Hospice crisis management: during short lengths of stay.

Many have expressed concern about the very short stay of patients in hospice, resulting in the difficulty to provide all the available benefits at end of life. These short-stay patients are a result of their physician’s reluctance to have “the conversation” about endof-life planning. The result of this delay is that patients and families are sometimes unwilling to accept a terminal prognosis and the incentives of the Medicare fee-for-service system (MedPac, 2013). The costs of hospital care during the final years of life are high. According to a 2012 report from the Agency for Healthcare Research and Quality (AHRQ), 5% of the population accounts for nearly 50% of spending (Cohen et al., 2012). A disproportionately large percentage of resources are spent on patient care in the last 2 years of life, much of it unwanted by patients, unnecessary, and ineffectual in prolonging life. A recent study by Joan Teno indicated that although death in hospitals has decreased to 25%, the percentage of people in the ICU in the last month of life increased to 29% in 2009 (Medicare Newsgroup, 2013). In 2011, 10% of all Medicare patients entering hospice had a length of stay (LOS) of 2 to 3 days and 25% of patients had a LOS of 7 days or less regardless of diagnosis (MedPac, 2013). According to MedPac, costs are higher at the beginning and end of care, which, for shortstay patients, includes both of these time frames (MedPac, 2013). Due to the intensity of hospice services, MedPac has made recommendations to At that time he was diagnosed with advanced gall bladder cancer and liver metastasis. Although he was in acute liver failure, with a recent hospitalization for a deep vein thrombosis and pulmonary embolus, he was still hoping for more chemotherapy, although he was too ill to tolerate it. During the hospice admission visit, he