tag:blogger.com,1999:blog-3672496731205380327.post8693031776667201333..comments2024-03-26T20:43:17.849-04:00Comments on freeforall--a health policy discussion: Do For Profit Hospices Milk the System?Don Taylorhttp://www.blogger.com/profile/16141749812035072101noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3672496731205380327.post-26735202232859849342011-05-01T00:23:25.841-04:002011-05-01T00:23:25.841-04:00I have worked in long term care for over 30 years....I have worked in long term care for over 30 years. Hospice services are utilized now more than ever. There is a long list of health conditions which can certify one for Hospice care. From my experience it is up to the doctors, their relationships with Hospice and different situations that play a big part with receiving services. Some physicans think the service is good and leave the decision to go on Hospice up to the patient and family. The physician will care for the patient either way. Some physicans do not believe in Hospice services and relinguish their care with the patient if they should choose Hospice. If a physican is concerned about legal issues with a family,in regards to patient care, they encourage families to utilize Hospice. This is as if to say all resources were taken to help the patient, whether or not they feel Hospice was appropiate at that time. I do see patients get recertified frequently and able stay on Hospice even for years. Example: Say a patient gets a UTI, is confused,has a dx of Dementia. The patient falls and sustains a fx<br />with physical decline. The patient is put on Hospice for End Stage Dementia. As time passes the UTI is gone, the fx is healed and the patient is back to their normal demented self, however Hospice remains. In time the patient loses some wt.from an URI and is recertified. The wt.is regained but the patient remains on Hospice. This scenario can go on for at least a year. Not all Hospices services run this way however this is a common practice. Another noted practice is when long term patients are seen by Hospice disciplines. They are only seen for a few minutes. Each discipline has their own paperwork to fill out. They take up facility staff time asking needed questions to get their paperwork done. Then they leave. Majority of the time their is no hands on care,interaction with the patient or recommendations. This is left up to the facility staff. Hospice is not doing things like turning the patient or offering fluids every two hours. The facility keeps up with the patients quality of care. They are held to Medicare standards too. If a patient is at the end of life where all interventions seem futile then Hospice should be considered. It seems like the system is being taken advantage of and there is a battle over who gets the medicare dollars. I am not agaist Hospice services.I feel there is the right time and place. Money can be saved and quality of care kept.New guidelines should be made for long term care settings.Especially with recertification parameters. Hospice should truley be for end of life and come with all of the bells and whistles anyone would want during their last days on earth.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-9170843654668363272011-02-03T20:14:25.510-05:002011-02-03T20:14:25.510-05:00Yes. Thanks Don, and I am glad you got something ...Yes. Thanks Don, and I am glad you got something out of it. I did for sure<br /><br />Brad<br /><br />PS--never would have seen above, came back to this post by an accidental click.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-38484456810894051512011-02-03T10:27:50.490-05:002011-02-03T10:27:50.490-05:00Brad F:
Was that you posting on the hospitalist b...Brad F:<br /><br />Was that you posting on the hospitalist blog about EOL? Nice post.Don Taylorhttps://www.blogger.com/profile/16141749812035072101noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-88183997111182332012011-02-03T08:45:16.248-05:002011-02-03T08:45:16.248-05:00Rose...didn't know you were once a hospice nur...Rose...didn't know you were once a hospice nurse. I agree satisfaction is key and hospice has passed the market test. More refined measurement of quality is needed to get hospice payment policy straight. I think the media has mostly spun this story as FP hospices are doing bad stuff....some may be....but Congress likes this as a story because it diverts attention from the hard issues necessary to address costs generally. More on the study soon...Don Taylorhttps://www.blogger.com/profile/16141749812035072101noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-27073272723261269832011-02-02T22:58:17.618-05:002011-02-02T22:58:17.618-05:00Intriguing Don. I think, for what it's worth,...Intriguing Don. I think, for what it's worth, that patient satisfaction can't be discounted. In hospice, people's expectations have changed so considerably, that I think other, more traditional, measures of quality start to lose their potency (for lack of a better word). <br /><br />E.g. Brad F talks about things like bedsores, which are usually good indicators of quality. But they might be more likely as peripheral circulation diminishes and nutrition declines. <br /><br />As a former hospice nurse, I look forward to what you folks come up with!Rose Hobannoreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-19457507190430389612011-02-02T19:41:36.821-05:002011-02-02T19:41:36.821-05:00Is hard to measure quality; key is you need measur...Is hard to measure quality; key is you need measures that have a chance to differentiate quality from around 5 day to 25 day stays given the epidemiology of hospice. Lots of measures focus on how well first 72 or 96 hours are. There is a team that is/has been working on measurement....will be measured as part of the care provision process. We will also look at non hospice palliative care. Will give more details of team/sites, etc. in a bit...just got grant and all paperwork not even signed.Don Taylorhttps://www.blogger.com/profile/16141749812035072101noreply@blogger.comtag:blogger.com,1999:blog-3672496731205380327.post-83118804782794374612011-02-02T19:22:29.236-05:002011-02-02T19:22:29.236-05:00Goodness, i cant even imagine how you would measur...Goodness, i cant even imagine how you would measure quality in a home hospice situation.<br /><br />In an inpatient unit, staffing ratios, decubitus development, pain, etc., can all be overseen to a greater degree (and measured) than at home.<br /><br />Given that the primary caregivers in a home hospice setting are family, a good thing-- however, skill, availability, and even quality of dwelling they reside in--all tough to measure. This all can have an impact on quality that may get lost due to coarseness of available instruments.<br /><br />Given your grant, how do you go forward and codify above? Tough stuff.<br /><br />Thanks<br />Brad FAnonymousnoreply@blogger.com