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[quote=Anonymous][quote=Anonymous]Hospice as a “movement” was a valuable correction to an excessively physician-controlled system that had evolved to sometimes forcing “curative” care on people who didn’t want it and would not benefit from it, sometimes from good motives and sometimes simply for profit.  Putting patients’ needs first, treating them as individuals instead of pincushions, going beyond medicine to address spiritual, social and psychological needs were all important and good ideas.

Hospice as a Medicare benefit was never a good idea. As PP’s have observed, it tends to take control away from patients and their families and put the hospice personnel in charge — exactly the opposite of what the hospice movement advocated for. Because the hospice benefit replaces other Medicare benefits once it is chosen, there can be a great deal of confusion over what is “allowed” and what is not. The result is that patients and families don’t always know what to expect, what they’re entitled to and, most importantly, what they’re giving up. The lack of clear guidance and the power granted to hospice personnel lead to confusing and inequitable results. As PP’s have observed, some hospices do a great job, even providing chemotherapy and radiation for their palliative effects. Others unfortunately demand that patients give up pretty much everything except a steady dose of morphine calculated to help them “die peacefully” whether they are ready to or not. This includes stopping antibiotics, even though untreated infection can make a patient feel far more miserable than they ought to even if they are terminal. Sadly, another effect of the imbalance of power with hospice is that some hospice personnel become controlling and even arrogant (even bullying, as PP’s have noted).

“For profit” hospice?  Well, the name says it all.

There are good hospice programs, both outpatient and inpatient. But the average consumer, especially in the midst of dying or losing a loved one, is ill equipped to make an informed evaluation of what is being offered. And “offered” may be the wrong word, since some physicians, faced with impending death, more or less abandon their patients to whatever fate any given hospice program may entail.

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So.... what is the best solution?  If someone wanted to figure this out ahead of time, before they're in a crisis situation.  What would you recommend? [/quote]

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