In Cache Valley we have a big selection of hospice entities. Last count there were thirteen or fourteen hospices to choose from. It seems like an awful lot of hospices to serve a population of roughly 120,000 people.
When Medicare made available the services for hospice care in the early 1980’s, most participants had a cancer diagnosis. The resources used by the hospice to provide end of life care were minimal and included medications, supplies and hands on care to be able to keep people in their own homes and to die in the company of their families. The concept of hospice care was a noble thing. Certain types of people are drawn to provide that type of care but as I often say, the rewards the hospice team reaps in our interactions with hospice families is immeasurable. It takes dedication, grit and compassion.
After some years and with much public education, the Hospice Medicare benefit was enhanced to encompass more services to terminally ill with many more diagnoses. With this came greater reimbursement to provide the services. As is the case in our country of free enterprise and entrepreneurial spirit, many people decided to get into the business of hospice care. And as with any business entity, the profitability factor comes in to play.
Agencies may be a for-profit entity or a not-for-profit business. Most of the hospices in Cache Valley are for-profit entities.
Most persons on hospice have the Medicare benefit. Medicare pays all hospice agencies the exact same fee in the locale in which they are. The daily fee is expected to cover visits from the team, medications for comfort and supplies to maintain the hospice patient in their own home setting.
Hospice agencies must comply with some basic standards of care. But how the care is administered and dispersed is up to the individual hospice company. If one were to need hospice care for their loved one, there are many things to consider.
The hospice patient must have a documented illness that their physician expects to be terminal within six months time. Regular reviews of the patient’s status are required to maintain them on care. If they improve or seek curative treatment, they must be discharged from the hospice benefit.
Hospices must have a complement of services to comply with Medicare. This includes a core team of professionals comprised of a medical director, registered nurses, social workers and chaplains. Agencies are also required to have a team of trained volunteers to work with the patient. In addition and most importantly is the involvement of nurse’s aides who may be employed by the agency or contracted. They are the team member who is most intimately in contact with the hospice patient. Agencies also have other therapies depending on their size and service area including physical, occupational, speech, music and massage therapists. Each team member has a role in keeping the hospice patient comfortable and in the home setting.
It is imperative that hospices honor and respect the patient’s personal and religious beliefs.
There are some questions or concerns for the family and patient to think about when seeking hospice services. One of the main concerns is free choice of hospices. If a setting, assisted living or nursing home is requiring or recommending a certain hospice service, families should question why – as free choice as well as changing services is the option Medicare intends.
Does the hospice allow the family and patient to be involved in the plan of care?
How is it decided the frequency with which the patient will be visited by team members? Does the frequency of visits change as the patient nears death?
How involved is the patient’s primary doctor and does the doctor feel hospice care is appropriate? It is the hope of the Medicare benefit that the patient’s primary doctor remain involved in the care. If the patient is required to use the hospice medical director, families should question those services. Is the hospice medical director skilled in end of life care? Is the Medical director a local physician?
We would hope that all hospice services that bill Medicare, a benefit our seniors deserve and in which they have contributed their tax dollars, are delivered ethically and righteously and that all appropriate services are rendered in the care of our loved one.
Ask questions and do your homework when seeking health care services for the ones you love at this delicate time of their life.