People near Life's End Choose Comfort, Control; LOW COST; Hospice Is Much Less Expensive Than Aggressive Hospital Care. PROFITS; Firms Could Recruit Unethically, Cherry-Pick Patients, Some Say; HEALTH CARE

Article excerpt

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 terms.

"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 cases.

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 costs.

"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. …


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