By Arnie Burchianti
Reprinted with permission from Celtic Healthcare
It saddens me to realize the continued misunderstanding of the true meaning, benefits, and value of hospice care.
I recently read a blog post by Alan Cato, MD on KevinMD.com entitled, “The problem of hospice in nursing homes.” Cato commented on “boutique care being driven by entrepreneurial interests,” and stated, “In the nursing homes, hospice care should be the responsibility of the attending physicians and nurses already being remunerated by Medicare for caring for their patients.”
The Medicare Hospice Benefit covers the services of the hospice team to supplement the usual nursing home care at a difficult time when nursing home staff, family members and the patient are facing the increased and urgent needs associated with the end-of-life process. The Medicare Hospice Benefit cannot be provided to nursing home residents who are receiving skilled Medicare coverage if their diagnoses for both hospice and nursing home skilled care are the same. Before the Medicare Hospice Benefit can be initiated, patients may choose to use all their skilled care days or elect to waive their skilled coverage. Hospice care in nursing homes is not “double dipping” as stated by Cato in his post.
As the CEO of Celtic Healthcare, a homecare and hospice agency, I know our team considers it a privileged ministry to provide physical, emotional, and spiritual support to individuals facing end of life wherever their “home” is – be it their house, an inpatient unit, assisted living, or nursing home.
It is herculean to think a primary care physician or nursing home staff member, with all of their other important functions, can manage the actual presence that is required, the compassion that is needed, and the quality and dignity of life that is so desired and deserved by nursing home residents and their loved ones facing this challenging end-of-life time.
A hospice team consists of many members – including the primary care physician. It is comforting for the patient and their family to know their physician will remain involved during this time of greatest need and will be working in collaboration with a team of experts who are skilled in end-of-life care.
The hospice team also includes a medical director, nurses, social workers, bereavement counselors, chaplains, and various volunteers. They begin hospice care by preparing an individualized personal plan of care that includes providing comfort measures and pain management. When the patient’s symptoms and pain are under control, that is when the hospice team really gets to work – supporting the whole individual’s needs and those of their family. The hospice team will evaluate and provide for the psychosocial needs of the patient and their family, facilitate a life review for the patient, identify and connect the patient and their family with supportive community resources, perform a spiritual assessment and provide spiritual support, grief support, bereavement support, assist the patient with letter-writing, phone calls, final wishes of special interests or activities, visit the family after the patient passes, and provide continuing support for many months following the death.
Hospice care is so much more than pain management and symptom control. That is only the beginning. When we provide hospice care in nursing homes, we also help support the staff with programs that include music, pet, and massage therapy. We help provide personal care, companionship, and feeding assistance. We are expert in palliative and comfort medications. We do word-painting/story-telling and produce bound memories for families. We provide memorial services and participate in hospice advisory committees. We even provide supportive bereavement services to the nursing home staff and other residents who shared their life and had become attached to the dying patient.
Our hospice team members consider their work a “calling.” They have a special heart for individuals and their families who are facing end of life. They are experts in a field where the patient and their loved ones only have one opportunity to experience this sacred time.
Increasing evidence has found that individuals facing end of life prefer, are more comfortable and may receive more comprehensive and satisfying care when palliative measures, rather than life-prolonging goals, are pursued. When a patient chooses hospice care, they forego expensive testing, scanning, and other life-sustaining measures. Hospice care is not a problem; it is a solution and much-needed service in our nation’s healthcare reform debacle..