New Medicare rule could cost hospice providers more and limit their reach

Source: Journalnow.com
By RICHARD CRAVER

A new Medicare rule requiring a doctor or nurse practitioner to visit patients in person after 180 days of hospice care is likely to raise staffing costs for providers and could limit the reach of assistance in rural areas.

The rule, which goes into effect today, requires a face-to-face visit before a hospice patient can continue to receive care after two 90-day periods. However, Medicare agreed Dec. 23 to postpone enforcing the rule until April 1 to give providers more time to meet its requirements.

The primary functions of the visit are to make sure that the patient still needs end-of-life care and that the care is appropriate for the person’s needs.

The goal of hospice care is to provide comfort to a patient who is close to dying rather than to continue treating the patient to extend his or her life. Some hospice care is provided in facilities, and some involves visits to patients’ homes. Care is provided by medical professionals and lay volunteers.

Local and state officials said the rule would affect about 9 percent of North Carolinians who receive hospice care.

Where the cost comes into play is that Medicare will not allow a provider to bill for the doctor or nurse practitioner visit. It’s considered an administrative requirement, so the bill must come out of Medicare’s per diem rate of about $130 a day.

“It’s going to stretch all of us, no question about it, more so with the smaller hospices,” said JoAnn Davis, the president and chief executive of Hospice & Palliative CareCenter, which is based in Winston-Salem and serves 13 counties.

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Driving performance, not age, dictates when it’s time to curtail driving. If your parent is showing problems with driving, it could be time for “that” conversation.

Ideally, you’ve set the stage through candid discussion over the past months or years. Perhaps you’ve even talked about how others have handled this phase-of-life issue. Sensitivity to your own emotions can help guide you when you talk with your loved one. It’s better to acknowledge the sadness than avoid the conversation and risk an accident.

- Consider who should deliver the news. It’s typically best received from a trusted family member or a health professional. Choose someone who can be supportive and empathetic. If Mom is able, have her talk to Dad, or vice versa. If it’s your role, go easy. Expect to have several conversations. Show your concern for maintaining your parent’s ability to get around and participate in life activities.

- Practice using alternatives. Work toward zero driving. Have family members and friends provide rides more often. Make it natural by saying, “Let’s go shopping together today.” Join Mom in trying public transportation. Arrange for home delivery of goods and for automated bank deposits/payments.

- Work with resistance. If Dad doesn’t follow through with promised changes, you need to take further action. See if the doctor will set limits. Remind Dad his behavior puts others at risk. Impose family restrictions, such as telling him he can no longer drive when the grandkids are in the car.

- Be firm. If all else fails, contact your state department of motor vehicles and find out how to report an unsafe driver. This will trigger a driver evaluation. If the license is revoked but your parent continues to drive, consider disabling the car or “losing” the keys.

For more, visit http://www.hospicecarecenter.org!

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There’s a lot to do after bringing someone home from the hospital. The obvious goal is continued recovery. But roughly 20% of older adults are rehospitalized within 30 days because of problems that develop at home.

Research shows there are three things you can do to prevent a backslide. It’s important to get going on them even before your loved one is discharged.

- Understand the new medication schedule. Meet with the discharge planner to review medications. Bring a list of what your loved one was taking before hospitalization. If any of these drugs are not on the current list, ask if they should be restarted. Review each new medication. When should it be taken? How long should it be taken? Any side effects? Have new prescriptions phoned in to the pharmacy before you leave the hospital.

- See the doctor for follow-up within a week. Find out what doctor(s) your loved one should see. Request that the hospital forward records to all of them. Before you leave the hospital, call the doctor’s office to set up an appointment for the next week. You may need to be firm with the receptionist and explain that your loved one has just been hospitalized.

- Know the signs and symptoms of problems. Before leaving the hospital, consult with the discharge planner about what to expect. Ask them to group symptoms as “green light,” normal recovery. “Yellow light,” early signs of a possible problem. And “red light,” a significant problem. Find out what to do and who to call in case of yellow or red light symptoms.

Focusing on these three tasks can significantly speed recovery and reduce your family member’s chance of rehospitalization. If you are confused about any of these tasks, insist on having your questions answered before you leave the hospital.

