Alzheimers Diagnosis questions regarding items covered....

kdrntx1 · Sep 28, 2010

Atlanta... Medicare regulations state that hospices are required to pay for related medications and treatment. Aricept is a related medication, and if the family insists on continuing, then it's the hospice responsibility to pay for it. I have been in hospice over 12 years, and we have only paid for supplements when it was the patients ONLY source of nutrition via a G-tube, and related to the diagnosis.

Hope this helps!

AtlantaRN, RN · Sep 28, 2010

Thank you kdrntx1-i looked in the computer system and patient is NOT on aricept, daughter said she "had been" on it, but i'm sure it was stopped months ago as it was having no effect. patient is chin to chest position, advanced alzheimers. The problem is the marketers go out and offer these folks everything under the sun, and then the family is mad at nursing when we don't comply. ((for instance, one marketer promised an esrd patient that we would help her get back and forth to dialysis........we put her under another diagnosis, but still-transporting is not covered under hospice diagnosis)).

I thought likewise with the nutrition-I could see if lady had a trach and a peg, but ensure because this is a natural progression of the disease process....

thx again!

Leda1st · Sep 29, 2010

Atlanta, I feel your pain. Although I DO feel like Hospice is a WONDERFUL thing and I know there are many folks out there who would be eligible but do not know they could receive the services, I have a BIG problem with the whole concept of "marketers". We have them at our Hospice (I know most Hospices have them). These folks usually have some sort of commission included in their pay (this is the case where I work), and they usually don't have a medical background, and these two things make the situation worse. Hospice is not a used car, it is a medical service. And that service is defined by a set of laws/regulations known as Medicare guidelines.

If any of you have read my posts, you know that I am in a terrible situation Hospice-wise, and I am sure this taints my view, but I still feel my problem with "marketers" is somewhat valid.

Oh, and my agency refuses to cover Aricept - supposedly it is "curative". Period. They also won't cover ensure, etc. unless it is the person's only source of nutrition. Not that my agency is the "gold standard" of Hospice by any stretch of the imagination. But there is is.

tewdles, RN · Sep 30, 2010

Aricept is not an appropriate drug for end stage alzheimers dementia...if the patient is appropriate for hospice with a dementia dx then the MD should be recommending DC of that med, because it is no longer medically recommended.

Many hospices are moving toward an inclusive, or open door type of hospice care. Care and treatment that used to be deal breakers are now reasonably common in hospice care. A good example would be palliative radiation or chemo, another example might be blood transfusions, IV antibiotics, etc.

The hospice I work for provides nutritional supplements on a case by case basis. We provide diapers and formula for our pedi patients.

We routinely order and deliver ensure, glycerna, enfamil, nutramigen, etc.

Me thinks the face of hospice and what is covered/provided will continue to evolve...and we will all have to skip and dance to keep up.

As for marketing...I think that the hospice which does not market in this health care environment will remain small and will struggle with resources, in many if not most cases. Those that market with the intent only to increase the profit margin will never be nice places for nurses to work. Those that market in order to develop a referral base which will allow them to develop a healthy care delivery strategy with a "stable" census can be good places to work. It is all about the corporate attitude and goals.

Leda1st · Oct 2, 2010

"It is all about the corporate attitude and goals."

Amen to that, Tewdles!

Hospice Nurse LPN, BSN, RN · Oct 2, 2010

I used to work for a large, nation-wide hospice and the marketers would promise everything--including CNA's 7 days/week and no problem for the nurse to visit after 6 pm when the family would be home. Excuse me!

We usually ask the doc to d/c Aricept for ES dementia pts if they are still on it. As far as the Ensure/Boost goes it's a case by case thing. Sometimes the family simply can't afford it and we'll help out. We also supplement briefs and blue pads. Marketers really drive me over the deep end! I have been with a small, privately owned hospice for the past 4 years and we NEVER have them talk to the pts. They market docs, home healths, hospitals, etc. One of the nurses will do the "info visit" and sign the legal papers if the pt and family want hospice. That way, we can explain to them from the get-go exactly what is and is not covered. I am actually the "marketer" to a long term care facility where we currently have 6 pts. The staff knows me as both the nurse and the "pen" lady!

ErinS, BSN, RN · Oct 3, 2010

We do not cover supplements in my hospice (often we do not cover tube feedings either). The reasoning for this is that we do not pay for patient food, and supplements are just a different source of nutrition.