Hospices Serving the Unbefriended

Ethics circles talk about challenges with serving unbefriended patients in hospitals, but this is an interesting application to hospices. (Summary taken from Hospice News Today, 6/13/19.)

Hospices Adapt to Support Patients Without Family Caregivers
Hospice News
June 12, 2019

Cultural changes to family dynamics and demographics may require hospices to adjust their care and business models to care for patients who have no family support. … Patients often lack caregivers due to outliving their relatives, being childless, divorce, having no siblings, or changes in geographic mobility. Few hospices can maintain round-the-clock care for patients in their homes, thus a lack of family caregivers can contribute to increased hospitalizations or nursing home admissions, as well as create ethical and legal challenges. Many of these patients have limited decision-making capacity and need assistance making health care choices, including decisions regarding hospice enrollment. … A 2014 study found that older adult patients without family support, often called “unbefriended,” often do not enroll in hospice due to inadequate state policies governing third-party medical decisions for these patients. With 1.4 million patients in hospice care and approximately 4% of older adults unbefriended, hospices can expect to see more of these patients as the population ages and hospice utilization continues to rise, according to the American Bar Associationʼs Commission on Law and Aging. … Encouraging referral partners and other health care providers in the community to discuss advance care plans with patients can help prevent later complications in medical decision making, allowing the patientʼs wishes to be documented before their decision-making ability becomes impaired. … In the absence of advanced planning, hospices may find themselves in difficult situations with unbefriended patients. … “Hospices may be harmed a bit, but the person who really suffers is the individual who is walking their last chapters. It is our fiduciary responsibility to educate and provide resources. We need to understand what the patient needs and act on that,” Tim Ihrig, M.D., chief medical officer at Crossroads Hospice in Oklahoma City, said. “We have to understand why these patients are so expensive. Itʼs not because theyʼre old, unbefriended, and so on. [Their care] costs so much because of what the health care system does to them that neither enhances their quality of life or longevity.”