Hospice Patients Get Too Little Care In Last Days Of Life, Study Says

[+Malamute]

Hospice patients get too little care in last days of life, study says

 

http://www.upi.com/Health_News/2016/02/09/Hospice-patients-get-too-little-care-in-last-days-of-life-study-says/6501455034042/

 

The U.S. Centers for Medicare and Medicaid Services changed its policies for hospice care payments for 2016 in order to encourage more visits toward the end of life

 

WASHINGTON, Feb. 9 (UPI) -- One in eight hospice patients do not see a doctor, nurse, or social worker during their last two days of life, researchers for the federal agency responsible for the end-of-life programs found in a recent study.

 

The U.S. Centers for Medicare and Medicaid Services changed its policies for hospice care payments for 2016 in order to encourage more visits toward the end of life, when the agency says families are most overwhelmed and patients often experience significant changes in symptoms and pain.

 

The change, effective Jan. 1, adds a "service intensity add-on payment" for up to four hours per day during the last seven days of life for a registered nurse or social worker, will address some of the problem, researchers said. Previously, Medicare paid a single rate per patient, regardless of how many times a medical professional visited them.

 

Hospice is a specialized type of care meant for the physical and emotional needs of people dying from incurable disease, and to help their families care for them and cope.

 

Aside from rural locations affecting the availability of some services, the researchers at the University of Washington who conducted the study also noted a lower likelihood of visits for patients who are black, die on a Sunday, or are in a nursing home.

 

"They can make changes to ensure that the dying patient is comfortable and to provide education to the family on how to care for the patient in the last days of life," Dr. Joan Teno, a professor of medicine at the University of Washington, told HealthDay of the importance for medical professionals to see patients in their last days of life.

 

For the study, published in JAMA Internal Medicine, researchers analyzed medical records for the last two days of life of 661,557 Medicare beneficiaries who died in hospice between October 2013 and September 2014.

 

The researchers found 12.3 percent of all patients in the study received no professional staff visits in their last two days of life, with rates ranging from 3.8 percent of patients in Wisconsin to 19.7 percent of patients in Alaska seeing no medical professionals before they died. Among 3,400 hospices, 8 percent didn't visit any patient during their last two days of life and less than 1 percent visited all patients in their final two days.

 

Black patients were about one-third less likely than white patients to have visits in their last two days, and people dying in a nursing home were 1.74 times less likely to have visits than people dying at home.

 

Patients who died on a Sunday were 3.35 times less likely to be visited compared to people who died on a Tuesday, the study also found.

 

Although the researchers were hopeful the payment change can correct some of the problem, researchers in an editorial also published in JAMA Internal Medicine suggest more research is needed to determine exactly what families need -- which has a better chance of solving the problem, they say.

 

"Rather than putting too much emphasis on a process measure," they wrote, "our goal should be to directly measure what matters to patients and their family members, use these data to craft solutions to improve the delivery of care by individual hospice programs, and ensure open access to this information to promote the best possible experiences for patients and their families near the end of life."

 

[AmishRnot4ganja]

In Israel hospice patients get as much cannabis as they want. In Great Britain hospice patients get heroin. Doctors there say that there is no better drug for hospice patients.

 

In the U.S. people are expected to "tough it out" the best they can because a bunch of ignorant Conservatives keep these drugs off limits.

 

I really dislike the fact that conservatives feel that they are commissioned by God to tell other people how to live their lives.

[t-pain]

worse than that, doctors refuse regular painkillers because "a person might get addicted" . thats really really disgusting.

[+Malamute]

Nixons war on drugs still coming to fruition.

[trichcycler]

my loved one received as much morphine from Hospice as desired by her and us. Blue Water Hospice withheld NO drugs or compassion. Their nurses would sometimes have tears in their eyes while hugging us and their patient. 

[beourbud]

In my experience hospice has provided an excellent, professional and compassionate service.

. St Joseph Mercy Health Care Oakland Co (x3)

 

This is just a way for the Medical Industrial Complex to squeeze more $$$ out of a family when they are vulnerable.

Edited February 10, 2016 by beourbud

[Greg Rx]

In Israel hospice patients get as much cannabis as they want. In Great Britain hospice patients get heroin. Doctors there say that there is no better drug for hospice patients.

 

In the U.S. people are expected to "tough it out" the best they can because a bunch of ignorant Conservatives keep these drugs off limits.

 

I really dislike the fact that conservatives feel that they are commissioned by God to tell other people how to live their lives.

