December 29, 2013

Regarding the Dec. 27 front-page article “In hospice, but not dying”:

In the late 1970s, hospice was a grass-roots movement formed to counter the burdensome medicalization of dying. Back then, hospice got cancer patients out of intensive care and home among family and friends, and it greatly improved treatment of pain. I know, because I was one of the first U.S. hospice doctors, and I cared for nearly 2,000 dying Washingtonians.

The Post captured many of the problems hospice faces now that it has become a big business. Now, most Americans will travel a different path to death, since most of us will live a few years with frailty. The hospice model is too rigid to offer what frail elders and their families need: reliable, long-term, continuous care for both medical needs and for mundane activities such as trimming toenails. With frailty, the timing of death remains unpredictable until the last few days, but the hospice program relies on predictable dying and provides very limited help with personal care.

The number of frail elderly in the United States will nearly double as baby boomers age. Shoehorning people into hospice invites the profiteering that The Post described, but providing good, affordable care will require substantial reforms in many largely ignored parts of the system. In the 1970s, dedicated people found the will to change the course of medical care by developing hospice. We need more of that will now.

Joanne Lynn, Washington

The writer is director of the Altarum Institute’s Center for Elder Care and Advanced Illness.

The Post article on hospice saddened me deeply. We have turned the hospice concept over to “the market,” which economists claim will bring the greatest benefit. Instead, hospice has become a cynical perversion of a once-noble cause. If Americans have any outrage left, they might object to their tax money being shoveled into the pockets of firms that appear to see death as just another hustle.

Thomas P. Lowry, Woodbridge

My husband has been receiving hospice care in an assisted-living group home for more than six months. The hospice support makes our difficult situation more bearable by improving his comfort and easing my responsibilities and financial burden for his care.  While our hospice is a nonprofit one, I am concerned that The Post article’s criticism of trends in for-profit operations may lead to “reforms” that hurt us all. 

Palliative care is vital when helplessness, frailty and dementia overwhelm a loved one. No one should be seen as a problem or as evidence of fraud when he or she doesn’t die within six months. I am most grateful that Medicare covers hospice care.

Bonnie Franklin, Arlington

The Post article highlighted important information about the business practices of many large for-profit organizations. Patients and families need to understand this important fact: Not all hospices are alike. You can choose the organization you want to provide hospice care to your loved one. The Post article clearly made the case for using a nonprofit, community-based hospice when your family needs professional, compassionate end-of-life services. 

Ann Mitchell, Rockville

The writer is president and chief executive of Montgomery Hospice.