Column 49

Column 49 - June 1 -2014

Every profession has its black humor.  In our business, we chuckle when a client uses the phrase, "IF I die".  I gently correct them to add, "if you die ...prematurely?  The reality is that humans have a 100% mortality rate." 

I have been working remotely from the Bay Area (and returning home to see clients two days per week) while serving as primary caregiver for my mother-in-law who has come home with Hospice.  I believe it is valuable for readers to understand this benefit which is provided by Medicare and most insurance companies. 

Hospice staff will lament the fact that too often families do not access these benefits early enough. There is a bit of a "grim reaper" perception when one says Hospice. This is simply not the case.  There comes a time in a person's life that there is simply nothing curative that can be done for a patient, regardless of the diagnosis. Hospice is not just for cancer patients.  Some patients access hospice benefits only to "come out" of the program. Also you can stop hospice at any time.

Often the patient will have experienced a cycle of acute care hospitalization, discharge to a Skilled Nursing Facility (SNF) and back again. The patient is poked and prodded, awaken every couple of hours for vitals, blood draws etc.  It is often exhausting and depressing for the patient and family.  The decision to transfer to Hospice allows the patient to return home and be treated with dignity and the additional care provided by family and the Hospice team. 

To qualify for hospice under Medicare you must meet all of the following conditions:

1)    Eligible for Medicare Part A

2)    Your doctor certifies that you are terminally ill and have 6 months or less to live if your illness runs its normal cores

3)    You sign a statement choosing hospice care in lieu of other Medicare benefits to treat your terminal illness.  Medicare will continue covered benefit that are not related to the terminal condition

4)    You use a Medicare-approved hospice program

The support team provided under hospice is extensive.  It includes physician, nurses, counselors, social workers, physical and occupational therapists, homemakers, home health aides and volunteers.  They provide approved medications for a $5 copay as well as diapers, wipes, gloves, chux, personal care supplies at no cost.  The program provided a hospital bed, wheelchair and lift for us as part of the durable medical equipment.  One bit of advice, be sure to request the electric bed.  The crank is not fun.  Also consider requesting a phone egg crate mattress or inflatable.  Unfortunately for us, they delivered the inflatable, which was not comfortable.  I was chagrined to find that it could not be returned, only discarded after one day of use. I thought it could be sterilized.

In our case, the home health aide comes by weekly to bath and change sheets for my mother in law.  This is a nice addition to our personal care for her.  The nurse comes by weekly for a thorough examination and progress report.  I have used the 24 hour hot line to ask how to manage medications and symptoms that are new to me.

There is also a limited benefit for respite care and counseling services. 

Medicare will not cover room and board if you get hospice care in your home or if you live in a nursing home or inpatient facility.  They will not provide care in the ER, inpatient facility or ambulance unless it's arrange by your hospice team or is unrelated to your terminal illness.

Hospice is provided in benefit periods, beginning with up to two 90 day periods followed by an unlimited number of 60 day periods. 

My dear friend and client Jack Kimple MD, said the greatest gift you can give someone is a graceful and dignified exit.  Hospice allows us to provide this to our loved ones. In that vein, I would recommend the following two books:

1)    "Medicare Care of the Soul" written by another client, Bruce G. Bartlow MD, who practice critical care in Redding.  This book discusses not only the physical process, but the ethical and spiritual considerations of the process.

2)    "How We Die" by Sherman B. Nuland.  This book is more a detailed process of how we die from the most common illnesses.   

Finally I would like to add a word of thanks to my staff and clients who have been so supportive of this change in schedule.

Note: All information in this column is provided" to the best of my knowledge" subject to final regulation by the respective agencies at press deadline.  Please submit questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .