Hospice care

U.S.A. Massachusetts

Published

I have worked in Hospice for 29 years. It has changed over time, some for the better, some no so much. Mostly I worked in small community based organizations, but recently moved and was offered a position with a corporate owned Hospice that also owns most of the facilities where our patients are located. Good pay, NO weekends or on call. How could I not accept.

The facilities were not the best, but the staff seemed friendly. From the first week on the job the aides started complaining about the patients being abused. I started looking into it and discovered the abuse was rampart. Patients in urine soaked beds for long periods of time, no supplies or linens for the hospice aides to do personal care, pressure ulcers left untreated, it was a nightmare. I went to the DON of the facility who was friendly and pretended to be concerned, but I could see it was fake. I went to my boss who basically told me our companies were married, there wasn't much they could do, and to my surprise the aides who had come to me with their concerns were fired.

I spoke to one of the social workers who told me there were lawsuits against the Hospice for wrongful termination, and the staff never lasted long because whenever they spoke or filed a complaint they were fired. I was totally shaken to the core by what I witnessed. I wonder what price I will pay for going to the department of public health. I'm told dozens of complaints have been filed by the staff before me and everything has come back unfounded. Please say a prayer for me.

Civalized, that is what I agree upon also. People think that Hospice, along with non-profit hospitals are in dire need of $ as they are "non profit". Our hospital is non profit and believe me there is a lot of profit being made. It is all about balancing the books. We have to take in "charity" cases, people who ought to be in the county hospital a few miles away, but we keep them and have medi-cal with them to honor our "non profit status" while the top dog of the corporation did so well 2 years ago that the hospital "forgave" (in other words paid off) a $750,000 loan on his home. How do we fix this system? It is so broken that I am afraid it is impossible. The top dogs pay off the right people to keep this going. Just as the drug companies do to politics. That is another subject I am strong about.....the drug reps, all pretty, giving free lunches, free pens and toys, for a little talk and hand out tons of drug samples to get the doc to hand out. Of course, they are not handing out the generics! These are the drugs that cost big time $, and the cycle begins again where profit is #1.

A Congressional advisory panel said this week that the average hospice care patient is in hospice care for longer and longer periods and that the system rewards fraud in this area. Reimbursent is up to $875 per day and hospice on site gets paid regardless of the hospice care rendered. Whislteblower cases are now popping up.

Don't want to argue, but I must defend some of these issues. Hospice traditionally has been called in so late in the case that they cannot make much of a difference. Through education this is changing. The patient benefits if he/she has time to make peace with dying. Visits from clergy and social services for counseling, time to adjust pain control and plan. All of these things take time. If the hospice is called in when the patient is near death there is no time to help the patient and family other than actual symtoms and support at the time of death and after. No one has time to prepare.

I once went to a patient's home and the patient was sleeping on the couch as she was too weak to get upstairs. She was wetting and they were having a terrible time. They DID NOT know what to do. I ordered a stat hospital bed and had it put in upstairs. The other staff came to help me and we carried this patient up the stairs to the new bed. That night she died.

All that time was wasted because they did not call us in until she was almost dead. We could have made things better for that poor family. Of course I felt terrible, like we had killed her, but I knew she was dying already when I admitted her. The doctor should have called us sooner. Educating the doctors has resulted in longer hospice care.

Reimbursement is high for inpatient days. The hospice patient can have inpatient days paid for by the hospice benefit for crisis or if there is no one to care for him/her in the last days. The patient can also have short stays in a nursing home if the family needs respite time for a vacation, etc. Inpatient care is expensive as you all know. Home care is not going to be reimbursed at $875 a day.

Yes there is abuse as there is with any health care. It is big money potential and the good ones suffer because of the bad. But if there was no hospice benefit these people would not qualify for LTC because medicare does not pay for it, they would not qualify for home health for much of the time because they are chronic and there is no skilled need beyond initial teaching unless pain is worsening. They would not qualify for acute care or rehab. There is nothing for them except hospice. It is a needed service and a needed benefit for terminal diagnosis in many, not all, people.

All CEOs in health care, education, and business are raking in the dough. No area is exempt. This is one of the big problems in the U.S. and I am not sure what we can do about it. It is wrong. Even in schools where they are laying off the lowest special ed aide who makes $14,000 a year and who is so needed, the superintendents are getting massive raises and nice fat 6 figure salaries. But that is another whole subject.

