More About Hospice
7/12/2009 - Mary Johnston
As I write this my co-workers and I are facing a deadline. We have until Monday at 5p.m. to resign from our jobs with a small monetary incentive or risk being laid-off on Tuesday. At this point our executive director cannot predict who may be laid-off until she sees who has resigned.
This announcement came during a staff meeting Friday, after a year of our hospice organization fighting to stop a decline in our census. This appears to be a nationwide trend and no one knows for sure why hospice admissions are declining. One theory is that people are forgoing all health care due to cost which impacts the number of hospice referrals from doctors, hospitals and long term care facilities.
A salesman who sells program software to health care agencies was in our office today and said that several states have been taken over by for-profit hospices who are selective about who they admit. In other words, they pick the patients who will be least costly in terms of medication, supplies, labor, etc. (Susan referred to this in a previous response). Which leaves the most expensive care to the not-for-profits who have an open door policy. The result has been devastating to patients and families who need hospice help the most since not-for-profit hospices cannot bear this burden and are having to close their doors. And all this is happening as pressures to cut Medicare and Medicaid hospice benefits mount.
This is so repugnant to me that I struggle to even write about it. I don’t know what Monday and Tuesday will bring for me personally, but maintaining the only hospice system that is willing to care for the dying regardless of diagnosis and expense needs to be priority one.
13 Comments From Other Members
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| 7/12/2009 |
Susan Terbay from Dayton OH wrote:
Before I left hospice in 1999, our census was changing as well. The reason - the pop-up of profit making hospices, plus referrals were down - new medications, new experiments to try to live longer - patients - families. Sometimes we would have a patient for a day or two before they died- referred at the very last minute. Hospice is about the whole person and two days does not allow much time for staff. It is a double edge sword - promise of possible longer life vs accepting the end of life. Cut backs on Medicare and Medicaid ends the life of hospice - thus ends sacredness of life.
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| 7/12/2009 |
from wrote:
Mary, I am so sorry to hear this.
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| 7/12/2009 |
Melissa Harmon from Woodbridge NJ wrote:
My father is in an elder care facility in NJ. Last month two patients there died. One was my fathers roommate for a couple days before being sent back to the hospital where he passed. I heard a similar story of another patient being sent to the elder care facility from the Hospital only to die a few days later as they attempted to rush him back to the hospital.
Not sure of the economics, but I don't doubt that it had some part in turning patients out of the hospital despite being in terrible shape.
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| 7/12/2009 |
Mary Johnston from Solon IA wrote:
It's so frustrating. The circumstances you describe could have been avoided if a not-for-profit hospice had been called to assess these situations, advocate for the patients to stay hospital in-patients and pay the bill so the hospital wouldn't feel compelled to discharge. My husband is a medical social worker in a large hospital and he has to continually educate physicians, nurses, etc. about the benefits of referring to a hospice.
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| 7/12/2009 |
Susan Terbay from Dayton OH wrote:
It is a great loss Mary - sorry you are caught in it - I use to work with social workers and they were our life-line to doctors and hospitals - they understood the need of hospice as do many nurses. There are also some very ego doctors out there who don't want to come across as 'failing' if a patient is dying - instead of giving dignity to the person - they try everything that insurance will pay to keep a person alive and then - when there is only a brief moment left - turn them over - or not. It is about dignity and some missed that lesson somewhere.
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| 7/12/2009 |
Suzanne Caplan from PA wrote:
Hospice is also for the living to learn that the process of dying is a loving act. I have been there. Mary, my thoughts are that you do not leave until forced because the unemployment benefits are denied if you quit and they are defrauding you to make you choose that decision. I wish I could be there to help but as we say here, I've got your back and will be there if you need to reinvent yourself. Good luck and God Bless for what you do.
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| 7/12/2009 |
Carol Wilson from Dyer IN wrote:
Having worked in a hospital in pediatrics and then intensive care, I can say, "Mary, thank you for all that you do."
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| 7/12/2009 |
Mary Johnston from Solon IA wrote:
Thank you to everyone for your kind and supportive words. Suzanne, just to clarify, our executive director made it clear that resigning would jeopardize unemployment benefits and suggested we do so only if we were already thinking about retiring/changing jobs. There will also be a small severance package which will be given to everyone who leaves, whether through resignation or lay-off.
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| 7/13/2009 |
LeAnn Farley from Mt. Pleasant IA wrote:
I think that it is a travesty to be moving patients back and forth between facilities as they are dying. Can the people in these systems not see the human beings involved at all? Have they no empathy at all? And to the doctors who want to keep hope alive until the last minute--they are not doing anyone a favor by doing that. People need time to prepare. There are things they need to do while they still can. They can only do that if they are given the respect of being told the truth. Baby boomers, this will soon be us. We need to speak up now. Mary, I'm sorry too that you are going through this
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| 7/13/2009 |
Suzanne Caplan from PA wrote:
simply, did you resign? You have been on my mind all day. Tell us when you are comfortable.
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| 7/14/2009 |
Mary Johnston from Solon IA wrote:
I didn't resign. No one in my department (chaplains) resigned. There are three of us. So we'll see what today brings. Thanks for thinking of me.
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| 7/14/2009 |
Susan Terbay from Dayton OH wrote:
My thoughts are of you. i did resign from hospice but certainly for different circumstances but in some ways similar. The leadership changed as did the focus - but that's a long story. please keep us updated.
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| 7/14/2009 |
Dorothy Sander from Durham NC wrote:
We are all thinking of you today. Hospice is an extremely important entity and we should all work to figure out a way to keep it going...and not for profit! Hospice made a huge difference to me and my siblings when my mother was dying. She ended up falling and breaking her hip and then going into healthcare where hospice was not able to be present. Perhaps that is what is happening. She had been in the retirement community and it was their natural progression. The family made some wrong decisions but in health care, insurance pays for round the clock care - theoretically!
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