For more, visit http://www.hospicecarecenter.org!

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Dying at home, surrounded by family
Source: CNN.com
By Madison Park, CNN

Elizabeth Edwards died Tuesday, after doctors had told her further cancer treatment would be “unproductive.” She was at home, surrounded by people who loved her.

Next to picking a life partner or becoming a parent, there isn’t a more personal decision than how to die for those who get the opportunity to choose.

When the limits of modern medicine are reached, it’s a heavy consideration for terminally ill patients. For some, making the conscious decision to end treatment is tantamount to giving up or giving in. They worry about disappointing the people who care about them.

But one end-of-life expert sees it differently, noting that a growing number of patients are choosing hospice, so they can be made comfortable in familiar surroundings with family and friends close by.

“People in hospice don’t want to die. They want to live, and they want to live well,” said Dr. David Casarett, associate professor of medicine at the University of Pennsylvania. “They want to use whatever time they have to live the best way they can. I don’t think it’s giving up. It’s making a careful choice.”

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Death and dying are not topics we talk about easily in our culture. As a general rule, in fact, we avoid them, almost as if to talk about them would bring on a premature demise. As a result, many families are unaware of their loved one’s wishes at the end of life and are faced with making difficult decisions. This can lead to family discord and can make a trying situation even harder than it already is.

Norene’s father, Richard, showed caring and foresight in planning ahead. He thought about what “quality of life” meant to him. Reflecting on what made life worth living helped him to make decisions about life support issues. (It also helped Richard and his family maximize the things that gave him pleasure!) After clarifying his own values, Richard was able to write an advance directive, a document that stated his wishes concerning health care decisions in case he was unable to speak for himself. He talked with his family about his wishes and asked his eldest son to be his health care representative if a situation came up that was not covered in the advance directive. By planning ahead, Richard was able to lay the groundwork for things to unfold the way he would have wanted them to.

In addition to health care planning, Richard took steps to plan his finances. When he began to have difficulty getting to the bank, he gave his daughter Norene “durable power of attorney.” He was able to continue making financial decisions on his own, but this simple document legally allowed Norene to step in and handle his affairs during those times when he was too ill to do so himself. Richard prepared documents stating his wishes for how his belongings were to be distributed. He was also mindful of the fact that medical expenses could eat up the resources he did have and leave very little for his wife to live on afterward. With some planning, Richard was able to protect his assets and safeguard his wife’s security.

Not all patients are able to make these kinds of decisions ahead of time. Many need help from family members who can assure the patient that it’s okay to talk about these things and, in fact, would be helpful for the family if they were discussed. Ideally, all of us adults would have documents stating our desires for the distribution of our belongings and the handling of our medical care at the end of life. After all, any one of us could get in an accident tomorrow! These decisions especially need to be made when a serious illness has been diagnosed, and the sooner the better while the patient still has the ability to think and communicate clearly. To help you, we have tips to start the conversation about planning. Although it can be awkward at first, families who do have these discussions fare a lot better emotionally at the end, not having to guess and knowing they are doing what their loved one wanted them to do.

For more, visit http://www.hospicecarecenter.org!

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Source: JournalNow.com

Bea Ackenbom-Kelly and her husband, Sid Kelly, are both dying.

But in the past few months, their house off Country Club Road has brimmed with life with the frequent comings and goings of family and friends.

Friends from their church, St. Anne’s Episcopal, and from Ackenbom-Kelly’s book club have come over and brought food. Their children and grandchildren have visited. And people they haven’t talked to in years have called.

“It feels like little miracles everyday when you hear from somebody you haven’t heard from in 30 years,” Ackenbom-Kelly said yesterday.

She said she has had a chance to mend estranged relationships and deepen other ones.

Both she and her husband, Sid Kelly, a founder of Crossing 52, a group devoted to improving race relations, have been getting care from Hospice & Palliative CareCenter in Winston-Salem.

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Hospice & Palliative CareCenter is committed to improving excellence in the delivery of palliative, hospice, and end-of-life care.