Interesting to hear that. It is so unfortunate that it is all about $$$$. I will repeat over and over, Hospice is sometimes needed but more than not, it is not. Another person posted that hospice helped in their hospital? I never heard of hospitals having hospice. Hospitals will refer to hospice. But acute care hospitals to the best of my knowledge, do not have hospice; they have comfort care. I always thought that there ought to be little places for hospice care for patients whose families cannot deal with the pressure, and work? I believe they had them at one time but now due to $$$$ it is not profitable.

CXG, missed that post. you are 100% correct. I find that docs are in either denial or just plain not seeing the "family" picture. It is a terrible situation indeed. When my dad was put on hospice, we moved him out of skilled nursing (who can afford that?) and into a board and care at 1/2 the cost and better care. I took him OFF hospice. Why? Because the board and care wanted 1K/mo for hospice. They were not going to do anything different with his care. I was in shock for a moment and fixed my shock by "off hospice". So for 1K more/mo he gets a hospice bed, a visit here and there, and meds that medi-care would have paid for anyways. On hospice, they do not call 9-1-1. So my dad was there 2 months and he did get his 9-1-1 call once. That is when I stepped in and put him on comfort care that day at the hospital. 48 hrs later he went to heaven not with the help of hospice. Of course, every persons situation is not the same. My dad did not have cancer or pain. So it was not a medication issue at the board and care.

Not sure what state you are in. The hospice benefit pays for hospice, not the patient. Unless you have private insurance and have co-pays, etc. The board and care wanted YOU to pay for hospice? Makes no sense to me. Did they have their OWN hospice that was not certified or something? I don't understand.

I know there are many people who only need personal care until the end. I do not dispute that. There are also many people who wish to fight to the end (911 call). They wish to "rage against the dying of the light". I think that is fine. No one has the right to judge another's feelings about dying. It is a personal experience, perhaps the only one that sometimes, just sometimes, we have a teensie bit of say about. To fight or to accept, to be compliant and try to do what is best and hang around as long as we can, or to cheat and be non-compliant, the who cares we are going to die anyway approach. If we know we are at a terminal point at least we can choose how to go out. And that is freedom, that is how it should be.

I am in California and board and care is private pay. The charge for my dad was $4500/mo which was very reasonable for this location. And yes, they wanted 1K additional just for being on hospice. I think they think that they will have to do more care? And yes, that 1K is private pay. Maybe the board and care needs some sort of license for it? I have no clue. I just took dad off hospice and no problem. I believe that one of the most important things is for someone who is dying or in pain, to have the best advocate chosen. My dad chose me, probably because I am a nurse. My goal was to keep him comfortable and not let any doc talk to me about peg feedings, etc. I see this in the hospital that I work at, when families do not "get what is happening" and the doc helps them by keeping the patient alive longer for more pain for all. I did exactly as my dad would want and I only hope someone will do the same for me if needed. I think the biggest problem in our system is that there is too much denial and docs are afraid of telling families what is really going on.

Specializes in Hospice.

The National Hospice Foundation is run by ******, she is also the CEO of the largest Hospice in the country. That Hospice was charged with Medicare fraud while ***** has been running it. Medicare has been fighting to get it's money back for years now. So what does the government do, they hire ***** to sit on an senate advisory panel for Hospice issues....... craziness, like much in healthcare, education, etc etc etc

That is typical American (and I am happy to be an American) behavior. Pay and Pay out to the louts and then hire them? I guess they know ***** knows what to do? CEO of hospice? See, non-profit means little. Good accountants in the whole business of health care. I am sure that ***** would not be happy if we got some sort of socialized/type medical here as her salary would be cut by 75%. It would not surprise me to learn that her salary along with bonuses is easily 1/2 mil/year. Maybe she donates to hospice? ha

civilized, I googled ***** and no results.

Specializes in Hospice.

Go to the "Hospice Patience Alliance" website, they have all kinds of facts about ***** since she was the CEO of the Hospice where ***** was. They also have information about her on the National Hospice Federation website. She is also the past president of NHPCO. I found out about her doing research on patient abuse, her history was questioned by the senate elder affairs committee.

This is getting a bit "uncomfortable". I googled that woman who has gotten "awards" and found a post of mine regarding some of my opinions of hospice. Not a happy camper. Think big brother is watching?

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