The hidden curriculum of hospice: die fast, not slow

Health Affairs Narrative Matters

Hospice care is meant to optimize quality of life and minimize sources of distress at the end of life. In theory, enrollees are entitled to an unlimited number of days of hospice care, though they have to be recertified after 6 months. But in practice, some patients end up discharged alive rather than re-enrolled.

In this episode of the Narrative Matters podcast, Health Affairs’ Jessica Bylander talks to Krista Lyn Harrison, an assistant professor of geriatrics and health policy at the University of California San Francisco. In this month’s essay, Harrison writes about her stepfather’s experience with the hospice care system at the end of his life, and how the model ultimately failed their family and how it fails other patients who die more slowly than expected. After being discharged alive from hospice, Harrison’s stepfather’s health soon declined again and he died nearly eight months after his initial hospice admission.

Harrison, a former hospice administrator, says she has the utmost respect for her hospice clinical colleagues, but that the hospice system is not quite keeping up with what’s best for patients and families. Hospice, or its alternative, should better support different disease trajectories and functional needs for patients who are dying, she says.

Following the interview, Harrison reads her essay “The Hidden Curriculum Of Hospice: Die Fast, Not Slow.”

This podcast is part of Health Affairs' Age-Friendly Health series, with support The John A. Hartford Foundation.

Related Links:

• The Hidden Curriculum Of Hospice: Die Fast, Not Slow (Health Affairs)
• 2020 Edition: Hospice Facts and Figures (National Hospice and Palliative Care Organization)
• A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death (Health Affairs)