Palliative care and hospice: Advancing the science of comfort, affirming the art of caring

Abstract

These scenarios of late hospice referrals were my steady diet in the early years of this work and sadly, they even occur today. The median length of stay for patients utilizing the Medicare Hospice Benefit is still hovering around 21 days (2010 Edition of NHPCO facts and figures: Hospice care in America. http://www.nhpco.org/files/public/Statistics-Research/Hospice-Facts-Figures-Oct-2010.pdf). Physicians not understanding the full purpose of hospice, coupled with the tendency to wait until the prognosis is clearly end-stage, delay assessments for hospice such that they are brink of death referrals (Cancer 94:2733-2737, 2002; Rescuing the end-of-life from the medical system, St. Martin's Press, New York, 2006). In the 22 years that I have done this work, families have repeated the mantra of why didn't we have this sooner; where were you 6 months ago? even as the physicians say, They aren't ready for hospice yet!