This is not true. True Hospice patients get all pain and comfort medication they need. Hospice patients that live for months, not so much. To clarifiy, some patients use hospice when it is not yet appropriate. You can tell the difference when they are still getting maintenance meds like BP and statins.

Edited February 10, 2016 by Greg Rx

[trichcycler]

This is not true. True Hospice patients get all pain and comfort medication they need. Hospice patients that live for months, not so much. To clarifiy, some patients use hospice when it is not yet appropriate. You can tell the difference when they are still getting maintenance meds like BP and statins.

 

good info^

Hospice is not immune to abuse. Drug abuse, suicide wishes, and inexperienced employees. I've worked very close with all of the mentioned. Each Hospice service may be independently owned and operated like a franchised business, which it may actually be. I've

personally witnessed facility kickbacks, and some facilities lock out competing Hospice services.

 

That may be a worse case scenario though, because when I became close with BWH my view changed concerning aftercare services. The group should be the example of how its done properly nationwide imo.

 

what I don't understand is how a few seconds at the veterinarians office and my beloved pet passes without issue, unwarranted/unneeded attentions, or wasted money and it works every time, while a hospice service can drag out the process for months or longer and the process, even at its best performance, is more upsetting than one needle, one last breath, and closed eyes for good. Even the executioners in our prison systems cannot get this right, over hundreds of years. one shot, one breath, closed eyes. what is the problem with that? $$imo

[keylan]

This is not true. True Hospice patients get all pain and comfort medication they need. Hospice patients that live for months, not so much. To clarifiy, some patients use hospice when it is not yet appropriate. You can tell the difference when they are still getting maintenance meds like BP and statins.

Well the dirty little secret is that a lot of longer term Hospice patients are getting Hospice because it is a way to get more services for patients who cannot get services they  may need any other way. The system has figured out Hospice can provide needed services that other agencies cant provide.

[Wild Bill]

My experience with hospice is that they stop all treatment except pain killers. The medical community's fear of addiction is alleviated by imminent death.

[trichcycler]

I watched one hospice service give antibiotics to get rid of  telling bed sores, a huge demerit on the facility they were "in" with. This is not the norm for them surely, but I've seen worse even. Shop your service carefully. They let anyone own a Hospice Service.

 

https://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html

http://www.palmbeachpost.com/news/business/hospice-for-profit-business-of-dying-is-booming/nL25c/

[outsideinthecold]

My mom went down in September, 2015. I visited with her in the morning. She was fine. That afternoon she went back to bed and never got out again until she died in December.

 

My wife and I cared for here with help from the Comfort Keeper lady who had been coming in twice-a-week to help.

 

Over three months. Hospice was some help, but in the end it was our responsibility, duty and privilege to provide this care.

 

We are all going to die. So whose responsibility is it to provide for end-of-life care? The government's? or hers? or mine? Not yours, right?

 

Consider that nice 21-yr-old girl manning the entrance booth at Benton Harbor's Jean Klock Park. Pregnant with her fourth child by a fourth father. A nice girl, lively, intelligent and fertile. And totally dependent on others now and forever.

 

There are no government programs that can change her trajectory and those of her children. The odd outlier aside, her children and her children's children will be poor. No government can fix this problem. Big government and more programs to this point have only worsened matters. It should be obvious to anyone that well-meaning efforts to this point have only compounded the problem.

 

Children can't be the responsibility of others. It won't work. Big government socialism can't compensate for bad parents.

 

You breed 'em, you feed 'em is the only true solution. Getting there from here is impossible.

Edited February 11, 2016 by outsideinthecold

[t-pain]

so what happens if they can't feed em?

[Wild Bill]

so what happens if they can't feed em?

 

Are there no prisons? - Ebenezer Scrooge

[beourbud]

Are there no prisons? - Ebenezer Scrooge

Why do I picture Trump in my mind when I read this line?

[outsideinthecold]

What happens when a parent can't provide for their children?

 

Don't we see the results daily across the world? What are refugees?

 

But of course that can't happen in America because .........?

 

Because of the government?

 

So what happens to them when the government goes broke?

 

But of course this can't happen in America.

 

We have rich people we can tax..........

 

Until we run out of rich people.

 

And then?

 

FY2016 and the Federal deficit is climbing again. FY2015 the interest on the national debt grew faster the the GDP and the trend is accelerating.

 

How does that work in the longer term? What happens if the interest on your credit card grows faster than your income? You go bankrupt. Government's are no different.

 

No matter how hard it tries, the government can't convert the entire mass of the known universe into human flesh and blood.

 

So maybe it is time to rethink the government's 'be fruitful and multiply' approach to governing and give so consideration to the generations who follow in our footsteps, if any.