Preparing to Die

Friday, July 22, 2011

Peter Waldman, reporter for Bloomberg Businessweek, discusses his investigation of for-profit hospice care.


Peter Waldman

Comments [18]

Deborah from Midwest

I believe it is irresponsible to arrive at the conclusion that all "for profit" hospices are in the practice of milking Medicare dollars from patients who are not yet terminal. In my experience, while unfortunately there are some that do, the majority of for profit hospices put patients on service because their physicians and caregivers believe that there is a need for added care near the end of life. Let us remember that hospice employees are the "end of life" experts. Let us remember that they possess knowledge of end of life care that is not standard practice. Additionally, two physicians must certify that IF THE PATIENT PROGRESSES at the expected trajectory, they have 6 months or less to live. These are both not typically physicians employed by the hospice. The key to remember is that if a patient plateaus or improves for some reason, they should be taken off hospice until they are truly end of life. Let us also remember that the "not for profit" hospice is reimbursed by Medicare in the same way that a "for profit" hospice is reimbursed. In my area, the non-profits also provide less medications and equipment from their per diem reimbursement than do the for profits. As a nurse, I have worked both for a non-profit and a for-profit agency in my area. I truly believe that the patients are receiving better care from the for profit agency. We are much more aggressive in providing equipment for comfort or ease of care, for which there is no additional reimbursement. This includes specialized wheelchairs, electric beds, pressure relieving mattresses, etc. The ONLY difference I can identify is because non-profits can fundraise, they are more likely to take patients that have no payer source and use donations to pay for their care. For profit agencies must "write off" the care given to patients with no funds for hospice because they are prohibited from fundraising.
Out of the hospice per diem comes all medications, all equipment, all staff visits, including a nurse, nurse's aide, medical social worker, and chaplain. In the radio broadcast, the caller who stated that their mother was on hospice and received a once per month nursing visit was either being untruthful, or her mother was on a hospice that did not follow hospice regulations. I have a very strong concern that inflammatory stories based on a few unscrupulous agencies are going to end up eliminating the hospice benefit for people who need it.

Jul. 26 2011 04:03 PM
Larry from Monmouth County, NJ

Fine program. You might consider a program on a somewhat related subject, Death With Dignity. The organization, Death With Dignity National Center, helped enact the Death With Dignity legislation in the states of Oregon and Washington.

Jul. 24 2011 05:01 PM
Mark RN... ohio

I am a hospice nurse at a non profit hospital based hospice. I've worked for a for-profit hospice in the past. What a differance. The for profit patients were much less acute and required many less visits and stayed on as patients much longer. I wish I could have called in during the show... your guest was right on the money (litteraly) about the for-profit hospice way of doing business. They seem to funnel patients into their program with less regard for real terminal diagnoses. And they also develop relationships with nursing homes and assissted living facilities that skims the "cream" off the top.

Jul. 23 2011 06:28 PM
Meredith from West End Ave.

For Amy from Manhattan, to dispel your anxiety about hospice: It really should not be surprising that the kind of care one gets in hospice—while not receiving aggressive and debilitating treatments at hospital—may lengthen life. Optimizing the quality of life by diminishing physical and emotional stress as Hospice can (through symptom-management and even inclusion of curative therapies aimed at palliation rather than cure) may, indeed, extend a patient’s life past 6 months—which is why hospice is renewable. This renewability was not built-in to foster fraud, but because no one has a crystal ball. And, alas, it is because nobody has one that most hospice referrals are made not too early but heartbreakingly too late.

Jul. 23 2011 09:11 AM
do you read the ny times? from NY, Also a major underutilizer of hospice,50% below US avrg

This is hardly news, there have been one or more articles in the NY Times re this exact issue. This is such a relatively small issue, that's known to the industry and medicare, and they do already monitor for this problem and respond (with industrywide policies and investigations and claims against offending hospices). Hospice and healthcare in general have bigger problems, frauds, and inefficiencies that need investigation publicity and follow up solutions.

Jul. 22 2011 06:53 PM
s haveson

just because it is not for profit does not mean that there are no abuses in the system. The bilking of medicare by hospice, VNS, Home Health Care Agencies, Hospitals, all perpetrated by "us the people" We all think that we are entitled to services whether we really need them or not. Obama idea of using evidence based medicine to determine the necessity of a treatment is the way to go whether it is a medication or a service

Jul. 22 2011 02:35 PM
michael glennon from Mount Sinai, New York

I am a hospice volunteer for a non profit. I see patients in their homes and at our 16- bed hospice. I am not able to comment on the issues dealt with here because I know nothing about them. However, I do want to include in the discussion my observations and judgment about the hospice care I observe and have observed for over six years. I see up close, care that is compassionate and comforting to the dying and to their families. I see caregivers doing God's work and hope that when my life is near its end I shall be in hospice care.

