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Hospice is great when appropriate. I have recommended hospice to patients that are terminally ill and I highly feel will die within 6 months. Most probably in weeks. I have seen patients with congestive heart failure, the above mentioned failure to thrive, end stage COPD on hospice. Not all of these do I feel are appropriate. I had a patient come in the ER at MIDNIGHT on the verge of taking her last breath(seriously) who had been on hospice for 12 days. No water or food and alot of Haldol and morphine. The daughters decided they did not just want to let her die. All she needed was IV hydration. She lived which I thought was a miracle considering her electrolyte abnormalities and pre-renal renal failure and her age of 85. Why she was put on hospice in the first place I do not know. She had a long hospitalization at another hospital. But she DID NOT have a terminal disease. They family took her home where one daugher had cared for her for 3 years already. She was speaking and eating at least. What I am stating is right now there is .gov money available for hospice so they are out looking for patients even in the NH where nursing care is already available 24 hours a day. The .gov will eventually cut the payments down to where they will stop looking for patients. That is the way the government works. They did the same thing with physician pay, home health,senior care psych wards, SNIF wards. They pay so pitiful on most things the system shifts to get the money when and where available. Rural clinics were a big thing in the 1980’s and 1990’s. They were reimbursed at a much higher rate than private physicians. Many were unneeded. There is no way the make .gov work efficiently. It is a rat race.