End-of-Life Hospice Care Underused

But Gazelle stressed that hospice continues to meet or exceed the expectations of terminally ill patients and the people who love them. In fact, one recent survey found that 98 percent of family members said they would strongly recommend hospice care to others in need.

And hospice isn't just focused on dying cancer patients. According to the National Hospice and Palliative Care Organization, about 40 percent of U.S. hospice admissions now involve patients with end-stage heart disease, dementia, lung disease or stroke.

Still, "people need to understand that hospice is about living," Gazelle said. "It's about living as well as you can when life has dealt you a bad deck of cards. Having your dignity, your quality of life, as little physical and emotional suffering as possible -- that's what hospice can do for people."

Hospice care focuses on the patient, of course, but also on those affected by his or her illness, Gazelle added. Counseling and support is made available to caregivers and can last for months after the patient's death. "To know that their family is going to be attended to is critically important for people near the end of life," said Gazelle, who is also president of the medical advocacy group MD Can Help.

But the fact remains that a full third of hospice patients enter the service only in the last week of their life -- even though Medicare covers six months of this type of care. "That's very, very sad," Gazelle said.

She and Wright believe things are about to change, however.

"Baby boomers are going to turn all of this around," Gazelle said. "They are so empowered around their health care and the health care of their loved ones -- they're going to push hard to make sure that their needs are met."

Wright agreed. "I think that we will see the reimbursement structure change dramatically over the next decade," she said. "Baby boomers have received the best medical care imaginable for their entire lives -- why should their death be any different?"

More information

Find out more about hospice and palliative care at the National Hospice and Palliative Care Organization.

SOURCES: Gail Gazelle, M.D., assistant clinical professor, Harvard Medical School, and president, MD Can Help, Boston; Alexi Wright, M.D., fellow, hematology/oncology, Dana-Farber Cancer Institute, Boston; July 26, 2007,New England Journal of Medicine