that curative treatment no longer can be of benefit. Moreover, the patient must have a short-term life expectancy.

Once the decision has been made that curative treatment is not an option, hospice care is discussed and agreed upon by the patient, the physician, and a hospice team doctor. The hospice team then will lead the patient and family step-by-step through an evaluation process, providing assistance for any concerns and explaining the services provided, including medical staff (nurses, doctors, etc.); medication, equipment, and supplies; personal care (bathing, feeding, and dressing); housekeeping and assistance with daily living; emotional, financial, and spiritual counseling; physical, speech, and occupational therapies; and volunteer services and support. Through these services for the patient and family, the palliative care provider can improve the patient's quality of life and focus on the enhancement of comfort.

Hospice takes the place of acute level care over a wide range of diagnoses, including AIDS; Alzheimer's disease; cancer; cardiovascular, cerebrovascular, and chronic obstructive pulmonary disease; congestive heart failure; and gastrointestinal, liver, and renal disease. Services are provided in the patient's residence, a nursing home, or a hospital by a team of trained professionals who render medical care and support services not only to the patient, but to the family and loved ones as well.

In nursing homes, services are designed to meet the needs of the acutely or chronically ill. A nursing home is a residence that provides room and board, meals, recreational activities, and help with daily living and offers protective supervision for residents. Generally, residents have physical or mental impairments that keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing, administered by a trained professional.

With home health, services are provided to those persons who prefer to stay at home, but still need ongoing care that can not be provided easily or effectively solely by family or friends. Home health aides, visiting nurses, and licensed therapists offer home-based assistance with activities of daily living and, in some cases, more sophisticated procedures such as rehabilitative care and infusion, physical, and speech therapy under the supervision of either a registered nurse or physician.

Assisted living includes a combination of housing, personalized support, and health care in a non-institutional setting. Residents live independently, an emerging trend for older adults, as opposed to group, rest, or nursing homes'. Residents receive meals, laundry service, medication, reminders, 24-hour security, housekeeping, planned activities, case management, and transportation.

Benefits

When choosing a hospice, it is important to understand what is compensated financially. The overwhelming majority of hospice cases are covered by the Medicare hospice benefit, which reimburses all expenses related to the terminal illness. To quality under Medicare, a patient 65 or older must be certified terminally ill with a prognosis for a life expectancy of six months or less. In 47 states, hospice care is a covered Medicaid benefit.

As for private insurance companies, most plans, including HMOs and managed care organizations, carry hospice care as a benefit. If coverage is not available or is insufficient, a hospice never will refuse care. Instead, most hospices will work with the patient and help to cover costs using funds allocated from grants or donations.

Over all, when searching for a palliative care provider, those organizations should be considered whose main goal is to dispense compassion, care, and comfort by a team of professionals, enabling patients to live each day to the fullest.

People do not want to die alone away from their family, friends, and familiar surroundings, nor do they want to die in pain. Through understanding, recognition, and acceptance of hospice care, those diagnosed with a terminal illness have a favorable alternative when curative treatment no longer is an option.

Mr. Burnham is president and CEO, Odyssey HealthCare, Inc., a palliative care organization with facilities in 12 states.