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Is Hospice just another big healthcare business now?
Old 12-02-2014, 08:26 AM   #1
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Is Hospice just another big healthcare business now?

We used Hospice in our home to help both my parents to the other side, in 1990 and 1997, in different cities. In 1990 it was wonderful, in 1997 still was but not as much, chalked up to simple differences of organization. We have an elder (DW mother) who may be approaching the need, but Medicare has brought her back from the brink so many times we think it may go on forever. Anyway.

When working I always made the pseudo-mandatory United Way contribution and directed it to the local hospice. Out of curiosity I just went to their website to find out how they're organized today. MBA for Director, Chief Financial Officer, Vice President of this, etc. Medicare and Medicaid pays for most of the services (I knew that) but they do offer grief counseling and services of that nature from donations. So I guess that's where donations would go.

I guess I'm just a little disillusioned as I thought Hospice was more of a volunteer organized entity, but of course with paid employees. Maybe that's the way it was 25 years ago. With my mother in 1990 it was like, yes, we've escaped the healthcare juggernaut and now have these compassionate folks who don't see her as a science experiment that generates money. Looking at the local organization it just looks a little too well connected to be what I thought it was.

Any comments on how Hospice has changed or am I just romanticizing "how things used to be?" I'm sure in most cases it's still a far better option than spending ones last days in an ICU.
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Old 12-02-2014, 08:51 AM   #2
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I don't think your expectations were realistic. Our local home health and hospice organizations is a not-for-profit (and most are to my knowledge) and have mostly paid employees with some volunteers for more of the grunt work. At least in our area it is a rather large and complex entity (over 150 employees and a $12m budget) so I think professional management is good.

Ours is not much different from 20 years ago, only bigger.
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Old 12-02-2014, 09:14 AM   #3
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Hospice is more about palliative medical needs rather than curative medical needs. A person can be in hospice care for days to years... I have a second cousin who is a hospice nurse - travelling to patients homes. She told me a touching story of a young boy (about 12) with terminal cancer... part of her job was to battle with the doctors to let they boy do the activities he wanted to, despite the risks... he was already terminal but the doctor was stressing about germs, not about his happiness.

The book "Being Mortal" (discussed in this thread ) has an excellent discussion of the differences between Hospice/Palliative care vs Curative care... and how our medical system is set up.

Having seen several family members deal with terminal cancer... I'm soundly of the opinion, *** for me ****, that I will switch to palliative/hospice type medical care pretty quickly after a terminal dx - especially if I don't react well to chemo like my brother's case.
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Old 12-02-2014, 10:12 AM   #4
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Don't get me wrong, I have always been and always will be a big fan of hospice and palliative care. I've seen some real problems with "curative" medicine practiced on the elderly, my mother and father in law in particular. It's more that it seems hospice has morphed from what many years ago was primarily a volunteer local boutique offering to a large non profit organization. And OK, I'll just say it. I've seen a lot of what I consider abuse in larger non-profit organizations where it astounds me what the top brass makes. That has made me very careful in where contributions go. I had the privilege of being designated a local government's overall coordinator for United Way the same year the Arimony scandal surfaced. Ever since then I've become almost pathologically skeptical. And yet I have nothing but admiration for those who donate time and money to truly good causes like hospice.

I will never forget how in my father's waning days after a tough weekend I thought it was getting time to call Hospice. Called his primary physician Monday afternoon to inquire about getting it started....the staff said my father had called that morning. He and I had not discussed it prior to that.
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Old 12-02-2014, 10:20 AM   #5
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My wife is a Hospice Nurse, and I had my father on Hospice for a while, so I have some experience from both sides. Hospice means you are terminal and will not get better. Hospice also does a good job of focusing on making the patient comfortable and helping the family cope and understand the dying process. There are two kinds of Hopice care: in-patient and home visit. In-patient is where the facility is like a hospital, and you generally go there to stay and ultimately die. Although there is respite care which is to allow a home-based person to come for a week or two and give the family caregivers a break. Home visit is just what it sounds like, the Hospice nurse, and other Hospice employees, go to the house where the patient is located.

Has it become a bigger business? Probably so, but most are non-profit and to be honest the pay for nurses is lower than they can get at a regular hospital. I believe Hospice provides a critical service that benefits society, so overall I do not see a problem with it being more like business and less like charity.

Probably 95% of Hospice is centered around cancer, as it does reach a no recovery point (terminal) and is fairly predictable, and unfortunately too common. The rest are other diseases like final alzheimer's, heart failure, other organ failure. Cancer is where Hospice really does excel and help provide quality of life issues for the dying patient.
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Old 12-02-2014, 10:35 AM   #6
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I know with Kaiser Permanente - they employ the hospice providers - it's not a separate corporation. It's run as a separate specialty, but still part of the Kaiser closed network.
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Old 12-02-2014, 12:22 PM   #7
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There are some for profit hospice out there. I'm not sure it matters. non-profit does not mean the workers take a vow of poverty. Some non-profits compensate overly well. (I'm not saying they are corrupt... Just saying that you need to choose your non-profit carefully.)

That said, we recently had a family member go under hospice care for end stage heart failure. This non-profit hospice was wonderful. We were glad to finally get out of that hospital where they were milking this poor 90 year old for his medicare. It was downright obvious and shameful. Hospice was a breath of fresh air.

