[doodlemom]

Originally Posted by nosonew

We currently have 58 patients. We live in a rural community and cover many counties. Luckily, we do have many donations and many/most of our clients do memorials to our hospice which helps make payroll (that is paid after paying medical bills of course!) and we also opened a hospice thrift shop with all donated items and that money is also used to pay for things patients need but are not covered.

I love love love my job... I wish I could win the lottery and donate half of it and work for free. Honestly.

Until last year, I have been told this hospice paid for all medications for all clients. They are still sad they can't keep doing that, but medications are just too expensive.

Are you saying that you are not paying for ANY medications at all?

[saribeth]

As far as I know Medicare pays a daily rate of $140???...there is no way our hospice could afford to have a pt on radiation or chemo, however, when we do have a pt that wants radiation for palliative tx we admit them as a home care pt but the hospice team follows them...that way their regular Medicare and or Ins will cover it...and Amy I can just hear those Docs saying "the pt will benefit from radiation" they just can't say no

[saribeth]

Notsonew...I would love to hear about your hospice thrift shop...how does it work? thanks Janie

[doodlemom]

Originally Posted by saribeth

As far as I know Medicare pays a daily rate of $140???...there is no way our hospice could afford to have a pt on radiation or chemo, however, when we do have a pt that wants radiation for palliative tx we admit them as a home care pt but the hospice team follows them...that way their regular Medicare and or Ins will cover it...and Amy I can just hear those Docs saying "the pt will benefit from radiation" they just can't say no

Actually the reimbursement rate depends on where you live. 140 is a lot higher than here - we're around 120. We are still able to pay for XRT pretty easily - it's not like it's happenning all of the time and the people who really need it are able to live more comfortably. The treatments can be as few as 3-4 and up to as many as 15. But when your talking about the patient being on service for a few months spending around 600 bucks to make them more comfortable seems pretty doable. We may have 2-3 people out of 300 patients receive it a month. Almost all of the patients that our medical director has recommended XRT for have benefitted from it. We use a lot of methadone which has brought our expenses down quite a bit, making doing things like XRT pretty affordable.

[aimeee]

Originally Posted by doodlemom

Actually the reimbursement rate depends on where you live. 140 is a lot higher than here - we're around 120. We are still able to pay for XRT pretty easily - it's not like it's happenning all of the time and the people who really need it are able to live more comfortably. The treatments can be as few as 3-4 and up to as many as 15. But when your talking about the patient being on service for a few months spending around 600 bucks to make them more comfortable seems pretty doable. We may have 2-3 people out of 300 patients receive it a month. Almost all of the patients that our medical director has recommended XRT for have benefitted from it. We use a lot of methadone which has brought our expenses down quite a bit, making doing things like XRT pretty affordable.

Ours is around $120 dollars too. I see a lot of the chemotherapy and radiation treatments being done not because any benefit is really expected but because the patient/family doesn't want to "give up" and the doctors just want to offer them something. They are not frank with them about the expected benefits versus the expected side effects.

[nosonew]

We pay for all meds associated with their hospice dx. Including any comfort care items (ie: bowel, bladder, depression, pain, etc. of course)

The thrift shop is in a rented building on our main street. They take donations, have volunteers that come in M-W to go thru the items, price, etc. It is open Thu-Fri-Sat. It is all based on donated items and volunteers. All monies go to help with hospice expenses.

I think they opened it because so many families lived out of town and didn't know what to do with the clothing, nik-naks, recipe books, crafts, Xmas items, etc... Occas. they get furniture. Lots of kitchen things.

Luckily, we nurses can use it for our patients needs as well. If a client with no money has a broken crock pot or coffee pot... we can go in there and get one for free. There is also a volunteer who checks everything electrical for frayed cords, if it works, etc.

[cateccrn]

I might seem like a dummy for asking this, but why would a pt. entering hospice be doing rad/chemo treatments at all? I am laboring under the impression that hospice is a place for diagnosed terminal pt.s and their families to be able to transition from health care through the death and dying process without artificial/useles interventions. The focus is supposedly on completing life work, and nurturing acceptance of death.
A "good" death is supposed to be the work of hospice, after all have accepted it's inevetibility(sp?).
If a pt. is still recieving chemo or radiation, (whether or not it be deemed palliative), is that not somehow imparting "hope" of a cure?
Because, I would bet that most pt.s and families look at any treatment as a "possible" miracle, and don't see it as "palliative" at all. Then all the work that needs to be done is delayed, and the goal of Hospice is unmet.

[doodlemom]

Originally Posted by cateccrn

I might seem like a dummy for asking this, but why would a pt. entering hospice be doing rad/chemo treatments at all? I am laboring under the impression that hospice is a place for diagnosed terminal pt.s and their families to be able to transition from health care through the death and dying process without artificial/useles interventions. The focus is supposedly on completing life work, and nurturing acceptance of death.
A "good" death is supposed to be the work of hospice, after all have accepted it's inevetibility(sp?).
If a pt. is still recieving chemo or radiation, (whether or not it be deemed palliative), is that not somehow imparting "hope" of a cure?
Because, I would bet that most pt.s and families look at any treatment as a "possible" miracle, and don't see it as "palliative" at all. Then all the work that needs to be done is delayed, and the goal of Hospice is unmet.

Quite frequently a patient may have pain that is r/t bone mets or tumor size and radiation can help shrink the tumor and therefore give pain relief. We've had patients that we were able to decrease pain meds a great deal and give them quality of life with decreased symptoms - which is the point. The intent is not a cure - or even to give them more time, but to help with symptom management. This does not delay any work that needs to be done and can actually give people the quality time to be able to complete their life's work. When radiation is recommended by a hospice physician it is because the patient can benefit from it and it is recommended to the patient for their symptoms. I don't think I've ever had a patient that we've recommended XRT to that had a hope of a cure or a miracle from it. It is very clear that the intent is to make them more comfortable. I have seen patients that have had XRT inappropriately recommended by their physician in the last stages of life which did destroy their quality of life and this is not the kind of treatment that I am talking about. I am talking about patients who are still fairly healthy and mobile and have intractible pain. They are able to dramatically decrease their pain and be able to spend time enjoying their last days with their families.