Care at the Time of Death

Michael

I've seen it across the board in this area. I understand that the
State has recently put a moratorium on Hospice licenses, but looks to be a little late, the creek had already arisen to uncrossable levels (I thought you may appreciate that analogy). Will be interesting to hear from others!

to avoid legal ramifications of the slippery slope, many hospices are adding palliative care benefits, thus broadening the scope and length of services.

leslie

Leslie,

Please explain adding palliative care benefits

Leslie,

Sorry, my last posting was incomplete. Please advise how adding the pallitive care benefits broadens the scope and length of service and
avoids the slippery slopes. I don't understand the difference. Thanks!

Thank you for the link I shall have a read when I am home from another day in Hospice.
Blessings to you all.

I am wondering the same thing: How is “palliative care” reimbursed?

“Hospice” is a package deal; it includes, MD, Nursing (including CNA’s), SW, Bereavement (usually some sort of Chaplain) and a Volunteer dept. It is loaded (some might say overloaded) with services and required personnel. Lots of patients do not need or want all that hospice offers, so stripping services down to only what patient/families may want/need would, theoretically, be cheaper.

Then of course hospice has to contend with the bugaboo of being a program for the “terminally ill.” Some terminally ill people cannot face up to that and prefer a different program that enables their denial. All of which points to a need for a “palliative care” program… but how is it billed? Like Home Health? As “Home Health?” For individual visits?

Michael

here is a comprehensive site, explaining anything one needs to know about palliative care.
it is from the Center to Advance Palliative Care.

www.capc.org/support-from-capc/capc_publications

click on capc manual.
everything one needs to know....


leslie

Hi Michael,

I thought that they were billed the same?

Palliative care the patient can still go for active treatment but require assistance in Hospice home, other institution or home. They do not need to have the so called '6 months or less' diagnosis.

So the treatment can be for longer periods until there is an obvious decline and treatment is not benefical, and patient then opts out for Hospice care for quality of care versus quantity.

Ya just gotta weight up the benefit versus burden with the trajectory of the illness.

Leslie…

I looked at the site you suggested about palliative care but it was too much bureaucratic jargon for me to wade through. Suffice to say, it is obvious that does not fit everyone, even if they are terminal. Hospice is like ordering the whole smorgasbord while palliative care (I suppose) is more like ordering off the menu.

As for Neale Donald Walsch, I actually have read some of his stuff. I did not recognize the name until looking him up (I’m lousy with names.) My wife read part of one of his books to me about a year ago. It was interesting. Some time later I picked up one of his books on CD (audio) and listened to most of it. One of the things that really resonated with me in that book was that all religions have something to offer… that the serious student of religious thought should study all religions, not just one. However, I would imagine that some folks would get hung up wondering about the “authenticity” of his books.

To me, the determination of truth is more the responsibility of the listener than of the speaker. In other words, it does not matter who says something; i.e. how many degrees they may have, if any. You could be walking down skid row and hear a drunk mumble something profound, or you could go to a lecture at Yale and listen to a Ph.D. say something asinine. Deciding whether or not what is said has any validity or relevance is ultimately your own responsibility.

Some of the most insightful lines I have heard came from lyricists or poets… who may have barely graduated from high school for all I know. In our society we tend to assign validity to statements that come from people with credentials… with the one notable exception of celebrities. If Sanje Gupta (sp?) were to announce on CNN that people should stick their fingers in fans (when they’re running) I’m sure a lot of folks would do just that.

My feeling is, (which is relevant to the author of the article that got this thread started) if you are going to wave your Ph.D. around in my face, for crying out loud, try to have something of significance to say. I really don’t care about your little piece of paper. What I am interested in are ideas and comments with some depth of meaning… and I really don’t care who says it.

Here is an example of a line with depth. It comes from a Leonard Cohen song. Leonard Cohen is a singer/songwriter who has long had a small, hard core group of devotees. He can’t sing a lick… which is sort of problematic for a singer… but some people manage to pull it off (like Bob Dylan.) I recently heard on the news that Leonard Cohen is one of Prince Charles’s favorite artists… which is sort of interesting. Anyway, here are a few lines:

So come my friend, be not afraid…
We are so lightly here.
It is in love that we are made…
In love we disappear.

Now, I don’t know if L. Cohn has a Ph.D. or if God whispered these lines in his ear or if Prince Charles suggested them to him or if he thought them up early one hung-over morning, but I do recognize a depth worthy of contemplation.

Michael

Michael

I agree, too much jargon for me also, and I'm still in the business ..... I'm told Medicare doesn't fund pallitive care, so not pursued in this area ... my only point being .... that as a Hospice nurse I'm getting bogged down with pallitive care (home health) mentalility ... and unable to spend the time you and Leslie espouse with actual end-of-life care with patients and/or caregivers that actually accept the Hospice philosophy.

I apologize if I'm not cerebral enough to communicate on your level.
From reading Leslie and your postings, I'm not sure we communicate on the same level, and I get the feeling you both get bored with the run-of-the-mill Hospice forum. I've had tried to compliment you both for your input, and appreciate where you are, but get the feeling I'm being condescended to. Maybe this is why we don't get more input on this forum ... so be it.

I've also read some Neale Donald Walsch, and I understand there is a movie biography of his calling. I couldn't relate .... "authenticity" or not.

I'm not familiar with Leonard Cohn, but I also can relate to his lines of depth ... for some reason reminds me of lyrics from "Tarzan", You'll be in my Heart .... Phil Colllins.

Allow Mystery ..... I got the name from a book I was reading by Doug Smith called "The Tao of Dying" ..... and if I may share

The mystery of beginnings and endings
is beyond description.
Foolish people limit the mystery
through words and concepts.
We must merely allow for the mystery.

There is a mystery in birth.
There is a mystery in death.
Every individual is a mystery.
The whole world is a mystery.

We must allow for the mystery.
We must accept the mystery.
We must be a part of the mystery.
We must be encompassed by the mystery.

What is not mystery?

Thank you for allowing me to share.

Allow Mystery