I will say things have changed in 20 years since another family member had hospice. Hospice now depends much more on medicare and payment. They made sure we had all our medicare ducks in a row before taking the case. The organizations are much bigger and well oiled.
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Old 12-02-2014, 02:18 PM   #8
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Hospice provides a valuable service but our experience using hospice for my MIL was less that ideal. MIL was spending her last weeks with us under hospice care. Some of the issues we dealt with included a tendency to "over medicate" as a way to deal with any issue, nurses who were doing hospice on the path to or from a better job, and constant staff turnover. We did appreciate one or two dedicated hospice nurses that provided care for my MIL, but they were the exception, unfortunately.
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Old 12-02-2014, 02:52 PM   #9
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During my mother's final months (nearly three years ago), I had a good conversation with a "palliative care nurse" at a local hospital.

We had two hospice organizations in the area (there are now several of them), and her opinion was that one was far better than the other, just as a general overall rating.

That said, one hospice outfit specialized in hospitalized or home care patients, while the other had its own facilities. So you have to consider all aspects of the situation.

If possible, I would recommend talking to several professionals (such as nurses) who can give you an informed opinion. As others have mentioned in other threads, that can also be a useful way to evaluate other medical professionals.
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Old 12-02-2014, 04:02 PM   #10
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Quote:
Originally Posted by 38Chevy454 View Post
Has it become a bigger business? Probably so, but most are non-profit and to be honest the pay for nurses is lower than they can get at a regular hospital. I believe Hospice provides a critical service that benefits society, so overall I do not see a problem with it being more like business and less like charity.
I agree with this, I think it should be run as a business. I flew home to Michigan to stay with my Aunt this summer. She started hospice due to congestive heart failure. I was so glad hospice was there for us. They answered questions for us, brought us equipment, supplies and medication. The nurses came to the house regularly. Near the end they came and bathed my Aunt. She was kept comfortable and died on her own terms. They definitely provided a critical service.
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Old 12-02-2014, 11:39 PM   #11
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Being on the other end of it, there used to be 2-3 hospice services in my city, there are now more than 20. Medicare pays them a bundled rate and they are supposed to provide a wide range of services like psychiatric care and social work/psychotherapy. There is not one hospice here who provides that and Medicare won't pay for me to see a patient because it's considered duplication of services. They also have to pay for all the medications they prescribe so they routinely take their patients off all the antidepressants, etc. that I previously prescribed. Some of these people are quite depressed yet they are off their meds. I have seen this time and again.

A medical director of one of the nursing homes I go to was conversing with me about this a few months ago. It has become a big business, otherwise there wouldn't be such a proliferation of them.

Some are good, some not so good.

Caveat emptor.

(Happy to be semi-retiring soon from the world of medicine.)


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Old 12-03-2014, 12:01 AM   #12
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Lots of "good works" are done by what are basically businesses.
I worked in one non-profit, and was surprised by how much the CEO made.
They also did stupid things like have another organization collect donations (for a fee of 60% of the donation).

I was paid, since I was one of the front-line grunts, the pay was low since I was expected to do it out of my goodness.
I guess the upper management didn't have any goodness
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Old 12-03-2014, 07:16 AM   #13
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Isn't the difference simply that hospice has become a routine offering across the country now (thus lots of non-profit and for profit companies involved) whereas decades ago it was an unusual offering staffed by idealists blazing a new and controversial trail? There seem to be a lot of dedicated individuals drawn to hospice work today but I suspect it was even more so decades past.
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Old 12-03-2014, 10:35 AM   #14
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Isn't the difference simply that hospice has become a routine offering across the country now (thus lots of non-profit and for profit companies involved) whereas decades ago it was an unusual offering staffed by idealists blazing a new and controversial trail? There seem to be a lot of dedicated individuals drawn to hospice work today but I suspect it was even more so decades past.
I think that pretty much nails it. My experiences in 1990 and 1997 were with something that was relatively new and an alternative to curative med. Now it's pretty much a standard option. I remember in 1990 "discovering" what hospice was; there are not too many people around now who don't have at least a vague idea of what it is.
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Old 12-03-2014, 10:47 AM   #15
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My experience with hospice was for my grandmother who had COPD and moderate dementia. Her PCM had suggested it a couple of times, but she wasn't eligible the first time out (lung function was "to good") but about 6 months later, she had declined to the point of qualifying under medicare rules. The organization who ran the program was a non-profit Jewish organization and they were amazing...even for our family who are agnostic, it made no difference to them. She had the same providers (Doc, RN, CNA, Volunteer) for the entire duration. She has been gone for almost 2 years and ALL of the providers still stay in touch and the CNA and volunteer come over and visit on an almost weekly basis just to say "hello".


She was in hospice for EXACTLY 365 days, which I think was very fitting for her financial ways...she got EVERY DIME she was entitled that she had contributed to!


Anyway, I am pretty sure that because of their help, my Grandfather is still around. If he had to deal with her issues alone, especially for his age, I am pretty sure it would have killed him. we did give them a sizable donation for all that they did.
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Old 12-05-2014, 10:44 PM   #16
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As a hospice volunteer for about ten years, I am interested in this discussion.

an observation, perhaps interesting, perhaps not. I have volunteered with two hospices, one "for profit" and one "not for profit". I was hesitant to sign up with "for profit" hospice until i learned bigwigs with "NOT for profit" one made significantly larger salaries than bigwigs with "for profit" hospice.
So.....the "not for profit" flag they waved stopped impressing me so much. This may be a totally isolated circumstance.

Both hospices seem to be big on patient comfort and happiness and employees that I have met of both seem kind & devoted to their mission.


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