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Home Hospice
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ChrisG said:
on November 8, 2009 11:29 AM ET
A few months ago, at the suggestion of her doctor, I enrolled Mom in home hospice. She is 87, in end stage Alzheimer’s and down to 72 pounds. Mom was not eating, but with the drug Megace now has an appetite and will eat. I just received the first Medicare statement and to my shock, for one month’s treatment in HOME hospice the charge was $7,800. Medicare paid $4,000 and the hospice has accepted that fee. Though they are not asking for any payment from me, I just feel even at $4,000 that charge is exorbitant. The nurse comes once a week for about a 15 minute visit where she checks Mom’s vitals. A CNA also comes twice a week to assist my live in caregiver to give Mom a bath. For supplies, they bring about a dozen diapers along with shampoo and medicated cream. There have been no medications or other equipment supplied. I have the prescription for the Magace filled myself. The nurse tells me that Mom’s vitals are very good and she could go on for a long time. Since Mom’s condition seems to have stabilized now that she’s eating, I am considering cancelling the hospice and re enroll if there is a major change in her condition. I have located a group of doctors that make house calls and I’m thinking of having a doctor visit once a month and a friend who is a nurse drop by weekly to monitor Mom’s blood pressure. I phoned the hospice to ask about the fee and I was told that even though my Mom doesn’t require a lot of attention now, that it could change and then they would be there more frequently. Since Mom has stabilized I asked what if this went on for a year or more and they said that would be no problem. Anyone else out there familiar with home hospice? |
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Dear Chris,
If this home hospice is Medicare certified, then it can't and won't bill you for the difference in what's billed and what's covered. I'm not sure how the pricing works, but Medicare pays home hospice services a flat rate, which needs to cover all that's available to your family, not just what is provided on any given day. Your mom could be at some point in need of an inpatient hospice stay, and that's VERY expensive (thousands of dollars a day, with more attention than someone receives in an ICU bed). But the daily rate doesn't change. Its a flat rate. So what seems astronomical is reasonable over time.
Hospices also provide a great deal of unreimbursed care. They're usually non profit charities, although not always, and so can receive donations. Another example of how people without health insurance still get health care and those of us with coverage have to chip in. (That's where health care reform comes in, but that's another topic for another day.)
My partner's mother had hospice for the last 2 months of her life, mostly at home but then at the inpatient hospice. She had Alzheimers and COPD, and was in pain, although we couldn't figure out why. She got EXCELLENT care, and the team guided the family very kindly and skillfully. She had a good death, surrounded by family.
If i were you, i'd keep your mom in the program. Is it a non profit hospice? is there any concerns you have about the quality of care? if its an otherwise good service for her, please stay in it.
Tell us more?
Jane,
a long time believer in hospice care both professionally (i used to work in cancer care) and personally (my father benefited from it at the end of his life.)
Reply to Post
Wow, I was amazed that the price. I had not thought about it because we didn't have hospice for mom. Even tho she was in a staffed residence and had at one point lost a lot of weight (they gave her Ensure 2x's each day). She then gained a lot of weight.
When mom went into the actual dying process, I was afraid of the decisions..would I make the right one...and later, did I make the right decision about not putting her on tubes and nutrition.
Something my pastor said, helped me not to feel guilty...he said..."we used to let our loved ones die naturally."..I thought on that and it seemed true. I didn't need to make any heroic efforts to prolong her life in the state she was in. (she was in late term Alzheimers also) So the dr made her comfortable at the end with meds and we were with her when she passed. I don't regret the decision we made. It wasn't easy, but worked for us.
I wish you well at this difficult time.
