End-of-Life Choice, Palliative Care and Counseling

Officials Say Medicare Patients Delay Using Hospiceby Sonja

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by Robin Williams Adams
The Ledger
February 1, 2013

How did a program to make the final months of someone’s life as rewarding as possible become an almost taboo topic?

Children think parents whose health is declining won’t want to hear about it.

Parents don’t want to upset their children.

Speakers from the three hospices covering Polk County talked for an hour Thursday about the benefits of hospice care and the importance of not waiting too late to enlist it.

Everyone from physicians and caregivers to patients and their relatives needs to be informed, they said, while acknowledging it’s often a struggle to get people to listen.

“It’s a difficult topic to discuss for me,” said Dr. Richard J. Cardosi, a gynecologic oncologist at Watson Clinic.

“People don’t want to discuss it.”

He is president of the Watson Clinic Foundation, which sponsored the hospice care summit at the Peggy Brown Building in Lakeland.

Why talk about hospice? Reasons given include these:

Symptoms are more likely to go unaddressed without hospice involvement.

Advance directives or living wills can get ignored.

Avoiding the topic means people often enter hospice, if they use hospice at all, days away from dying.

“Nearly one-third of patients die within one week of admission,” said Dan Heisserer, community liaison for Compassionate Care Hospice.

That isn’t because hospice hastens death, he and others said. It’s because people don’t use that Medicare benefit quickly enough.

“We don’t understand why people don’t take advantage of it,” said Gail Kalch, professional relations representative for Good Shepherd Hospice.

“It’s frustrating. It’s very frustrating.”

People who elect hospice for end-of-life care live 29 days longer than those who don’t, Heisserer said, quoting national statistics.

In times past, when people were far more likely to die at home, death was recognized more as a natural part of the life cycle, said Deb Harley, Cornerstone Hospice’s executive director over Polk, Highlands and Hardee counties.

Now, avoidance and denial are common.

“I’m challenging you all to see it in a different way,” Harley said.

“I’m not sure America really understands that death is sacred. … We’re going to have to think about life being sacred as well as death being sacred.”

Hospice services can encompass more than people realize.

Among them are physical care, grief and loss counseling, dietary counseling, medications, durable medical equipment and different therapies, such as physical therapy or occupational therapy, if those are in the care plan.

“Things change rapidly when you have a life-limiting diagnosis,” Kalch said, adding, “We make sure all the medications are delivered right to your door.”

To get Medicare hospice benefits, patients need to meet all these conditions:

Be eligible for Medicare Part A (hospital insurance).

Have their doctor and a hospice medical director certify the individual is terminally ill and has six months or less to live if illness runs a normal course. People can stay in hospice longer than six months if the hospice doctor recertifies them as terminally ill.

Get care from a Medicare-approved hospice program.

Sign a statement choosing hospice care instead of other Medicare-covered benefits to treat the terminal illness.

Medicare still will pay covered benefits for any health problems that aren’t related to the terminal illness.

Being on Medicare isn’t required for hospice care.