Posted on 11/27/2007 6:50:27 AM PST by shrinkermd
Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.
Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.
The charges are assessed retrospectively, so in most cases the money has long since been spent on salaries, medicine and supplies. After absorbing huge assessments for several years, often by borrowing at high rates, a number of hospice providers are bracing for a new round that they fear may shut their doors.
One is Hometown Hospice, which has been providing care here since 2003 to some of the most destitute residents of Wilcox County, the poorest place in Alabama.
The locally owned, for-profit agency, which serves about 60 patients, mostly in their homes, had to repay the government $900,000, or 27 percent of its revenues, from its first two years of operation, said Tanya O. Walker-Butts, a co-owner. Its profits were wiped out in the time it took to open the demand letters, Ms. Walker-Butts said.
Hometown paid its first assessment with a bank loan. When the bank declined credit for the second year, the hospice structured a five-year payment plan with the Centers for Medicare and Medicaid Services, the federal agency that administers the program, at 12.5 percent interest.
(Excerpt) Read more at nytimes.com ...
Hospices are as different as individual doctors are. Some hospice maangers are in it because they love death, others are in it because they love the living.
For example, my wife was impressed and inspired by her hospice rotation, but then we have folks like the hospice management in Pinellas Park, Florida who let a woman die of thirst when she shouldn't have been in hospice at all...nuff said!
Thanks, Mr. Silverback.
Sometimes, with the elderly, comfort care is the only reasonable course, because surgery, radiation or chemo become worse than the disease.
Absolutely. Our local health network has a very good hospice, but I wouldn't wish the hospice Terri Schiavo was in on a dog.
OK...now you've gone off the rails. My wife and her colleagues have been the last caregivers for a number of dying patients, and though hospice is a better environment, the last thing they are is uncaring.
You've asked another Freeper if he ever had to be with someone at the end of their life. I'd ask, have you done so in a traditional hospital setting, and if so, why do you feel confident you can put that noise on every nurse, doctor and CNA who works in those wards?
A friend of mine is an owner of an assisted living facility in Southern California. Recently she told me what she had learned by observing hospice workers coming to her facility. She holds some in very high professional regard while others she wouldn't want caring for a pet. One hospice firm, in particular, was noted for its rather frequent use of pain killers in hospice patients.
You are lumping good and evil together and calling them both evil. That's not only wrong, but counterproductive. Pro-lifers should be focusing on supporting those in the medical community who value life and accept natural death, rather than bashing anyone who is involved in end of life care.
I’m reminded of something I heard from one of the Schindler’s lawyers on C-Span the other day: “A living will isn’t worth the paper it’s written on. What you need is a medical power of attorney given to someone who will not hesitate to get in the doctor’s face, and who will if necessary call a lawyer who will get in the doctor’s face.”
Most doctors are willing to fight pain, but a few are pansies. I’m told that the only time nurses go over a doctor’s head at the loacl hospital is when the doctor is prescribing too little pain medication.
Alright, alright..I’m sorry, I take back the uncaring part.
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Heavens to Betsy. Time to go ice-skating.
I am absolutely astonished at the gullibility of some of our pro-lifers to let this go on. The culture of death vultures flock to hospices like birds in the winter. The eerie feel of enjoyment at the demise of others is so thick you can cut it with a knife.
Oh, I'm sure you outsiders see the whole pretty picture that you want to see while you are there during the day. The only thing that is missing with these "good" folks is a hook and a black cape...but hey!...they will continue to take really excellent care of everyone, for now, until it is no longer expedient to do so.
Yes...I'm an insider. So don't give me any administrative song and dance about the good side of humanity.
Take me off your ping list..I suspect you to be just another corporate clone.
Explain what? Why I requested a barf bag? Because I get sick watching you talk about the deaths of your parents, brother and son or daughter. You’ve said enough over the years to paint an ugly picture that turns the stomachs of decent folks.
Some people rave about their experiences with hospice. They vary. My grandpa (mom’s dad) was dying from dementia. He just stopped eating. We tried a feeding tube, but it didn’t work. He got weaker and lost weight. There was nothing we could do but keep him comfortable. When things were getting bad, my grandma called in hospice. My grandpa was no longer breathing right. He was making a “gurgling” sound due to build up of fluids which we have come to call the “death gurgle”. My grandma (dad’s mom) did the same thing when she died. It was midnight, and my grandma and aunt left to get some sleep. The hospice worker said his vitals were good, so they planned to be back in the morning. My aunt didn’t particulary care for the hospice worker. She said she could see my grandpa’s window as she pulled out of the parking lot. The nurse was watching them as though to be sure they were gone. They barely were home when they recieved the call that my grandpa had died. My family always wonders if she put something in his IV or put a pillow over his face to end it quick. We have no proof of such a thing, and there was no autopsy. We just weren’t impressed with hospice.
But trust me...both sides of the political isle will let this happen. There are too many of us coming to old age.
Suddenly..after the boomers are gone, one party or another will see a need to shut these places down...after the fact.
If you love your relatives..don't fall for it. Let them die in peace in the loving arms of their family, it doesn't cost a dime but maybe some lost wages and one less color TV with cable. We have got to make people see that what goes around comes around and we are heading in the wrong direction.
In mine too.
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Agreed.
I realize sometimes people can get too sick for family to handle. If I ever had to use a hospice like facility, I would search for the best one possible and watch what they do. I generally have not been satisfied with nursing homes I’ve been in for my two grandparents and others. I’m only 19, so I hope to not have to deal with this for a while, but I would like to try to care for parents with a private nurse at home when they get sick and elderly.
I think the doctors have a hammer so everything looks like a nail. Three times in the past year, they’ve brought my father-in-law to the hospital via ambulance and performed the same tests each time. All of which say he is fine, although suffering severe dementia. I understand the first time, but the same tests within months? That is hard to understand isn’t it?
Don't touch it for any other reason. The situation is going to get really bad and really dirty. There will be so many bad stories told. Protect yourself from it.
Or leave the room when an IV morphine drip is going.
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