Breathing has become increasingly difficult for Jeanne Lampe, who
spends her days hooked to an oxygen tank.
Lampe, 79, has "end stage" emphysema but still lives at home in
an apartment in south St. Louis. She is visited twice a week by a
nurse from Hope Hospice Inc., which also provides a massage
therapist, a social worker, a chaplain and workers to help with
showers and chores - all paid for by Medicare.
When the end comes, Lampe has resolved to die at home, on her own
"Death itself doesn't bother me, but emphysema is a crappy death.
You're basically gasping for breath," she said. "When I'm ready to
go, I want morphine and a margarita."
Lampe is among a fast-growing number of patients locally and
nationally who are choosing hospice, which seeks to provide comfort
rather than a cure. Advocates say the trend holds great potential to
hold down runaway U.S. health costs by steering end-of-life patients
away from more expensive and aggressive hospital care. But the
industry's rapid growth also presents regulatory challenges to
federal authorities concerned about unethical recruitment of
patients and the cherry-picking of less complex but more profitable
The number of hospice patients on Medicare doubled to 1.1 million
between 1998 and 2008, according to the federal Centers for Medicare
& Medicaid Services. Another estimate of hospice patients this year,
from the National Hospice & Palliative Care Organization, put the
number at 1.6 million.
"With the aging population and many people suffering from chronic
illnesses, the number of people choosing hospice has exploded," said
Melissa D.A. Carlson, an assistant professor at Mount Sinai School
of Medicine in New York. "As people understand hospice, they want
more and more to stay at home with their family."
And more health care providers want to get into the burgeoning
market. About 58 percent of Americans still die without hospice
care, says the National Hospice & Palliative Care Organization,
leaving ample room to grow the business.
A decade ago, hospice care was a niche dominated by nonprofit
organizations. But now at least two-thirds of licensed hospices in
the St. Louis area are run by for-profit companies, according to the
state Department of Health & Senior Services. And about 80 percent
of Medicare-certified hospice providers entering the market between
2000 and 2009 were for-profit firms, according to a study published
in June by Health Affairs, a policy journal based in Bethesda, Md.
"There's obviously money to be made," said Carlson, who co-
authored the study.
In the big picture, advocates say, hospice can offer many
patients more quality of life and dignity in death - at much lower
cost. In St. Louis County, for instance, providers receive a daily
rate from Medicare of $144.91 for each patient in "routine" hospice
care. That typically includes the cost of drugs, medical equipment,
supplies, and nursing care, but not room and board.
By contrast, hospitalization in an intensive care unit can cost
upwards of $10,000 a day, including drugs, equipment and staff
"It is a phenomenal benefit to the family members and the patient
as well as the health care delivery system," said Judy Alexander-
Weber, president and chief executive of the Visiting Nurse
Association of Greater St. Louis, a nonprofit organization whose
hospice workers visit residences and nursing homes. "It's the most
cost-effective way to manage end-of-life care."
Costs aside, many hospice patients choose that option out of a
more fundamental desire to control their manner of dying.
Benny Davenport, 84, a former flight engineer and auto mechanic,
resides in St. Charles County with his wife, Martha - and wants to
keep it that way until his death. SSM Hospice is helping his wife
take care of him as his lung cancer spreads through his body. …