Mission House blends in with all the other homes on its quiet residential street in Redwood City. The only difference is that it houses terminally ill patients.
On a recent Monday afternoon, five residents were staying at the six-bedroom house. Some were behind closed doors, labeled with their first names. Others sat outside on a sunny terrace, chatting with visitors. In the kitchen, a staff member baked chocolate chip cookies.
Run by the nonprofit Mission Hospice & Home Care of San Mateo, Mission House is among the local alternatives for those seeking specialized hospice care. The vast majority of hospitalized patients — defined by Medicare as people expected to live six months or less — receive care at home, in assisted living facilities or nursing homes.
Local carers said specialist palliative care is not about focusing on death.
“The focus can be on living and understanding the goals you have with the time you have left and how we can help you enjoy it,” said Christine Ritzo, registered nurse at Mission Hospice & Home Care. .
It’s a myth that all hospice patients are bedridden or on morphine, Ritzo said, noting that some patients even take the opportunity to travel with “transfer” hospice support, possibly making be last trips to Hawaii or Lake Tahoe.
The demand for palliative care services is increasing as the elderly population and the number of patients with life-threatening illnesses increase. Nationally, the number of hospitalized patients rose from 1.38 million in 2015 to 1.61 million in 2019, according to the National Hospice and Palliative Care Organization. Medicare spending on palliative care increased by $5 billion over a five-year period: in 2019, spending reached $20.9 billion, up from $15.9 billion in 2015.
Last October, Governor Gavin Newsom signed legislation to strengthen oversight of hospice care across the state. The new laws now place auditing and monitoring procedures for palliative care providers under the responsibility of the Department of Public Health.
“For a long time people have treated death as a medical event, but death is a human event, and hospice brings humanity back to the experience of death,” said Terri Simpson-Tucker, director of the hospice for Sutter Care at Home.
Hospitalized patients receive visits from nurses or orderlies as needed — Medicare defines and reimburses four levels of care — and families receive help from social workers, doctors, chaplains, bereavement counselors and many volunteers.
But the choice to enter palliative care – which belongs to the patient and can be revoked at any time – is difficult to face because it requires accepting only comfort care for a terminal illness while explicitly renouncing medical efforts to cure the person’s illness.
With advances in chemotherapy, radiation and drugs, “people are holding on to that hope,” said Dolores Miller, CEO of Mission. “Sometimes people aren’t ready. … It’s not until they’ve been in hospital, five times, six times, seven times or in their last year of life that they start thinking about hospice or something different.
“The (doctor) will say, ‘There’s nothing more we can do for you. We don’t have curative treatment options anymore – there’s only symptom management.” But that’s what hospice does.”
For patients and families accustomed to comprehensive treatment, hospice can feel like giving up or even hastening death.
But high-quality palliative care can actually prolong life, according to Palo Alto Medical Foundation physician David Tran, who directs palliative care and support services there.
“With good early palliative care, people actually live longer and more comfortably than we often expect,” Tran said. “I think it has to do with reducing medical complications from treatment, reducing the number of people placed in institutions and allowing people to stay at home longer in a less stressful environment.”
Simpson-Tucker, of Sutter Care at Home, said some patients “die when we admit them, which is not optimal. Most patients are on our ward for four or five months.”
Some even get better and leave hospice, but may come back later if they get worse, she added.
Between 2015 and 2019, the average length of stay for people in hospice rose from 86.7 days to 92.6 days, according to the National Hospice and Palliative Care Organization. About 19% of patients were enrolled in palliative care for two days or less, 25% were enrolled for five days or less and 50% were enrolled for 18 days or less, the group said. Patients with Alzheimer’s disease, dementia and Parkinson’s disease had the longest stays, while those with kidney failure and cancer had much shorter stays.
Local providers have said that working in palliative care is one of the most rewarding in their medical career.
Tran became a hospice and hospice physician after the lonely experience of being the primary caregiver during his own father’s four-year terminal illness as a teenager.
“It would have been great, back then, to have the social support and the kind of spiritual support that hospice provides,” Tran said. “As I progressed in my career, this kind of work really appealed to me.”
Simpson-Tucker called hospice “the most rewarding kind of nursing I have ever had.”
“I have the privilege of doing something that not many people can do, to sit down and talk with someone about their life, the connections they’ve made in life,” she said. “I see so much grace with which people leave this world.”
While California’s hospice movement began with volunteers and nonprofit organizations in the 1970s, the majority of programs in the state are now for-profit.
To help potential patients select a provider, Medicare publishes comparative information — including family ratings in categories such as “communication with family” and “getting help fast” — at medicare.gov/care-compare.