Crystal Ball! What's Hospice's Future Look Like

  1. I'm a hospice case manager with 2.5 years of experience, and I absolutely love what I do, but day by day I am starting to worry about if hospice will even exist 10-15 years down the line... I know I am stating the obvious, but since reimbursement is tied to MediCare, I'm assuming if MediCare goes "buh bye", than so does Hospice. I know that there will be changes to Hospice (as I and other staff get near daily emails from our managers about "new Medicare updates" :***, but I'm trying to educate myself about my own field and any insight or insider info on what hospice clinicians can maybe expect in Hospice in the next 10-15 years would be great to read! Thank you all for your help!
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  2. 13 Comments

  3. by   lifelearningrn
    Most insurance plans offer the same hospice benefit Medicare does. I do not think Medicare is going anywhere, anytime soon. I do think they will continue to make it a pain in the backside for us to give the level of care we'd like to our patients though. I think hospice needs to start lobbying for better reimbursement/CC services.
  4. by   ktwlpn
    I think it will no longer be covered in LTC in the near future.
  5. by   toomuchbaloney
    Quote from ktwlpn
    I think it will no longer be covered in LTC in the near future.
    Yeah, because LTCs don't need or appreciate any help with the symptom management of their patients and their nurses have the time to case manage them.

    I think the future of health benefits for citizens will depend entirely upon how our Congress prefers to spend the nation's $$. There seems to be less and less initiative to spend on the welfare of the people, the infrastructure, or investment in new technologies.
  6. by   ktwlpn
    We do need the input even if many of us don't like to admit it. I do appreciate the extra support they provide the resident and family but many of my co-workers are not on the same page. We (myself as the palliative care nurse) and the unit nurses are often making multiple calls to the doc and family during a crisis, hospice is usually not there at those times. That's where a lot of the resentment comes from.Folks in LTC are sicker and more demanding of our time then ever before-we DO need the support
  7. by   toomuchbaloney
    Quote from ktwlpn
    We do need the input even if many of us don't like to admit it. I do appreciate the extra support they provide the resident and family but many of my co-workers are not on the same page. We (myself as the palliative care nurse) and the unit nurses are often making multiple calls to the doc and family during a crisis, hospice is usually not there at those times. That's where a lot of the resentment comes from.Folks in LTC are sicker and more demanding of our time then ever before-we DO need the support
    When I managed hospice patients in LTC and ALFs I made certain that the facility staff knew EXACTLY how to get hospice staff into the facility after hours, on weekends or holidays, and just any old day because the facility had a need or concern relative to the patient.

    It is the job of the hospice professional to assist the facility staff in the care of the patient, just like we would assist the family member or lay caregiver. When the facility is the caregiver hospice must be just as responsive to them as we would be to a family member or lay caregiver. That is the nature of the collaborative and supportive role of the hospice professional.
  8. by   lifelearningrn
    Quote from ktwlpn
    I think it will no longer be covered in LTC in the near future.
    What leads you to believe this? LTC is the patient's home, they are entitled to Hospice benefits no matter where they reside.
  9. by   ktwlpn
    The hospice agencies we are working with in the LTC are generally not available when we contact them (and we know how to contact them) They both have major staffing issues. They have made big promises to us in the past but can't seem to come through when we really need them,they always seem to have something going on an hour and a half away.
    As for hospice in LTC-I think insurance plans and Medicare will change the admission criteria for LTC residents.They have 24 hour nursing care,social services, chaplain support, volunteers, most everything required per the regulations for a free standing hospice-it's all in place. I can see incentives for nursing homes to educate and certify a percentage of staff in the future. It makes good fiscal sense.
  10. by   toomuchbaloney
    Quote from ktwlpn
    The hospice agencies we are working with in the LTC are generally not available when we contact them (and we know how to contact them) They both have major staffing issues. They have made big promises to us in the past but can't seem to come through when we really need them,they always seem to have something going on an hour and a half away.
    As for hospice in LTC-I think insurance plans and Medicare will change the admission criteria for LTC residents.They have 24 hour nursing care,social services, chaplain support, volunteers, most everything required per the regulations for a free standing hospice-it's all in place. I can see incentives for nursing homes to educate and certify a percentage of staff in the future. It makes good fiscal sense.
    If the hospice agencies are NOT meeting the care needs of the hospice patient(s) residing in your facility you have an obligation to report them. Collecting the money without providing the support required amounts to fraud and should be reported up the chain immediately. I don't really care what their excuse is.

