This Thanksgiving Talk about the Care You Would Want

NHPCO Encourages Americans to Spend Time Talking about Health Care Choices before Facing a Crisis

(Alexandria, Va) –A family is gathered by the bedside of a loved one who has been seriously ill, and now is likely near the end of life. Each member of the family has a different idea of what should be done and what their loved one would have wanted. That’s the point when they realize they should have planned ahead and talked about what they each would want in a medical crisis.

Heartbreaking scenes like this happen far too often.

The National Hospice and Palliative Care Organization is encouraging families to spend time when they may be gathered for the holidays, to talk about the care they would or would not want. This is particularly important if a family is coping with a serious or life-limiting illness of a loved one.

Having discussions about one’s health care wishes is part of advance care planning.

Advance care planning involves making decisions about the care you would want to receive in a medical crisis that might be the result of a serious illness or an unexpected accident.  Advance care planning also involves deciding who will speak for you if you are not able to speak for yourself.

An essential part of advance care planning involves having these important conversations with your loved ones.

Advance care planning also includes:

  • Deciding what types of treatment you would or would not want should you be diagnosed with a life-limiting illness or faced with a serious medical crisis.
  • Sharing your personal values and beliefs with your loved ones.
  • Completing an advance directive to put into writing what types of treatment you would or would not want.
  • Designating a person as your health care power of attorney (sometimes called a health care proxy) to speak for you if you cannot speak for yourself.

“Not only is it important for each of us to clearly make our wishes known but it is one of the most important gifts we can give to our families and loved ones,” said J. Donald Schumacher, NHPCO president and CEO. “During the holiday season, families are often gathered together and that’s the best time to have these caring conversations with one another.”

Added Schumacher, “Hospice and palliative care providers see how difficult it can be for families that have never talked about care choices and are in a crisis situation. Similarly, they see how beneficial it can be when the priorities at life’s end have been discussed and are clearly understood.”

NHPCO’s offers free state-specific advance directive forms and free information to help families talk about the care they would want. Visit


Your Latest Hospice News Update is Ready!


Happy National Hospice and Palliative Care Month! We are happy to kick off a month-long awareness campaign about hospice and palliative care with our monthly news update!

For additional resources, shareable content, and more, check out NHPCO’s National Hospice and Palliative Care Month page! Don’t forget to share the link to the Know Your Options Tool and share the newest Moments of Life Video, Lyle’s Hawaiian Dream. 

News from the Hill:

Hospice Advocates Stave Off MA Carve-In, For Now

Regulatory Update:

  1. 1. NHPCO Meets with CMS to talk NOE/NOTR
  2. NHPCO Podcast: OIG Report on Election Statements and Certification
  3. NHPCO Podcast: The Non-Discrimmination in Health Programs Final Rule
  4. 4. New CMS Data Visualization Tool Available

Advocacy Shout-Out:

Samaritan Healthcare and Hospice hosts Congressman Donald Norcross for a sneak peak of their new Samaritan Center at Voorhees

Good Reads:

  1. French Hospital Adds Wine Bar for Terminally Ill Patients
  2. A Dance for Gloria
  3. The Role of Nurse Practitioners in POLST Form Completion
  4. Facts About Hospice Care (A great article to share for #HospiceMonth!)
  5. Home Based Palliative Care Better, Less Costly than Hospitalization (Another good share for #HospiceMonth!)

A Look Ahead:

  1. Join us Friday, November 4 for Social Media Day! 
  2. Election Day is Tuesday, November 8
  3. Veterans Day is November 11. Make sure you invite your Members of Congress to any Veterans Day or National Hospice and Palliative Care Month Activities!
  4. National Rural Health Day is Novemeber 17. This is a great day to share stories about providing care in rural areas!

We Honor Veterans is now on Twitter @WeHonorVeterans. Follow them to learn more about the great work their partners do for our Veterans!

Shout out to everyone attending the NHPCO Intensives down in Florida! Thank you to Ron Culberson and BJ Miller for providing our keynote addresses. You can follow along on social media using #Intensives16.

Don’t forget to join the #hpm community each Wednesday night at 9pm ET/6pm PT to chat about all things hospice, palliative, end-of-life, etc! Patients, families, clinical staff, friends, supporters, curious onlookers all welcome! Just use #hpm on Twitter to join the conversation!

We hope you have a lovely National Hospice and Palliative Care Month, and please let us know about any events or initiatives you have going on this month! Make sure to use #HospiceMonth, #HospiceAwareness and #hpm on your Facebook and Twitter posts! And as always, you can follow us on Facebook, Twitter, and on our blog!

Facts About Hospice Care

In advance of National Hospice and Palliative Care Month (November), I wanted to share this article from August by Jon Radulovic. This is a great article to share with friends and family, post to social media, or even share with your local news outlets to help educate people during National Hospice and Palliative Care Month!


Facts about hospice care you might not know

Author: Jon Radulovic, MA
26 August 2016
  • The majority of hospice care in the US takes place in the home (photo from NHPCO member hospice).
    Hospice isn’t a place. It’s a type of care that focuses on living…living as fully as possible, up until the end of life. Hospice brings comfort, love, and respect to the patients and families they care for.
Considered to be the model for high-quality, compassionate care at the end of life, hospice care involves a team-oriented approach to care that includes expert medical care, pain-and-symptom management, and emotional and spiritual support. All care is expressly tailored to the patient’s needs and wishes.

