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Abstract

Hospice is designed to provide quality end-of-life medical care for patients and support for their families. Most insurance, including Medicaid, provides hospice benefits. Why then do so few people enter hospice? I hypothesized that the perception of hospice care as a last resort drives the decision to choose hospital care at terminal diagnosis. However, the data shows that although a large number of respondents across age and income groups did not regard hospice care as a last resort, when asked to make a hypothetical decision between hospice and hospital care, they primarily chose hospital care except when life expectancy was less than 3 months. Subjects aged 30 and under showed higher preference for hospital care even when given life expectancy of less than 3 months. Respondents were more likely to choose hospital over hospice care when making the decision for a family member than for themselves. Given 6 months or more to live with a terminal disease, respondents generally chose hospital care, perhaps in anticipation of a curative option which may not be available for diseases such as end-stage Alzheimer�s. Thus my hypothesis that the perception of hospice as a last resort drives choice of hospital care at terminal diagnosis was not proven. Multiple factors affect decision making when life expectancy is 3 months or less. Age and income do impact the choice; however end-of-life care decisions are clearly more complex and require careful guidance and support.

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