ethically speaking

[cargal]

Our facilty has a policy that when a resident has decreased po food intake (like end stage dementia) that the family has three options: 1) IV hydration 2) GT 3) hospice. While I love hospice, i feel that they are being denied the right to let their loved one die without any of the above.

My question is : How does Hospice operate financially? My understanding is that Medicare will pick up the Hospice, supplies, meds, etc, but then the family would be responsible for room and board/nursing care. Some families would not be able to afford it, and they could be co-erced into IV hydration or GT, both of which would ensure the facility more income.

When I tried to discuss this with our social worker, she told me that "as a staff nurse you don't need to worry about this" and I promptly replied that as a patient advocate I did need to know. I am still confused about this. Also, I see resident's skilled so that hospice doesnt step in yet. A hospice nurse told me that this IS a good thing as Medicare would cover it and save the family money.

Please advise,

[renerian, BSN, RN]

Okay hopsice contracts with a SNF/LTC which usually reimburses the facility around 95% of the medicaid cost for the room. The family does not have to pay the room. The hospice will pay for DME, meds related to the terminal diagnosis, other supplies, some pay for supplements , some pay for diapers, they can provide nurses, therapist, hhas, social workers, pastoral care, nutritional evaluation, bereavement support for the family....they can provide several levels of hospice care based on needs of the patient. They can provide some hourly care or respite as well as volunteers. I do think the ultimate choice should be up the patient but your right if the person is no longer skilled they could get stuck with a big room and board bill.

renerian

[aimeee, BSN, RN]

If the patient has Medicaid, but not Medicare, then Medicaid will pay Hospice for their Hospice care and an amount for their room and board...Hospice then pays the facility. The patient is then responsible for their monthly spend down amount plus personal care items.

If the patient has Medicaid AND Medicare A, then Medicaid pays Hospice for their room and board, Medicare pays Hospice for their services, Hospice then pays the nursing home for the room and board, and as above, the patient is responsibile for their monthly spend down amount plus personal care items.

If the patient has Medicare A and is private pay for room and board, the patient continues to pay privately for room and board and Medicare pays Hospice for their services.

If a patient qualifies for skilled services under Medicare A, they cannot receive skilled services from the nursing home AND be under Hospice care at the same time. Medicare A will only pay for one service at a time. I often run into that sort of scenario...although the hospice care would be of greater benefit to the patient, families often opt to use up the skilled care days available to them because of the financial concerns.