hospice

[teriwtt]

<p>Ellen - I am a chaplain; I will let busyparent speak for herself because I think she has had multiple roles. </p>

<p>I don’t do gross very well (actually smells, either). I’ve been known to excuse myself from rooms when someone thought they were going to throw up - the last thing we’d need is for two people to throw up. I carry with me a small bottle of essential oils (lavender) I use sometimes for doing a blessing of the body; I’ve been known to pull it out and put a little under my nose to mask certain odors. </p>

<p>Some of the most caring home health aides I’ve seen are males - sometimes they’re actually physicians in their native countries, but cannot get licensced here. Our agency carries a daily census anywhere between the 160s and 200. Average is usually around 180.</p>

[mini]

<p>“Yes, I am the nurse, David would be a terrible nurse, for one thing he doesn’t do gross well.”</p>

<p>I’d be an EXCELLENT nurse, Ms. Mini. I’d be the best paperwork-wielding charge nurse you ever saw. (But I’d never get past my required rotations. :))</p>

[teriwtt]

<p>I’m resurrecting this thread for a personal agenda. I was very appreciative here of those who shared their hospice stories. Unfortunately, the future of many hospices is at risk right now. I am sharing a piece from a hospice blog that I follow that explains how the Centers of Medicare and Medicaid Services has finalized rate cuts for hospices, beginning October 1, 2008:</p>

<p>

First, to understand how hospices can claim their rates have been cut while the government claims they gave hospices a pay raise, you must understand that there are two parts to the formula used to figure hospice payment rates. The first part of the formula is the national hospice payment rate. It is the amount of money that Medicare pays for a day of hospice services. The second part of the formula is the wage index, which basically accounts for the fact that it costs more to provide care in some parts of the nation as opposed to other parts. Typically, it costs more money to provide care in metro areas than in rural areas. Thus, the wage index assigns a “multiplier” to every county in the nation. To make the math easy – if the payment rate for a day of service is $100, an area that has a multiplier of 1.1 will actually get paid $110 per day while a hospice with a multiplier of .8 will only get $80 a day. With that in mind, let me explain how hospices across the nation got a pay raise and a pay cut in the same day.</p>

<p>Medicare’s press release focuses on the 3.6% increase in the hospice payment rate. Thus, that $100 per day of service will become $103.60 next year. The payment rate is increased every year, it is a raise that reflects the increase of the cost of living… Hospices know it is coming and know that it is usually around 3%. Thus, Medicare’s press release focuses on the normal pay raise that hospices get.</p>

<p>The pay cut comes on the wage index side of the formula. This year, Medicare decided to totally phase out the “hospice wage index” and move hospices to the “hospital wage index”. Again, for reasons I don’t care to explain and you probably don’t care to understand, there were significant differences in the two wage indexes. In fact, the differences are so large, that they are going to allow this transition to be phased in over a three year period to ease the pain. According to Medicare, the average hospice’s pain will be a 1.1% decrease this year. Some are in much more trouble than that. </p>

<p>According to the government the average hospice makes a profit of 3.4%. At the same time, the three year effect of this wage index change is 4.8% for the average hospice. (Both numbers are from NHPCO communications.) That math doesn’t work in the best of times, and these are not the best of times. Medicare has already established new rules to govern hospice care, and those rules will not be cheap to implement. Those rules are going to cut out some of the 3.4% profit. This new wage index change will take all the wind out of many hospice’s sails.

</p>

<p>For those who have read through this, you can see why there is concern for many hospice organizations (mostly the non-for-profit). Last Friday, both the Senate and the House of Representatives introduced bills to stop the Medicare hospice rate cuts. If you are one of those people who are so inclined to send e-mails to your representatives and senators, I’m giving you this information so that you can make your opinions known to them. If you go to the The National Hospice and Palliative Care Organization (NHPCO)website, they have an easy link to facilitate contacting your elected officials.</p>

<p>Yes, I’m very concerned about my job right now; as a chaplain, we are the only members of the hospice team whose visits are not reimbursed by Medicare. We will likely be the first discipline hit by these cuts when agencies are trying to make ends meet. Interestingly, Medicare requires that all hospices provide spiritual support to their patients. I could write a whole thesis on why getting rid of hospice-trained chaplains is a bad idea, but that’s for another post. Please let me know if I can clarify any of this for you. If I can’t, I know there are several hospice workers on this board, who have participated in these discussions before.</p>

[mommusic]

<p>I have only heard good things about hospice, having had friends, acquaintances, and one husband of a friend enter hospice at the end of their lives. Also my uncle had home care from hospice so he was able to be very comfortable with end stage colon cancer.</p>

<p>The older I get, the more acquainted I am with these things, unfortunately. There was a time when I didn’t personally know anyone in this situation…except the grandparents, and as a child it wasn’t my worry or responsibility. </p>

<p>Ah, the sandwich generation.</p>