Frances Reeves

What is hospice? First, it is a type of care and philosophy that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms, as well as attending to their emotional and spiritual needs. OK - so what is palliation? Palliation is a service that makes you feel better even though it can't cure you.

Hospice is a positive addition to our medicare system because the focus is the patient. The goal is to keep each patient as comfortable as possible. This means additional care over what your loved one is already receiving. Between nurses, social workers and priests, there is someone there two to three times a week to make certain there is no pain or discomfort.

The other side of this service is that it is run by Medicare. That means that hospice is free if you’re in Medicare, as most of our seniors are. This also means not all hospice providers are the same. There are thousands of hospice providers and you have to be certain that they are doing their job (much like those Medicare doctors I’ve described in earlier articles).

A little background. Once a patient has been admitted to hospice, its doctors, nurses and aides “rule” the care. If the patient is a diabetic he or she will still stay on diabetes medicine but perhaps be taken off non-essential medication depending on the comfort level. Yes, the facility still feeds and provides a clean environment but hospice is in charge of the patient’s comfort.

I’ve had two different patients in different facilities with different hospice providers and that’s how I discovered that “not all hospice is created equal.” One provider serviced a Medicaid nursing home (poorer patients) and we’ll call it A. The other provider serviced an assisted living facility -- one that cost $4500/month. This provider is called F.

In most nursing homes the patients are in full blown dementia but not necessarily at the end of their life physically. Therefore, it is much more difficult to qualify for hospice in a nursing home. It took my client over a year to qualify, but once hospice A took over the care provided was beyond great. I could call anytime to check on her, once the children had given their permission.

The other client was in an Assisted Living Facility (ALF) and qualified for hospice before his children had requested it. They had no indication he was in his last days, weeks or months. Parent Your Parents was called in because once this client became “sicker” the children received the “run around.” The Assisted Living Center blamed the patients discomfort on hospice, and hospice blamed it on the Assisted Living Center.

We went into advocate mode. Hospice F was called daily and reminded that their job was comfort and they had to start providing real comfort, not reports to the children. Daily inspections were made by us or the kids. Remember these hospice companies want to make a profit and the more they can pass off to someone else they will. After the client became even sicker (due to the “run around”) we demanded a bed in a 24-hour facility. After three days of arguments, “F” finally found a bed in an extremely lovely location, where the client passed away comfortably and peacefully.

Bottom line: Not all hospice is created equal.

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