Continuing Medical Education Offerings
Hospice & Palliative CareCenter’s medical staff services department offers several opportunities for medical professionals to gain a deeper understanding of end-of-life care.

Through a series of conferences, case studies, and other forums, our team of experienced physicians and nurse practitioners, will offer the following opportunities:

CME General Medicine Conference Series in Palliative Medicine
Hospice and palliative care focused training – various topics offered by our staff and guest speakers. The conference series is open to medical staff and other healthcare professionals interested in expanding their knowledge of Hospice and Palliative medicine.

Conferences are offered the 2nd & 4th Friday’s of each month and run from September thru June. Appropriate continuing education credits are awarded to healthcare professionals who attend.

For more, visit http://www.hospicecarecenter.org!

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Some people maintain strong driving skills as they age. But over time, most of us lose physical abilities that are key to safe driving. Indeed, only teens have more accidents per mile than do adults over age 65.

Advanced years alone are not a reason to stop driving, however. Health, fitness, and thinking power, not age, determine a person’s ability.

Following are signs of possible problems:

- Trouble with vision or hearing. Watch for problems seeing lane lines or pedestrians, overlooking stop signs, or judging the speed of oncoming traffic. Other signs include discomfort with glare or driving at night.

- Inability to twist or turn easily. Arthritis and stiff muscles can make it painful to turn and look when needed. This can lead to trouble when backing up, changing lanes, or merging with traffic.

- Medication use. Many medicines can slow thinking and response time. Drugs for depression and anxiety can do this, as can sleeping pills and medicines for heart conditions, colds, and allergies.

- Dementia. At “early” stages, many individuals can still drive safely. Talk to your loved one’s doctor about a driving skills evaluation.

- Two or more recent tickets. Consider tickets a yellow, warning light. Common infractions include poor parking, running a stop sign, or going the wrong way.

- Two or more recent accidents. Parking lot and sideswipe accidents indicate driver error. Poor depth perception also causes seniors to have a very high rate of left turn accidents.

Take regular ride-along outings. Notice your loved one’s skill level and confidence level. Ask for input from friends and neighbors.

It is important to approach this subject with sensitivity. In the meantime, you may want to explore self-assessments your loved one can take privately, at home. These two were created by the American Automobile Association’s Foundation for Traffic Safety.

AAA Roadwise Review (30-minute multimedia screening tool measuring specific mental and physical capabilities)

AAA Drivers 55 Plus: Self-Rating Form (15 multiple choice, text-based questions)

For more, visit http://www.hospicecarecenter.org!

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Are drug costs a worry for your elder family member? This year, new assistance is available for many Medicare Part D participants.

Your family member may qualify for “Extra Help.” This program helps pay for a Medicare prescription plan. It trims monthly premiums and the annual deductible. And it shrinks the co-pay costs for prescriptions. The average annual savings is $3,900.

If your family member didn’t qualify for the program last year, apply again. There are new criteria this year. They make the “extra help” available to more people. Eligibility is based on income and financial resources. Specifically,

• Income must be less than $16,245 per year for an individual or $21,855 for a couple.
• This year, income does NOT include any help received from others for expenses such as rent, utilities, and food.
• Financial resources include bank savings, stocks, and bonds. An individual can have no more than $12,510 in such savings. A couple can have no more than $25,010.
• This year, life insurance policies are not counted.

You can apply online or call Social Security at 800-772-1213. Ask for help with prescription drug plan costs. They will send you the application.

Even without Extra Help, your loved one may get a rebate. The rebate is for individuals who fall into the Medicare Part D coverage gap. This is also called the “donut hole.” This year, everyone reaching the coverage gap will receive a tax-free rebate of $250. No application is necessary. A rebate check will be sent automatically to those who qualify. Next year, a 50% drug discount is planned for people who fall in the donut hole. The discount will apply to brand name drugs covered by the individual’s Part D plan.

Some drug companies offer special assistance programs. Check our prescription assistance page for information.

For more, visit http://www.hospicecarecenter.org!

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Joann Davis, CEO of Hospice & Palliative CareCenter on Triad Today!

For more, visit http://www.hospicecarecenter.org!

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