Hospice care has long been recognized as a valuable resource for individuals facing terminal illnesses, offering physical and psychological symptom management, spiritual care, and support for family caregivers. It has consistently proven to enhance the quality of life for patients and reduce the use of burdensome treatments. However, despite the clear benefits, many individuals in the United States who could benefit from hospice care often experience very short stays or never enroll due to the current policies governing hospice care. A proposed solution to this issue is to allow concurrent availability of disease-directed therapy and hospice care, known as concurrent care (Concurrent care is currently offered primarily to pediatric patients and by the VA Health system to our veterans). This approach presents an opportunity to boost hospice utilization and prolong the length of stay, thereby enhancing the end-of-life experience for many. In this opinion piece, we will explore the pros and cons of making all hospice care concurrent care.
Pros of Making All Hospice Care Concurrent Care:
- Improved Patient Experience: Concurrent care allows individuals to receive hospice care without having to forego disease-directed therapies that they may depend on for prolonging life. This approach aligns more closely with the preferences of patients who want to continue with treatments that they believe contribute to their comfort and quality of life.
- Increased Hospice Utilization: The current policy has inadvertently discouraged people from enrolling in hospice because of the requirement to discontinue costly life-prolonging treatments. Concurrent care removes this barrier, making hospice a more attractive option and increasing the likelihood of individuals accessing the beneficial services it offers.
- Enhanced Symptom Management: Concurrent care can help address symptoms and issues that may not be adequately covered by traditional hospice services. It allows for the continuation of treatments like dialysis or transfusions, which can alleviate symptoms and improve the quality of life for patients.
- Bridge to Hospice: Concurrent care can serve as a bridge for patients and families who may not be willing to fully stop their disease-directed therapies. This model encourages people to enroll in hospice without completely discontinuing the treatments they rely on, thereby facilitating a smoother transition into hospice care.
- Cultural Sensitivity: Concurrent care is more flexible and can accommodate the preferences of communities that traditionally underuse hospice. For example, it respects the cultural reasons and trust issues that may lead certain populations, such as Black patients, to prefer continuing life-prolonging therapies.
Cons of Making All Hospice Care Concurrent Care:
- Complex Care Coordination: The delivery of concurrent care is complex, requiring seamless coordination between hospice and disease-directed clinicians. This may strain smaller hospices, which already serve rural areas with fewer resources.
- Resource Burden: Providing concurrent care can be resource-intensive, which could be a significant barrier for many small, nonprofit hospices. These hospices may struggle to offer the high level of care required by this model.
- Family Caregiver Demands: Family caregivers play a crucial role in facilitating treatments while providing hospice care. The demands on family caregivers may increase significantly with concurrent care, as they would be responsible for transporting patients to dialysis sessions, for instance.
- Variability in Treatment Plans: The high variability in treatment plans and care coordination can make it challenging to implement concurrent care effectively. It may require standardized guidelines, education, and support to ensure consistency.
- Developing and Refining Models: While concurrent care holds promise, clinical and payment models for broad implementation via Medicare policy are still under development. Determining the eligibility criteria, payment rates, and standardized implementation will take time and may pose challenges.
In conclusion, the concept of concurrent care offers significant advantages in terms of improving the patient experience, increasing hospice utilization, and bridging the gap between disease-directed therapy and hospice care. However, it comes with complexities related to care coordination, resource burden, and the demands on family caregivers. Developing and refining models of concurrent care will be essential to ensure its successful implementation and to better meet the diverse needs of individuals facing serious illness in the United States. Ultimately, concurrent care offers an innovative opportunity to enhance the quality of end-of-life care, and it deserves careful consideration as part of ongoing healthcare reforms.
