THE HOSPICE movement is growing in strength and public support. More Americans who are terminally ill are choosing to die at home in familiar surroundings with family and friends nearby. Last year, Congress authorized the Medicare program to make some payment for hospice care, and now regulations have been proposed to put that program into effect.
Proponents of hospice care stress not only its humanitarian aspects but also its cost-saving features. They suggest that Medicare will save money by allowing terminally ill patients to be cared for at home or in a relatively low-cost hospice instead of in a high-tech hospital. Government budget watchers, however, wonder if things will actually turn out this way if care now provided by family members and volunteers is reimbursed. Both Congress and the regulators at the Department of Health and Human Services have taken great care in setting up a program that continues to use volunteers to the greatest extent possible and discourages the commercialization of this movement.
Under the proposed regulations published last week, Medicare would be authorized to pay $53 a day for routine home health care of the dying and up to $286 a day if round-the-clock help is needed. In addition, if a patient has to be admitted to an institutional hospice or to the hospice unit of a general hospital for emergencies or for the alleviation of pain, the program would pay $271 a day. This, of course, is less than the actual cost of providing such care, but so are the payments Medicare makes for regular medical treatment in a hospital. Hospice organizations have characterized the proposed rates as a big improvement over figures that had been floated last spring and praised administration officials for taking "a long stride in the right direction." HHS Secretary Margaret Heckler was a cosponsor, in Congress, of the legislation making this program possible and she has clearly brought her support and enthusiasm to the department.
There are now more than 30,000 people, mostly cancer patients, in hospice care. Health experts expect that number to rise to 50,000 in the next three years. It is right and compassionate for the government to assist them and their families through the trauma of terminal illness and to help, when there is no cure, to provide solace and care at home. If money can be saved by offering this alternative, all the better. But surely serenity, loving consolation and a peaceful death are worth paying for too.