The question Why are Referrals to Hospice Slowing? seems to be making the rounds these days.
Misconceptions about hospice and palliative care have abounded well before the latest efforts to refrom the health care system. How else to explain the persistent and continuing reticence to refer to, and accept hospice services, in most US communities. What's different today is that the skeptics of hospice and palliative medicine are more vitriolic than their predecessors, and their talking points (arguments) are more vivid - "death panels, socialized medicine".
I served as the chief executive of a hospice affiliated with a highly-regarded academic health center in the 90s, and the reasons then were abundant for the low referral rate to hospice: patients were referred to academic health centers because they wanted to avail themselves of the most sophisticated medical care for cure; the attending physicians were providing palliative care; the patients' religious/cultural beliefs made them unready for hospice, etc. We've all heard them before, and we still hear these reasons now.
It's just that now, in the context of health reform, palliative care, for some, is considered 'rationing."
And it gains credence because there is so much money in late-life care.
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