Hospice offers the services and support that Americans want when coping with a serious or life-limiting illness.

The goal of this type of care is to treat the person instead of the disease, and focus on the family caregivers, not just the individual.  The quality of life is emphasized, not its duration.

Just the Facts: National Hospice and Palliative Care Organization* reports:

• Hospice usage in the U.S. is growing. Every year, more than 1.6 to 1.7 million Americans with life-limiting illness are cared for by the nation’s hospice providers.

• The median length of service for hospice patients is 17.4 days (half of patients receive care for more days, half of patients receive care for fewer days).   Yet, more than 35 percent of patients die or are discharged in seven days or less – too short a time to benefit from the full ranges of services a hospice can offer.

• Cancer accounts for 36.6 percent of hospice patients – which surprises many people who mistakenly think hospice only serves cancer patients. The five other leading diagnoses are: heart disease, debility, dementia (this includes Alzheimer’s disease), lung disease, and stroke.

• Hospice is covered under Medicare, Medicaid, most private insurance plans, HMOs and other managed care organizations.

• An estimated 430,000 trained volunteers contribute more than 19 million hours of service every year.

• Research shows that 8 out of 10 Americans would want to stay in their homes surrounded by family and loved ones if they were faced with a life-limiting illness. Hospice makes this happen.   

For more information or to find a hospice in your area, visit or call the NHPCO HelpLine at 800-658-8898.


* Download the NHPCO report, Facts and Figures: Hospice Care in America, 2015 edition.


Home-Based Palliative Care Better, Less Costly than Hospitalization

Reposted from

A new study, published in the Journal of Palliative Medicine, analyzed the quality of life and financial impacts of a home-based palliative care program for patients with serious illness. Palliative care is specialized medical care for people with serious illness.

  • Authors conclude that patients in their final months of life have more of their needs met in a home-based program compared to hospitalization.
  • Home-based palliative care resulted in reduced costs of $12,000 per patient in comparison to those getting care in a hospital in the final three months of life.

Home-based palliative care was associated with significant reductions in total Medicare cost, fewer hospital admissions and an increase in hospice utilization in the final months of life. Described by the authors as important research for public policy implications, the study showed a 34 percent reduction in hospital admissions in the patients’ final months. The cost per patient during the final three months of life was $12,000 lower with home-based palliative care than for usual care. Approximately 90 percent of patients in the program were able to die at home, consistent with the expressed desires of the vast majority of people.

The authors believe the study provides strong evidence that patients obtain a better quality of life and have their needs better met when they stay out of the hospital. “Less hospitalization in the final month of life is important. Typically, hospitals are associated with more burdens, suffering, loneliness and stress,” says Dr. Dana Lustbader, a study co-author.

File photo by Portra Images via Getty Images
File photo by Portra Images via Getty Images

The sickest five percent of patients in the United States account for 50 percent of costs, with the largest portion spent in the final months of life, generally for inpatient care.[1] Over the past decade, hospital-based palliative care teams have demonstrated improved outcomes and cost savings.[2][3][4] To date, little has been reported on the economic impact of home-based palliative care programs.[5] Home-based care is important since hospitals may accelerate functional decline for those with advanced illness.[6]

Clear-cut research was needed to examine cost and outcome metrics for home-based palliative care — and to show if that service model could result in better care coordination and high quality end-of-life care.

The study, titled “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” was performed by ProHEALTH, a large multi-specialty physician provider group in New York that is a part of the national health care delivery organization, OptumCare. Dr. Lustbader, chairman of the Department of Palliative Medicine at ProHEALTH, led a 16-person study team.  A control group was used for comparison purposes during the 18-month study period.

The study will be presented at the Accountable Care Organization World Congress this month in Washington DC and also at the national conference for the Center to Advanced Palliative Care in Orlando this month.

The study was a retrospective analysis to quantify cost savings associated with a home-based palliative care in a Medicare Shared Savings Program ACO where total cost of care is available. The researchers studied 651 decedents; 82 enrolled in a home-based palliative care program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. The researchers also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.


[1]Institute of Medicine: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Report Brief. 2015. Washington, DC: The National Academies Press. (Last accessed July 16, 2016).

[2]May P, Normand C, Morrison RS: Economic impact of hospital inpatient palliative care consultation: Review of current evidence and directions for future research. J Palliat Med 2014;17:1054–1063.

[3]Smith TJ, Cassel JB: Cost and non-clinical outcomes of palliative care. J Pain Symptom Manage 2009;38:32–44

[4] Morrison RS, Dietrich J, Ladwig S, et al.: Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood) 2011;30:454–463.

[5]Rabow M, Kvale E, Barbour L, et al.: Moving upstream: A review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013;12:1540–1549.

[6]Gill TM, Gahbauer EA, Han L, et al.: The role of intervening hospital admissions on trajectories of disability in the last year of life: Prospective cohort study of older people. BMJ 2015;350:h2361.

New NHPCO Podcast Episode: The Non-Discrimination in Health Programs Final Rule

How do you currently serve patients with Limited English Proficiency? Do you know the top 15 languages in your state? Do you have a plan to meet the new requirements of the nondiscrimination in health programs regulation? A provision of the Affordable Care Act outlines what hospice providers need to do, above and beyond what they have in place, to be compliant. This Medicare regulation, that came out of HHS/OCR with little fanfare is taking many in the provider community by surprise. It went into effect on October 16- and it is not optional.

Listen here! The NHPCO podcast is also available on ITunes.