Some readers have expressed an interest in the history of the hospice movement. Here is a skinny version, with some relevant statistics,
Hospice care was conceived by a visionary physician in England, Dame Cicely Saunders, in the late 1960’s. She had witnessed too many unnecessarily difficult deaths and started the movement that retains her principles for end of life care to this day (a biography is available: “Cicely Saunders, The Founder of the Modern Hospice Movement” by Shirley du Boulay) . The hospice movement made it to the United States in the late 1970’s, championed by the Dean of the Yale School of Nursing, Florence Wald, and Senator Robert Dole. In 1979, 26 demonstration programs were established across the country, and, in 1986, Congress made the Medicare Hospice Benefit permanent.
Here are some stats, taken from the NHPCO internet site (National Hospice and Palliative Care Organization, released in 2019). 1.49 million Medicare beneficiaries were enrolled in hospice in 2017, up from 1.27 million in 2012. Medicare spent $18.99 billion in 2017 for hospice services, compared to $16.20 billion in 2012.
Of those who died while on Medicare in 2017, 48.2% received one or more days of hospice care. This figure varied dramatically from state to state, with Utah having the highest percentage at 59.9% and Alaska coming in at the bottom with 22.5 %. The overall percentages correlate with greater usage in blue states, although this is by no means a perfect association (New York’s percentage, for instance, was 30.6%). I have no idea why this is the case.
Hospice advocates believe hospice services in general are underutilized. They point to the fact that 40.5% of hospice utilizers receive the benefit for 14 days or less, a sign that the healthcare system is failing to make the hospice referrals in a timely fashion.
Some gainsayers say Medicare expenditures, especially the growth, are way too high. It is easy, however, to make the case that hospice intervention is extremely cost effective, a subject for a later post.