Hawai'i's hospice programs can expect changes in coming months and years as the sensitive business of providing end-of-life care faces new competition from the Mainland and providers look for ways to handle an expected increase of baby-boomer patients.

That's some insight from J. Donald Schumacher, head of the National Hospice and Palliative Care Organization, who was in Hawai'i last week to talk with healthcare leaders about trends and possible changes facing his industry. Schumacher and others say demand for hospice services is increasing as more people explore care alternatives for life-ending illnesses and injuries.

In Hawai'i about 2,200 people who died, or 24 percent of all deaths, involved hospice care last year, according to Ken Zeri, president of Hospice Hawai'i and of Kokua Mau, the organization representing nine hospice providers in the state.

Hospice has been gaining acceptance since it was introduced in the U.S. more than 40 years ago, and revolves around the belief that people have a right to die with dignity. Instead of receiving treatment for a cure up until they die, hospice patients can get pain management along with having emotional and spiritual needs addressed.

Hawai'i's hospice use is below the national average of 35 percent of deaths, and people here typically come to hospice care later in their illnesses than the Mainland, Zeri said. He said some of the reasons for this are cultural, while other factors involve the structure of Hawai'i's healthcare system and lack of nursing homes.

Still, "the number has been increasing," Zeri said.

Schumacher said this should continue into the future as 40 million baby boomers move toward retirement nationally and as more people see hospice as an end-of-life care alternative.

One of the issues discussed while Schumacher was here was a recent Duke University study that showed Medicare costs would be reduced for seven in 10 hospice users if hospice had been used for a longer period of time. It also found hospice reduced Medicare spending by an average of $2,309 per patient when compared with normal care.

The study noted when patients and families spend more time in hospice programs, they are better able to use hospice benefits such as bereavement counseling and respite for caregivers.

"It shows significant savings to the Medicare system," said Schumacher, adding this is in addition to support, pain management and family counseling provided by hospice.

Schumacher said he expects more Mainland hospice programs may start offering services here.

He said the industry also is looking for legislative changes in pediatric services.

Currently, hospice services can't be involved while parents engage aggressive treatment plans for their children, Schumacher said. He said a waiver should be enacted so that hospice services can also be provided while the the children undergo therapy.

Reach Greg Wiles at gwiles@honoluluadvertiser.com.