PATIENT care directors for Oahu's two hospices scanned the list of causes of 7,803 deaths in Hawaii last year. They said hospice care, which I'll define more fully shortly, could have helped more than 5,100 of the dying people die better but actually helped only about 1,600. Hospice care could
help more in HawaiiGood, compassionate terminal care is a boon for both the patients and their survivors, whose memories will last a long time.
The elements hospice can add include very high-level pain control, relaxants to help deal with shortness of breath, relief from nausea and better management of incontinence. To that add counseling to help both patients and survivors make peace with the world around them.
Hospices offer a 24-hour help line and on-call service. They handle the details when death occurs. Hospice care, including medications, is insured under Medicare-Medicaid standards and most private plans.
Hospice care, much of it at home, is far superior to ordinary home health-care programs when death draws near. The latter have no volunteers or counseling. They are not governed by federal hospice standards.
To qualify for hospice, however, patients must accept that their life expectancy may be less than six months. Their lives then shift to regimens aimed at caring rather than curing. They gain dignity and physical comfort by ending or at least cutting down on chemotherapy, surgery, radiation and feeding tubes.
This usually costs less than acute care aimed at curing but no one tries to sell it on that basis. For most dying patients it is simply a better choice.
Patricia Kalua of St. Francis Hospice, Hawaii's first hospice, and Barbara Shirland of Hospice Hawaii said diseases where hospice can usually be of great help in the terminal period include heart, cancer, brain, pulmonary, liver, HIV and atherosclerosis.
Unfortunately most hospice referrals still are for cancer. Even more unfortunate, the average patient spends less time in the program than desirable. Thirty percent may spend less than a week before death. Several months can better help patients make peace with their worlds, tidy up their personal affairs and mend broken relationships.
More doctors are making hospice referrals than ever before but some do it terribly late. Patient requests based on word of mouth still may exceed doctor referrals. Word from families in Hawaii that have dealt with hospices is overwhelmingly favorable. Such families often can also be a good source of contributions to help others.
Kalua and Shirland would like to see hospice insurance benefits extended to a year instead of six months. They would like Medicare payments boosted from $107 a day to cover the actual $147 average at-home cost, which includes medications. The difference now is made up by contributions.
They would like to see payments for "resident care" in facilities managed by the hospices boosted to $250 a day.
ST. Francis has 12 beds in an old Nuuanu Valley mansion. It will add 24 in September at St. Francis Hospital-West. Hospice Hawaii has five beds in a Kailua residence, plus the right to use six beds each in the Castle, Queens, Kuakini and Wahiawa hospitals.
Hospice Hawaii has state authorization for two more five-bed homes. One will be at Ewa Beach, the other at a still unchosen Honolulu site. Both hospices still handle most deaths at home, which is where most patients prefer to be.
The state hospice association estimates 1,600 people died last year under care from the two Oahu hospices and six neighbor island hospices. If Kalua and Shirland are right hospices could have brought better deaths to 3,500 more.