ROANOKE TIMES
Copyright (c) 1995, Roanoke Times
DATE: Sunday, December 3, 1995 TAG: 9512050007
SECTION: EDITORIAL PAGE: F-2 EDITION: METRO
SOURCE: SUE MOORE
I FOUND the Nov. 22 article in your newspaper (``Doctors make dying difficult'') very interesting, but, unfortunately, not at all surprising. For years, those of us in the hospice field have been battling misperceptions about the way life has to end. Although the vast majority of people state they wish to die at home, statistics show that 80 percent will die in the hospital.
Hospice is often seen as end-of-the-road time, or time to give up hope. I wish I could express how much the hospice is about life and living to the very end, with the best quality of life possible for patients and their families. Hospice patients have hope - lots of hope - that they will maintain control over their decisions, be physically comfortable, be able to live life to the fullest, always have someone to talk to, can say what needs to be said before it's too late, and will not be alone. The hospice helps patients reclaim the spirit of life. It helps them understand that even though death can mean sadness, it can also be preceded by opportunities for reminiscence, laughter, reunion and personal growth.
But let us set aside the quality-of-life part for a moment and talk about economics. Approximately 90 percent of hospice services are delivered in the home. The great majority of patients don't have to die in a hospital, nursing facility or an inpatient hospice. Because hospice care is primarily home-based and relies heavily on volunteer support, it saves money.
A study released in April, ``An Analysis of the Cost Savings of the Medicare Hospice Benefit,'' compared the relative cost of hospice care to conventional care for Medicare beneficiaries with cancer. Analysis of almost 200,000 beneficiaries' claims found that for every dollar Medicare spent on hospice patients, it saved $1.52 in Medicare Part A and Part B expenditures. In an era of budget cuts and precarious balancing acts, the hospice cannot be overlooked as a major player in health-care delivery at the end of life.
Despite the proven advantages of hospice care, it still remains an underutilized service. Some insurance companies refuse to cover hospice care, yet will pay for terminal care in the hospital. Some physicians wait until the 11th hour or until the patient is imminently dying before suggesting hospice. Some physicians never discuss it at all with patients and families.
The hospice believes that anyone with a life-limiting illness who desires comfort care rather than aggressive treatment deserves information about and access to hospice services. We routinely care for patients in nursing facilities as well as patients at home. Patients with end-stage pulmonary disease, heart disease, dementia such as Alzheimer's, AIDS, neuromuscular diseases and cancer have found the hospice to be very effective in promoting comfort, dignity and choice without resorting to euthanasia or assisted suicide. The Task Force on Quality of Care at the End of LIfe, formed by the American Medical Association, would do well to include hospice representatives who deal daily with these issues.
We must stop seeing death as the enemy and as something to be avoided, regardless of personal and economic cost. A Nov. 18 article in your newspaper (``Now models in life also seek to be models in death'') stated that ``the ability to let go without clinging to life at all costs can be a powerful witness both to the sacredness of life and to the naturalness of death.''
Yes, let's stop fighting death at all costs, and look at what most people want: comfort, dignity and control. Let's seek a more mature, compassionate way of bringing peace to this special time of life.
Sue Moore is president of Good Samaritan Hospice in Roanoke.
LENGTH: Medium: 66 linesby CNB