In Hospice Care, Longer Lives Mean Money Lost (Patients Refuse To Die)

NY Times ^ | 27 November 2007 | By KEVIN SACK

[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.

[RosieCotton]

Let them die in peace in the loving arms of their family

Not to keep harping on this, but this is *exactly* what hospice allowed us in my mother's case. Otherwise, she would have been in a hospital somewhere, without all of us being able to crowd into the room, without having her garden in view out her window, without close neighbors constantly stopping by.

There's hospice and there's hospice.

[Earthdweller]

It’s the facilities that are prone to corruption and cost mega bucks. I see no problem with limited private hospice care in the home.

[Mrs. Don-o]

You need to check into what kind of hospice program it is.

We had my father on a home-hospice program with CNA's coming in our front door early every morning to give him a sponge-bath and shave and change his linens. They made sure he got pain management very promptly when he needed it, advised us on feeding and other comfort care --- they even arranged to have his earwax cleared out by a visiting medic so he could appreciate his favorite CD's.

Without them, it's hard to see how we could have kept him home in his period of long decline (he actually received home hospice services for 27 months.) Those gals loved ol' Edward and treated him as they would have treated their own fathers. Four of them came to his funeral Mass and prayed and wept with us when he died.

[Earthdweller]

Any good home care company can do this. It doesn’t have to be funded by a death cult.

[therut]

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.

[traviskicks]

Perverse government incentive alert...



Libertarian ping! To be added or removed from my ping list freepmail me or post a message here.

[traviskicks]

“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.”

Hillary/Romney/Huckbee care coming @ us...

[KoRn]

"IN my experience that is already occuring."

My wife, who is a Registered Nurse, has told me about this too. She was bothered by it when she first became a nurse and noticed it happening with patients who were nearing death. She came home one day a little disturbed and told me of how increasingly high doses of Dilaudid or Fentanyl will eventually push a dying person over the edge. She has since moved to the Women's Health unit and helps deliver and care for babies and their mothers. She's MUCH happier doing that being a young mother herself.

[Hildy]

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

So taking care of one's parents and family when they're ill turns your stomach? Interesting admission about yourself.

[cyborg]

I’m starting nursing school in January. All is well with the world of me :-)

[Tired of Taxes]

She came home one day a little disturbed and told me of how increasingly high doses of Dilaudid or Fentanyl will eventually push a dying person over the edge.

OMG. I can't believe what I'm reading here. My father fought for months, pleading with physicians to treat him for his cancer, after a surgeon messed everything up. We pleaded with them, too. We finally found doctors who agreed to treat him, but the hospital ethics committee tried to stop them, and the other doctors tried to bully us into accepting hospice. Finally, Dad was given a treatment by the sympathetic doctors, and he was tolerating it well, until another doctor gave him Dilaudid. (He was not supposed to be given any narcotics.) Eventually, the other doctors realized what happened, and they gave him an antidote. But Dad ended up in ICU and died within days.

[Tired of Taxes]

Adding: We always suspected the Dilaudid.

[KoRn]

"But Dad ended up in ICU and died within days."

Very sorry to hear that.

[Hildy]

Thank you for that informative post. It’s a difficult situation no matter where you’re sitting on this one.

[Mr. Silverback]

Have you ever seen the inside of a bad hospice or nursing home at night when all the relatives and administration have gone home? Until then, don't tell me what I am saying is just simple bashing.

No, I admit I haven't. Have you been to every, or most hospices? More than, say, ten? Have you ever seen the inside of a good hospice, nursing home or hospital geriatric ward at night when all the relatives and administration have gone home? I have, in the latter two cases.

Take me off your ping list..I suspect you to be just another corporate clone.

Thanks for the insult. Of course if I disagree with you I must be a cog in some big corporation. As a small business owner who's never done a minute of work for a hospice, nursing home or any large medical corp, I am proud to be the target of your prejudice. Happy trails.

[Mr. Silverback]

Alright, alright..I’m sorry, I take back the uncaring part.

Gracious of you. Apology accepted.

[LilAngel]

Is that what you call what you did to your own child? Is that what you call what you say you allowed to happen to your own father?

Killing is ugly.

[Mr. Silverback]

Please explain how having a professional come to your home to help take care of a loved one and ease some of their pain is a part of the culture of death. I’m all ears.

Seconded.

[Mr. Silverback]

Request for facts seconded.

Whenever someone starts telling me thaey have special knowledge that no one else in their whole political movement (or line of work, etc.) has, my bogometer pegs.

[Mr. Silverback]

Since you have so much experience and such strong opinions on hospice care in the US, I would really like to know what are your recommendations for the care of people who are no longer seeking active health care interventions for their medical problems? You have told me that my perspective is wrong, so please add to my knowledge of the issue.

Seconded!