Careful and rigorous regulation should be controlling hospice care and eliminating those who would distort these services for their gain. I thank Mr. Bergman for calling attention to it. Michael Glennon

Jul. 22 2011 02:13 PM
Meredith Lisagor from 910 West End Ave, NY 10025

I regret having tuned in late to your hospice discussion. I am not sure whether anyone noted that the national average hospice stay is @ seven days. As a hospital chaplain, who has worked with palliative care for seven years (and, of course, with the dying all my career) I must note that many (many) people are referred to hospice two or three days before their deaths.

I applaud an interest in exposing for-profit facilities that go trolling for patients and physicians who may bilk Medicare; but the broad and tragic healthcare fact not addressed is an obdurate commitment by many docs to curative treatment-plans that are almost contemptuous of patients’ comfort/quality of life. This is abetted by the heartbreaking popular misconception that if there is nothing more that can be done to cure, there is nothing more that can be done to help: the fallacy of “death panel” contention.

Jul. 22 2011 02:05 PM
Susan from nyc

Yes Brian, very often patients who are treated aggressively with conventional therapies do die faster than if left in hospice care. I wish you and Leonard Lopate would do an expose on the medical industry vs. alternative medicine. The medical industry has demonized alternative medicine not because it doesn't work, but because it works better than most things like chemo and radiation and some surgeries for cancer, and they are non-toxic, but the medical industry can't make money off them. If you don't believe me, you should read a book called "Outsmart Your Cancer" by Tanya Harter Pierce which you can get on line at Amazon or Barnes & Noble. It is one of many books on the subject which the Medical industry tries to suppress.

Jul. 22 2011 11:40 AM

My grandfather received hospice care in-home in Michigan. It was one of the most beautiful things I've ever seen. The hospice nurse spoke to him about things from his generation.

Jul. 22 2011 11:33 AM
Pat from New York, NY

Eleven years ago my husband was severely debilitated by metastacized cancer and was expected to have a short time to live. Then he got a stroke and clearly expectations were shortened. There was no question that hospice was the right solution; I chose to care for him at home with an aide sent by Hospice for a few hours a day. The program was to do nothing to extend his life; only to make him more comfortable, and the expectation was that he had only days to live. But somehow he lived three months, in great discomfort. I chose to pay out of pocket to deal with some of his problems that were not deemed important enough for hospice to cover; and was told this was very rare; most hospice patients die in a few days, certainly just a few weeks. Hospice management and the professionals who supervised were excellent and caring; the aides less so.

Jul. 22 2011 11:30 AM
rose-ellen from jackson hts.

Beware when something is over praised.I have never trusted hospice,though I have no direct experience with them,the over praise of them always striked me as a red flag.The indirect experience I have is with a friend whose dying father was placed in hospice. My friend was quick to praise the care[with all the cliches you hear from the pro hospice media] but once ,in commenting about his latest visit to see his father he stated that when a particular nurse entered the room he [the father] started shaking like a leaf.He mentioned this in passing but it stayed with me and about a weeks or so later his father died,No family member was present.I just don't trust these overhyped institutions.[and reluctance to give drugs to stop pain is cruelty.]

Jul. 22 2011 11:24 AM
Rachael from Brooklyn

We are looking into hospice for my elderly grandmother who suffers from dimensia and anxiety... the assisted living center is not able to give her the care she needs and are concerned for her well being - she has an extreme phobia of hospitals so hospice seems like the only viable option for her to get the care she needs and have a decent life while it lasts

Jul. 22 2011 11:23 AM
jmurphy from long island

My father, in his 80s, was diagnosed with stage 4 prostate cancer,which men can live with for quite some time, in 2009.

He was so spooked by his brother's collapse and death (home alone, not found for 2 days) that he checked himself into hospice in December 2009. He was ambulatory and pain free. He didn't die until April 15, 2011.

I thank your expert for noting the lack of palliative home care in this country. It is not discussed often enough.

Jul. 22 2011 11:21 AM
Amy from Manhattan

If patients are being sent to hospice care when they could live longer than 6 months, does that mean people who could be helped by more aggressive care aren't getting it because they've been switched to hospice care?

Jul. 22 2011 11:20 AM
karin johnson from Long Island mean for profit healthcare can interfere with best practices?!

Jul. 22 2011 11:16 AM
Bernard Bergman from MoneyTreeAll

Just like the 1970s nursing home scandal with Bernard Bergman whenever there is profit motive to health care, people will cheat and harm patients.

Did anyone fread the NYTimes article a few months ago about how US hospitals do two scans MRI rather than one as other countries just to get an extra payment?

Cannot allow a profit motive in health care

Jul. 22 2011 11:14 AM
Steve Viederman from 135 E 83, NY 10018

There is too little discussion of hypnosis and the alleviation of pain. As early as the late 50s Ernest Hilgard, emeritus professor at Stanford, wrote about how hypnosis could be used where pain was chronic and not symptomatic. The benefit was that patients would not be comatose as they often are when conventional pain killers are used.

Jul. 22 2011 09:51 AM

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