Patients don't have to trade treatment for comfort

• At Home Support patients don't have to give up treatment to get traditional hospice services.
• Medical director: The program not only reduces health costs, it improves the quality of lives.
• "The job of my hospice nurse is to keep me out of hospice."

His nurse works for Hospice of Michigan, but Frederick Tinsley is pretty clear: He has no intentions of dying yet.

That's just fine.

The retired metallurgy technician is part of a growing program by Hospice of Michigan that upends what most people think about hospice care.

Traditionally, hospice has helped patients face their final days but only if they give up curative treatment.

Consider a patient with advanced cancer, said Dr. Michael Paletta, Hospice of Michigan's medical director.

"To come onto hospice, you had to stop chemo. You had to stop radiation," he said.

Hospice of Michigan's small but growing At Home Support program allows patients to continue their fight to live even as it extends traditional hospice services such as palliative care.

"My dad lived 'til he was 98¹/₂, and my mother lived to 97¹/₂," said Tinsley, 77, of West Bloomfield, whose life relies on a tracheostomy tube, a feeding tube, and a daily rotation of medications after several bouts with recurring cancer.

Plus, he added with a laugh: The Tigers are looking promising this year.

Now, a cost analysis of the At Home Support program suggests that accepting even the sickest patients into the Hospice of Michigan program — long before they're ready to die — not only improves their quality of lives, it also reduces health care costs.

That's especially important during that steep end-of-life cost curve. That's when diseases slip out of control — sometimes because of something frustratingly avoidable, such as a missed medication, prompting panicked runs to emergency rooms.

But in the At Home program, patient costs dropped from about $9,294 during the first month to $5,878 a month six months later, even when a patient's chronic illnesses theoretically were getting no better, according to a review by Wayne State University.

And when patients entered the program, 84% had been hospitalized in the prior six months. By the sixth month in At Home Support, just 54% of those who were still living had been hospitalized the prior six months, said Faith Hopp, whose areas of focus at Wayne's School of Social Work include chronic disease and end-of-life care.

Most important, patients and caregivers have reported less stress and fear when they have access to At Home Support, according to Paletta.

The At Home program rides a big shift in thinking.

Traditional hospice services have focused on palliative care rather than cures, in part because insurers generally don't pay for curative treatment once hospice has begun, Paletta said. Why pay to help patients fight for life even as they prepare to die?

That handed patients and loved ones an excruciating decision: Continue with last-ditch efforts to fight for life, or surrender curative measures and let hospice ease the process of dying.

To many, hospice has signaled lost hope and a service to be delayed until the final few days of life, when quality of life is reduced mostly to alleviating pain.

But at its best, hospice also offers psychological and social work support for patients and families with a nod to cultural and religious sensitivities. It coordinates transportation and non-medical services, and it helps patients and loved ones understand the process of dying and, for some, face it more peacefully.

In 2007, Hospice of Michigan formed a partnership with Health Alliance Plan of Michigan and Blue Cross Blue Shield of Michigan to offer its services through its a new At Home Support program.

Nearly all of the 148 patients in the earliest test cases had advanced cancer, COPD, congestive heart failure, or progressive neurodegenerative disease, such as Alzheimer's type dementia or Parkinson's disease — "pretty sick people with a significant disease burden," Paletta said.

They had begun the end-of-life revolving door into the hospital, often driven by what Paletta calls the "we-didn't-know-what-else-to-do" phone call to 911.

"You'll have the patient crying 'Please don't send me back (to the hospital)' and 'I want to stay home.' But you have the daughter saying, 'My mom can't breathe. What am I supposed to do?' " Paletta said.

Very often, too, the grueling runs to the hospital, the bright lights and chaos of an emergency room, and more days in an unfamiliar bed weaken the patient further.

For Tinsley and others in the At Home program, there are regular visits by At Home staff and 24-hour phone access to nurses — all part of traditional hospice care. Medical staff take vitals, but also address those under-the-surface concerns that might erupt in a 3 a.m. panic. Social workers try to keep patients connected to community services and encourage links to loved ones.

And if Tinsley's cancer returns, he isn't forced to pass up curative treatment to keep those services.

"If you put certain services in place, delivered in the home, that allow (patients) to continue therapy, and you also provide hospice-like services, you're going to have better cost outcomes," Paletta said.

Tinsley, in fact, didn't realize his nurse worked for Hospice of Michigan until many months into the program, he said.

"The job of my hospice nurse," Tinsley quipped, "is to keep me out of hospice."

Contact Robin Erb : rerb@freepress.com or 313-222-2708. Follow her on Twitter @Freephealth.