NY Times recognizes length-of-stay problem
NY Times recognizes length-of-stay problem
'Blind bureaucracy' draws fire
The growing problem of short lengths of stay in hospice has been recognized with a front-page story in the March 4 New York Times. The story, titled "As Life Ebbs, So Does Time to Elect Comforts of Hospice," by Sheryl Gay Stolberg, describes the final months in the life of a cancer patient, as well as the emotional barriers standing in the way of doctors making timely hospice referrals.
Marilyn Snyder's adult children knew that the end was near for their mother, Stolberg reports. "But nobody else, it seemed to Mrs. Snyder's children, would admit that their mother was dying, least of all her doctors. None suggested hospice care." One of the doctors refused to make an earlier hospice referral based on the belief that there were other chemotherapies still to be tried.
"Mrs. Snyder's difficulty in obtaining hospice care is troubling, experts say, but not uncommon. As medical professionals campaign to improve care of the dying, experts agree that hospices offer what many call a `good death.' But they say people often enter hospice care too late to take full advantage of it, sometimes just days, even hours before death."
The article quotes Carolyn Cassin, CEO of Hospice of Michigan; University of Chicago researcher Nicholas Christakis, MD; and Missoula, MT, hospice physician and author Ira Byock, MD. It concludes that "doctors equate hospice with giving up on their patients, and patients equate it with giving up on themselves."
"My reaction? I'm absolutely thrilled to see hospice on the front page of The New York Times," observes Amber Jones, MEd, president of the New York State Hospice Association. "How long have we waited? And then to see a well-done article, a thoughtful piece, not hype." However, Jones adds, the article mainly identifies the problem and doesn't point the way toward solutions. "On the other hand, I recognize that the problem is complicated, and articles like this are important in terms of raising awareness."
The following week, a March 11 New York Times Op-Ed piece by journalist and author Marilyn Webb (The Good Death: The New American Search to Reshape the End of Life) attacked a "blind bureaucracy . . . an antiquated provision of the Medicare law and the Government's aggressive enforcement of it" for creating barriers to timely hospice referral.
Medicare's requirement of six months or less to live as a condition of hospice enrollment and the Office of Inspector General's short-sighted investigations of hospice fail to take into account the fact that dying has changed since 1983, Webb says. Her conclusion: "We need to overhaul our entire financing system so that families and patients don't crumble under the burden of the very success of modern medicine."
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