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It’s still a good idea – more about hospice

A geriatrician holds the hand of an elderly woman with arthritis.How often have you said, “I wish I’d known that!” especially when it comes to your health or lifestyle choices? I’ve heard it many times, and said it a few times myself, so I hope that the information I’m presenting to you here in this blog will spare you a few “I wish I’d known that!” comments.

After reading The Business of Dying, the recent series of articles in the Washington Post about hospice care in America, I got to thinking about how the authors focused on the negatives which in some ways is good, but it left me wondering how, apart from using the guide they provided, someone figures out which hospice is best for them. I wanted to know more about hospice and I had questions, so I asked a friend who has worked for a couple of hospice companies, one for-profit and one not-for-profit, if he could help me. Here are some of the things I learned.

In order to qualify for hospice, two doctors have to agree that the patient is terminally ill with six months or less to live if their illness runs the expected course. They would take into consideration whether the patient was losing weight unintentionally, changes in mental health including cognition, and how often the patient had been admitted to hospital in recent months.

The rate that Medicare pays for hospice varies according to location and is related to the cost of living for that area. The Washington Post article, Hospice firms draining billions from Medicare  states that “Medicare pays a hospice about $150 a day per patient for routine care, regardless of whether the company sends a nurse or any other worker out on that day.” If you only take into consideration the time hospice workers spend with a patient and family, then this can sound like a huge rip-off. It’s only fair to the hospice companies that we consider their additional costs such as:
• overall administration and management for each case
• the team that is supporting the patient and family, their wages and expenses (some of whom visit the patient, and others who support them by phone. The team would most likely include the physician, RN case manager, home health aide, chaplain, and social worker, all of whom should be meeting with the patient and family initially, as well as various times throughout the period of care.
• Durable medical equipment such as hospital beds, and mobility devices (walkers, wheelchairs), and other supplies and equipment that can help the patient to be more comfortable might also be provided depending on each individual’s care plan.
•  Prescriptions that are related to the hospice diagnosis as well as those that are prescribed to relieve pain and manage symptoms.

In the Washington Post article Terminal neglect? How some hospices decline to treat the dying  the terms “continuous care” or “crisis care” were used. I was confused about the definition of these terms as were other people I spoke to. The explanation is that it is nursing care, provided for short periods of time for flare-ups or crises, with a minimum of 8 hours of care by a skilled Registered Nurse (RN). It can be part of hospice care but would not be provided the entire time and may not be required at all.

I also wanted a better understanding of what palliative care is because it is so often confused with hospice care. They are not the same thing – they are two separate kinds of care.
• Palliative care provides relief for pain and uncontrolled symptoms and can be provided at any stage of an illness whether the patient is receiving treatment because a cure is likely or in hospice. While receiving palliative care, it does not necessarily mean that the patient will also receive hospice care. Palliative care is covered by Medicare part B.
• A patient in hospice care will most likely receive palliative care (pain relief) as part of their care plan. Hospice care is covered by Medicare part A.
In both palliative and hospice care, a team of medical professionals may work with the patient and family.

When working on your Advance Directive, you might include your thoughts on palliative and hospice care. What appeals to me about both concepts is that you have a team caring for you that is taking into consideration not only your physical comfort, but also your emotional and spiritual needs.

Patients are people, too!
It’s easy to get caught up in only one perspective be it good or bad, positive or negative. If you don’t feel that you’ve fully understood something that you’ve been told or that you’ve read . . .  Keep researching and asking questions!

• The Centers for Medicare & Medicaid Services provides an official government booklet – Medicare Hospice Benefits
• Durable medical equipment covered by Medicare – www.medicare.gov/coverage/durable-medical-equipment-coverage.html
** Although Medicare covers this equipment, it doesn’t mean that everyone will receive it. What a patient receives must be medically justified and included in their “custom plan of care.”
• What Medicare Covers – www.medicare.gov/what-medicare-covers/index.html

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