    Some LTCs and ALFs already have hospice certified professional staff on their payrolls.
  11. by   ktwlpn
    Quote from toomuchbaloney
    If the hospice agencies are NOT meeting the care needs of the hospice patient(s) residing in your facility you have an obligation to report them. Collecting the money without providing the support required amounts to fraud and should be reported up the chain immediately. I don't really care what their excuse is.

    Some LTCs and ALFs already have hospice certified professional staff on their payrolls.
    Their contracts are under review. I am certified and as such am currently in a position that has me "up the chain" a bit. I am striving to improve our relationships for the better, constantly working on education our staff and establishing procedures for the agency staff as well. As we say "you are only as strong as your weakest link". Those chains are pretty weak on weekends, holidays and after hours.
  12. by   HazelnutCream
    I personally don't think the hospice benefits are going anywhere and will only be expanded/protected in the future. There are so many statistics thrown around about the crazy high percentages of total medicare dollars that are spent in the last year of a persons life. In addition to the very important role hospice plays in providing team-led case management and emotional and spiritual support for both the patient and family, it also provides a very real benefit of controlling costs by reducing unnecessary procedures during that time.

    There are just too many benefits... financial, medical, and psychosocial among them, to see that benefit getting cut back. Just my 2 cents.
  13. by   lifelearningrn
    Quote from ktwlpn
    The hospice agencies we are working with in the LTC are generally not available when we contact them (and we know how to contact them) They both have major staffing issues. They have made big promises to us in the past but can't seem to come through when we really need them,they always seem to have something going on an hour and a half away.
    As for hospice in LTC-I think insurance plans and Medicare will change the admission criteria for LTC residents.They have 24 hour nursing care,social services, chaplain support, volunteers, most everything required per the regulations for a free standing hospice-it's all in place. I can see incentives for nursing homes to educate and certify a percentage of staff in the future. It makes good fiscal sense.
    I don't like the idea of a facility only using their in house hospice exclusively, it opens the door to more fraud than is already taking place. I think it's great facilities have dedicated hospice professionals, but right now I believe it's illegal for facilities/doctors to force a patient to a specific provider, which in essence having an 'in house' hospice provider would do. Patient's should always get to choose. (Please someone correct me if I am wrong)

    If I may ask, what situations have you had where the hospice refused to send people out (or said nobody could be there in under 1.5+ hours)? Do you live in a large geographic area where your nurse may have to drive long distances in traffic? We like to be to a patient in an emergency in less than an hour, but if it's rush hour, it can take that long to travel 10 miles in our city.

    We have many LTC facilities that believe hospice should be there 24/7 for all actively dying patients, even when their symptoms are under control. Unfortunately, we can not do that as it can not be justified to Medicare/Medicaid under their own regulations.

    If any hospice rep makes the claim of continuous care for dying patients no matter what, they are using enticements, which is illegal.
  14. by   ktwlpn
    Quote from newhospicern
    I don't like the idea of a facility only using their in house hospice exclusively, it opens the door to more fraud than is already taking place. I think it's great facilities have dedicated hospice professionals, but right now I believe it's illegal for facilities/doctors to force a patient to a specific provider, which in essence having an 'in house' hospice provider would do. Patient's should always get to choose. (Please someone correct me if I am wrong)

    If I may ask, what situations have you had where the hospice refused to send people out (or said nobody could be there in under 1.5+ hours)? Do you live in a large geographic area where your nurse may have to drive long distances in traffic? We like to be to a patient in an emergency in less than an hour, but if it's rush hour, it can take that long to travel 10 miles in our city.

    We have many LTC facilities that believe hospice should be there 24/7 for all actively dying patients, even when their symptoms are under control. Unfortunately, we can not do that as it can not be justified to Medicare/Medicaid under their own regulations.

    If any hospice rep makes the claim of continuous care for dying patients no matter what, they are using enticements, which is illegal.
    It's true, we have to offer a choice of agencies. Some family members and residents will defer hospice, that is their choice as well. I don't believe that is forcing a specific provider-it's just another choice.
    We have had family members in crisis at the bedside and were lucky to see an on-call chaplain.I believe the lack of support from the agency is directly related to their staffing issues, not geography. We seldom have issues with symptom control-we order and adjust those comfort medications ourselves with our PCP's, we don't wait for hospice.
    The family is well aware no-one can sustain a bedside vigil,it's often our staff who needs to be reminded of this. These nurses have another 20 or more residents to manage, we know how it is. But you have representatives of the agencies talking about "being a visible presence at the bedside at end of life" and we all had that expectation.It just never pans out.

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