Category: Hospice Care

Equal Access

If you have a few minutes to read this article: https://splinternews.com/how-to-not-die-in-america-1822555151 (it’s a few pages long) – it is a worthwhile time investment that highlights the healthcare disparities in the employer-driven US insurance market.  As more people, both younger and older, find themselves self-employed they are at risk for bankruptcy if they become seriously ill.  Being hospitalized and intubated in the ICU for a bad case of the flu might not kill you, but could wipe out your savings.  There is no fairness in a system that charges an accountant working in a temp agency tens of thousands of dollars for a hospital stay, while an accountant who is a full time employee pays a maximum of $5,000 out of pocket for the same services and procedures (or better ones, depending on their plan’s affiliations).

Hospice care is the only part of our healthcare system where everyone has access to the same support and services regardless of insurance plan.  Everyone gets home visits from RNs, aides, social workers, chaplains and volunteers.  At Care Partners, an RN will come every day if your condition requires.  Our social workers help with a wide variety of non-medical needs, from legal documents to family dinners out to arranging travel.  Whether wealthy or indigent, you will get the best care we have to offer.  Hopefully one day the same will be true for the rest of healthcare in America.

Not All Hospices Are the Same

A recent article in the New York Times (“This was not the good death we were promised” published on 1/7/18) highlighted once again that not all hospices are the same in their prioritization of patient and family needs.  Glossy brochures and service “extras” don’t substitute for being able to count on a highly trained healthcare professional to respond in times of crisis – which can be at any hour of the day or night.  Cancer patients in particular have a less predictable disease course, and the potential for unanticipated symptoms arising in their final weeks.

Care Partners prides itself on having a nurse on-call 24 hours a day, 7 days a week.  If needed, one of our physicians will also evaluate the situation and recommend a course of action – even at 3 am.  We often visit patients more than once a week (potentially multiple times in one day if required) and we are in contact with the home at least four times in the first 48 hours after admission. There is never a time, including holidays, when our phone is not answered.  We always do advance planning and coaching with our families, making sure that an adequate supply of medications is in the home, as well as specialty “kits” we have created for emergencies like seizures.

Hospice has the potential to help patients through a good death experience (see another New York Times article, “One last visit to see my patient” published on 9/25/17), but Medicare payment reforms are needed to insure that funds are available to cover services for patients with high needs.  Currently hospice is the only type of care with flat reimbursement unrelated to patient acuity.  As a result, for-profit agencies have fewer incentives to care for medically-complex patients with short stays, while non-profits whose mission is to provide exceptional care without exception are under pressure for incurring costs far above the daily rate they are paid.