Chris McFaul: It’s time to help rural hospice patients

It may seem odd to think about snow in August, but recently I’ve been pondering barriers. To reach a hospice patient in rural Spokane County last February, our team battled treacherous roads and even climbed a massive snowbank to get to the patient’s house and deliver needed care.

You might not expect that of hospice and, like me, may not even be aware of what hospice entails until someone close to you receives a life-limiting diagnosis. When this happened to a family member 11 years ago, I discovered what hospice truly is: care with dignity, which allows patients to remain at home in their last days while honoring their life and their wishes. Hospice, in short, provides patients with peace of mind and body, all while enabling families to give quality care to their loved one, with expert support to lean on while doing so.

Contrary to what many believe, seeking hospice care is not giving up. Instead, when further curative treatments will cause harm rather than help, hospice provides support, peace and comfort from a specially trained team of dedicated caregivers. My personal experience was so inspiring that I joined this incredible movement. I quickly discovered that my counterparts within hospice provide extraordinary support for those who are most vulnerable, along their loved ones who navigate the difficult ordeal with them.

So, climbing over a snowbank to deliver care is just a start. In truth, an 8-foot barrier is a relatively small hurdle compared to other challenges hospices face in Eastern Washington. We providers are navigating shrinking resources, a limited workforce and increasingly burdensome regulations. We also face a rather unique challenge caring for patients in rural areas of our state.

Fortunately, some congressional leaders have recognized that rural access to health care is a growing concern. A recently established bipartisan task force was charged with exploring policy solutions to address health care delivery challenges in rural and underserved areas. According to the Washington State Department of Health, large portions of Ferry, Franklin, Columbia, Asotin, Pend Oreille, and parts of Stevens, Lincoln and Adams counties are considered medically underserved.

These populations already face a shortage of doctors, but federal policy adds another barrier, making it more difficult for rural hospice patients to find and keep their doctor. I am writing because I believe our rural neighbors and their families deserve equal access to quality end-of-life care regardless of their ZIP code.

Here are some technical details. Primary care can be found at Rural Health Clinics (RHC) or Federally Qualified Health Clinics (FQHC) in underserved areas, but unlike their urban counterparts, doctors employed by these clinics are ineligible to receive payment for providing hospice services. Rural patients at the end of life must grapple with a difficult decision – do I keep my local doctor and forgo the support and comfort of hospice? Or do I choose hospice care, knowing it will create a barrier with my current physician? There is an easy fix which will protect rural Washingtonians and all Americans from this impossible choice. Legislation exists in both chambers of Congress to correct this oversight: the Rural Access to Hospice Act (H.R. 2594/S.1190).

If passed, this bill would allow doctors to continue acting as the attending physician for patients in hospice. This common-sense, bipartisan legislation would remove a significant barrier to hospice care access in rural areas and is supported by leading national groups like the National Hospice and Palliative Care Organization.

As a co-chair for the House Rural Health Care Coalition, I strongly encourage our representative, Congresswoman Cathy McMorris Rodgers, to sign on as a co-sponsor to this legislation. Her support would send a powerful message to her colleagues that Americans living in rural areas – including the many Washingtonians served by our state’s RHCs – deserve quality, compassionate care all the time, but especially at the end of life. It’s time for our federal lawmakers to embrace common-sense solutions so that rural hospice patients can get the end-of-life care they need and deserve.

No matter where barriers arise, hospice providers stand ready to provide support and comfort - even take on the snowbanks. Now it’s Congress’ turn to do its part, show its support and take on these bad policy hurdles.

Chris McFaul is chief executive officer of Horizon Hospice and president of the Washington State Hospice and Palliative Care Organization.