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

[QEOLAdvocate]

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!

[ktwlpn, LPN]

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.

[Nashvillejeanne]

There will always be a need for trained professionals to assist with end of life care. Think of it this way....you are a trained professional in an area that most people have no idea what to do. You could market youself as a private end of life doula (midwife for dying patients) if worse came to worse.

When one door closes, another one opens.

Peace