Expanding Hospice Care for Our Patients

My thoughts about our new joint venture with Hospice of the Western Reserve

By Cliff Megerian, MD
President, UH Physician Network and System Institutes

UH Clinical Update - April 2019

I’ve always considered hospice as part of the continuum of care in medicine. But this was brought home to me last year in a powerful way when I had a family member referred to hospice care at UH.

Yes, I know that some people in medicine may view hospice as the result of a failure to cure, but nothing could be further from the truth. And that is not at all the way we saw it. My relative had received the best possible care that UH could offer -- quaternary and surgical care. Despite all efforts, my family member was not able to be cured, and he was in the ICU enduring the pain of his illness. 

So he was moved from curative care to hospice care. The transition was effortless and brought tremendous solace and comfort not only to him, but to all of us who were at his bedside.

The arrival of hospice care was one of the best things that happened to him and to our family, and we remain intensely grateful for the care given by UH hospice and palliative care providers. So I know personally how important these services are to our health system’s mission of delivering high-value care.

As physicians and caregivers, we are all committed to doing everything we can to cure our patients.  Most of our therapies in this and other health care systems are built around the concept of providing a cure. But in certain circumstances -- and we are all aware of them – that is not possible. But we are also obliged to care for that patient with the same vigor and the same tenderness -- perhaps even more so -- when we find out that patient is no longer able to be cured.

Early this year, we as a system saw the opportunity to promote these ideas among our larger patient population. UH formed a joint venture with Hospice of the Western Reserve, allowing us to provide enhanced hospice services to our UH patient population and families, including a continuum of individualized services. The joint venture is equally own by UH and Hospice of the Western Reserve, with Hospice of the Western Reserve managing the day-to-day clinical and patient-facing operations, and UH providing administrative and managerial support.

This new arrangement provides our patients with both palliative care and hospice care, each of which is an important part of a large health care organization like ours. Sometimes there is confusion about the difference between these two types of care.

Palliative care addresses a broad range of needs facing patients with serious illness and their families, including communication/decision making, physical symptoms, and needs for psycho/socio/spiritual as well as caregiving support.  Palliative care can be offered at any time over the course of an advanced illness, including concurrently with curative or survival-oriented medical care. 

Hospice care is a program focused on the comprehensive quality of life needs facing patients near the end of life and their families, being typically offered in the final six months or less of life.  The goal of hospice is to help patients live comfortably when a cure it not likely, and generally is not offered concurrently with survival-oriented care (Medicare is experimenting with models that extend hospice eligibility to a year and/or allow it concurrently with survival-oriented care).  Hospice care can be provided in people’s own homes, in nursing facilities, or in inpatient hospice settings. 

Why is hospice so important? Consider these two scenarios: 

If your patient is terminal but not hospitalized, you can refer him or her to hospice for care. (You will find specifics on hospice referrals at the end of this blog.) That can prevent a patient from seeking care in an emergency room, which would no longer be appropriate. This referral also allows the benefits and comfort provided by hospice to begin.

If a patient is in the hospital and it has been determined that they should be moved from curative care to hospice care, a referral to hospice means the patient doesn’t stay in the ICU or a cancer floor and is instead moved to a hospice facility, or home, to receive hospice care there. The hospice care will be provided through, and within, our UH system. 

In both of these cases, utilizing hospice means the patient can avoid unnecessary pain and suffering and trips to the emergency room. And we avoid prolonging high-intensity delivery of care, which comes at great cost. 

Too often, patients are not moved to hospice care until a short time – days, or a week – before death. But it’s increasingly clear that the earlier that a patient can be helped by hospice, the better – for the patient and his or her family. 

The faster we recognize that this option and specialty is just as important in the lifespan of our patients as all the other care we provide, the more quickly patients can benefit from the specialized end-of-life care we can provide

That’s why this new, close relationship with the Hospice of Western Reserve, an agency with a long history of expertise in providing end-of-life care, is so crucial. Together with our palliative care physicians, we are offering a new way to ensure that patients who need these services will receive them.