Patients become eligible for hospice care when both a referring physician and a hospice physician agree that, on average, a patient has less than six months to live. More than 1.49 million people were hospice beneficiaries in 2017, and this represented 48.2 percent of Medicare decedents. Even with these large numbers, experts feel hospice services are underutilized.
In this era of prescription drug abuse the potential for misuse must be kept in mind. In my ten plus years in hospice work, I ran into only one convincing abuse situation.
A 65-year-old female with lung cancer that had spread to her lymph nodes came under the care of my team. Norma was a phlegmatic individual, who was pretty matter-of-fact about her pain, but, due to the extent of her disease, we were prescribing narcotics. She said she lived alone, but hospice personnel, when making routine visits, often encountered several young men whom the patient variously identified as sons, other relatives, or friends. One of our aides characterized these guys as “shady.”
The narcotic pill counts nurses monitor carefully kept coming up short. Even though the patient did not seem to be in much distress, she always said her pain was inadequately controlled. I kept increasing her doses of morphine and decreasing the intervals between them. Of course we began to wonder if Norma’s drugs, the “good stuff,” were making their way to the street. Accordingly, we stopped dispensing the usual month’s supply of narcotics and reassessed every two weeks. Then we went to once a week. When the pills still disappeared faster than prescribed, we told the patient that we would give her no more pills than the prescribed amount—if she ran out, we would not supply more drugs until the next scheduled interval. Soon after we instituted this policy, the patient revoked her hospice care.