Annals of Long Term Care

To the Editor:

I wanted to add a point to Dr. Finestone and Gail Inderwies’ excellent article “Quo Vadis ICU Hospitalization for End-of-Life Care?”1 A major problem we encounter with hospice enrollment is competition with the Medicare skilled benefit for patients leaving the hospital and going to a nursing home. It is financially advantageous for families and facilities to “skill” patients even when they are at the end of life, and we see numerous patients die without hospice. This not only deprives the patient of services while alive, but also deprives the family of 13 months of bereavement services after the patient’s death.

I would like to see Medicare change the reimbursement to equalize payment for hospice and skilled care. Families, patients, and nursing facilities could focus on palliative care and preparation for a comfortable death in patients for whom rehab and cure are no longer realistic goals.

Hospice never means no treatment or no hope; rather, it is a time-intensive individual approach to symptom management, spiritual peace, and end-of-life planning that I hope more physicians will embrace.

Cynthia Kuttner-Sands, MD, CMD
Associate Medical Director
Hospice of Washington County
Hagerstown, MD