Are All Hospices Created Equal?

Posted on June 6th, 2019

The hospice I dealt with as a parish pastor was excellent.  Staff invited me to participate in the formulation of my member’s care plan.  Volunteers and staff dedicated themselves to a philosophy of helping people in their care live more fully until they died.  That’s what Hospice is about . . . right?

When I became director of National Lutherans For Life, I began to hear another side.  “I just got kicked out of a Hospice center,” one pastor told me.  “I was told the hospice chaplain would handle spiritual care,” said another.  More than once I heard, “I think hospice hastened mom’s death” and “They wouldn’t let dad keep any of his medications.”

Changing Landscape

The landscape has changed.  Polemic over the increase in the number of states legalizing doctor-assisted suicide changes the way some people think.  This method of suicide is not thought of as suicide.  We hear euphemisms like, “Death with Dignity,” “Aid in Dying,” and “the Compassionate Relief of Suffering.”   Such right sounding rhetoric leads people to think of compassion as relief of suffering by eliminating the sufferer instead of its true meaning, “to suffer with.”

The landscape has changed.  Medicare now pays for hospice care.  While a blessing for many, it also leads to profit easing out caring as the underlying philosophy.  More and bigger for-profit hospice organizations dot the map often eclipsing non-profit, faith-based hospices.

Palliative or Curative?

Because of such changes, I believe it is true that not all hospices are created equal.  So how do you discern which hospice will honor your beliefs and values?  First, understand the difference between “palliative” and “curative.”

Palliative care consists of specialized care offered by trained professionals to provide medical, emotional, social, comfort, and spiritual care.  Palliative care can be helpful for those battling disease and undergoing various treatments and therapies. The goal is to help people get through these as comfortably as possible and hold out hope for a cure.  Palliative care is also used in hospice when hope for a cure no longer exists.  Here the goal is to help people live as comfortably and as well as possible until they die.

Curative care and treatment, as its name implies, aims for a cure.  It consists of trained professionals doing what they are able to prolong life.  Radiation to eliminate cancer tumors is a good example of a curative treatment.

Who Decides?

Now here is the important part when it comes to selecting an appropriate hospice.  Medicare will pay for palliative treatment but not curative treatment under hospice.  However, Medicare does not determine which treatments are palliative and which are curative.  The hospice facility does that.

Let’s say, for example, that your dad is on oxygen for his emphysema and goes under hospice care because he is dying from pancreatic cancer.  If the hospice labels the oxygen “palliative,” something that will help keep him more comfortable and help him live better until he dies of the cancer, then Medicare will pay for it.  But if the hospice labels in “curative,” Medicare will not pay, and the hospice may not even allow it.

Questions to Ask

A good way to determine if a hospice is actually trying to get people to die sooner rather than help them live fully until they die is if they have a tendency to very broadly interpret the prohibition of “curative” treatments.

Rev. Chris Wheatley is the Director of Christian Ministry Programming for the hospice Optage (Optimum Aging), a service division of Presbyterian Homes in Minnesota.  He has done significant study on hospice organizations and the shift toward hastening death rather than helping people live.  He has developed a series of questions to ask Hospice to help Christians make good decisions.

  1. How do you determine what is palliative, and what is curative?
  2. Do you accept client’s on oxygen? Do you pay for it?
  3. Do you accept client’s on fluids? Do you pay for it?
  4. Do you accept client’s on feeding tubes? Do you pay for it?  What is your procedure for infection around the feeding tube site?
  5. How do you determine the correct dosages of pain mediations? What non-pharmacological interventions do you employ to treat pain?
  6. How do you employ morphine? What has been your experience with it?
  7. Do you employ palliative sedation? If so, when?
  8. Do you employ palliative chemo? If so, when?
  9. Who decides when to discontinue a treatment? What input is given by hospice staff, my family, my agent?
  10. Can I keep my primary doctor? How does your medical director work and communicate with my primary?
  11. Does your hospice have a policy regarding physician assisted suicide? What is it?  Why not?
  12. [This one added by the author] Will my pastor be able to provide for all aspects of my spiritual care?

You can obtain a PDF copy of these questions by Clicking Here.

A Word from God!

The Holy Spirit writes through the Apostle Paul, “I am hard pressed between the two.  My desire is to depart and be with Christ, for that is far better.  But to remain in the flesh is more necessary on your account” (Philippians 1:23-24).

This is the tension we live in as Christians, especially when death seems near.  It is between the “far better” and the “more necessary.”  We can certainly join Paul in desiring the far better of being with Christ.  We can pray for this for ourselves or a loved one.  But it may be more necessary for us to continue to live.  The crucial thing is to be reminded that God is in charge of the “more necessary.”  As long as He gives life, He gives life value and purpose.  As long as He gives life, He works in that life according to His will and the spiritual good of that person and/or those around him or her.  He alone decides when it is time to call us home.

Rev. Jim Lamb, Mdiv. Dmin.
Life Advocate for Lutheran Family Service