Vantage Hospice in Houston saw substantial growth in its patient census during the COVID-19 pandemic, which the company in part attributes to a rising number of patients with advance care plans. Vantage is now calling for initiatives to make advance care planning a standard medical practice.
While Vantage did see growth in their patient intake, they saw a higher number of patients who had very short length of stays as well as more severe symptoms. The company’s administrator Nicole Knight contends that expanding advance care planning would help bring patients under the wings of hospice earlier in the course of their illnesses.
“Advance care plans provide direction to physicians and loved ones in the midst of a medical crisis,” Knight said “So many patients could have had the opportunity to die comfortably at home instead of alone in the hospital if advance care plans were a standard practice.”
Nearly 30% of hospice patients received care for seven days or less during 2018, according to the National Hospice & Palliative Care Organization. Nearly 13% receive care for 14 days or less. According to Vantage Hospice, patients should receive as much as three months of services to experience the full range of benefits.
Advance care planning has been shown to have a significant impact on the quality and experience of life’s final stages, yet broaching these conversations with patients and families involves breaking down walls around end-of-life care. Advocates nationwide are calling for improved strategies to bring the conversation of death into a new light and shift the culture of dying in America.
Public perceptions of advance care planning, as well as a lack of understanding of the nature of hospice and palliative care, have many reluctant to pursue these options, according to a recent study in the Journal of Palliative Medicine.
When patients do pursue advance care planning, early conversations are positively associated with family decisions to limit or withdraw life-sustaining treatments, fewer in-hospital deaths, fewer unplanned hospital admissions, shorter hospital stays, family satisfaction with end-of-life care, and increased odds of receiving strong opioid pain medications in the last 24 hours of life, according to a study in the March 2019 issue of the Journal of the American Medical Directors Association.
National efforts may be underway to grow advance care planning. Sen. Richard Blumenthal (D-Conn.) has introduced the Compassionate Care Act in the U.S. Senate. If enacted the bill would significantly expand federal resources to support advance care planning and end-of-life care decision making. The legislation would also finance public awareness campaigns about hospice and palliative care.
“This bill will help Americans have the difficult but necessary conversations about end-of-life care,” said Blumenthal. “The COVID-19 pandemic has reminded Americans of all ages of the importance to have a plan in place in case of severe illness or death.”