Hospice Care

By Virginia ‘Ginya’ Carnahan, APR, CPRC – Dattoli Cancer Center & Brachytherapy Research Institute

People often ask me if it is difficult to work day in and day out with cancer patients.  Indeed some days it is very hard to say goodbye to someone who has fought so hard to live.  For me most days are a celebration of victory over cancer, however.

I would ask the same question to the noble staff who work strictly with dying patients.  During this month, National Hospice Month, I’d like to salute all those who embrace and deliver the hospice philosophy of care to those around us who are terminally ill and facing death.

Recently I had the opportunity to sit with Dr. Neville Sarkari, the Medical Director of Tidewell Hospice, at a dinner.  We talked about some of the misconceptions held by the public regarding hospice care.

Perhaps the biggest of these is the belief that the patient’s death must be imminent – with in just a few days or weeks – in order to call upon hospice.  This belief unfortunately prevents many patients and their families or caregivers from taking advantage of the helpful hospice services until the very end of life.

To the contrary, Dr. Sarkari emphasized that inviting hospice in at the optimum time can provide the patient with real meaning and opportunity during his last months.  In the process, the caregiver is allowed to de-stress and find help with the everyday obligations to the patient.  Hospice becomes a partner in the patient’s journey toward a peaceful end of life.

Hospice care can help the patient and family accomplish some goals, such as reconnecting with estranged family members or friends.  If the patient is still active, hospice can assist him in making short trips to places and people he wishes to see.  Spiritual guidance through hospice can help the patient and family accept the finality of life and plan for the patient’s desired departure.  Hospice assistance can change the process from merely waiting to die, to actively living the rest of your life.

The textbook definition as to when one can or should start investigating hospice care is when the patient’s expected life span is about 12 months.  The Medicare criteria is when the patient is within 6 months of death.  Any patient requesting hospice care will be evaluated by at least two physicians in order to qualify for hospice care.  Once the patient is accepted into the hospice program, his care is completely provided by hospice.  (The patient’s Medicare benefits for hospice care are quite generous with absolutely no co-pay or deductible.)

There are two types of care through the hospice system:  hospice at home and inpatient hospice care at a medical facility or “hospice house.”  When interviewed about dying preferences, 85% of the public will say they wish to die at home, however only about 20-25% actually do.  Many more could spend their final days in the comfort of their home if they took advantage of their area hospice organization.

The vast majority of hospice patients do receive their care at home.  This involves hospice staff (doctors, nurses, social workers, and others) coming to the home as frequently as needed.

In speaking with Dr. Sarkari, something that surprised me is the fact that once under hospice care, all costs for the patient are borne by hospice.   This includes all drugs – even the wildly expensive chemotherapy pharmaceuticals (when appropriate).  If a patient requires this medication in order to alleviate pain, he will be given it regardless of cost to hospice.  This is the mission and philosophy of hospice – to optimize the comfort of patients by providing palliative support.  Hospice exists in the realm of peace and dignity, at a time when the patient should be surrounded by love.

Hospice operates by collecting Medicare and other insurance benefits, and by the generous donations from the public.  For those readers who are not familiar with the Medicare reimbursement model, for all medical services the Federal government, through Medicare and Medicaid, negotiates a set fee for every service.  These fees are generally greatly reduced from the actual charges.  Medicare (the largest sector of the hospice population) reimburses approximately $150 a day for hospice care.  This does not begin to cover the actual costs associated with sending professionals (and volunteers) to a patient’s home, or to cover inpatient care at a hospital or the “hospice house.”  Therefore a rigorous, year-round fund raising campaign is necessary to keep the hospice program afloat.  (I was very mistaken in assuming Medicare fees covered the bulk of hospice operating expenses.)

Not-for-profit hospice organizations (such as Tidewell) accept any patient, regardless of ability to pay.  It should be a great comfort to our community to know that in our final time on earth there is an organization dedicated to making that last transition one of peace, comfort and of our own design and wishes.

The hospice concept began in Europe as far back as the 17th century.  Today’s hospice is attuned to today’s fast-paced world where the focus of life is on this day.  Hospice services allow each of us to embrace the final day without fear and prepared for what lies beyond.   Not just in November, but year-round we should be grateful for our hospice organization and all the caring angels who deliver their services.

DATTOLI CANCER CARE
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