Vermont lags in use of hospice care

RUTLAND - November was National Hospice month.

Hospice is largely an untapped resource by Vermonters. In 2010 Vermont had the 49th lowest use of the Medicare Hospice benefit in the entire USA. Vermont - a state that was a pioneer in creating the Medicare hospice benefit in the 1980s - dropped to the second lowest state in the use of hospice, an excellent resource for elderly or younger Vermonters at end of life. Only Alaska had a lower utilization of this holistic and comprehensive benefit that is available to all in need of care at end of life. Hospice is all about comfort and care and support of the client and family who do not want to continue to access aggressive treatment for a condition that is no longer responding curative efforts.

2010 statistics from the National Hospice and Palliative Care Organization show that nationally 64 percent of Medicare beneficiaries were on hospice when they died. In Arizona 97 percent were on hospice, in Vermont - only 36 percent accessed their hospice benefit and for a much shorter period (52 days average) than the rest of the nation (67 days on average). Easily twice as many people in Vermont - over 3.200 people per year are eligible for hospice, yet only 1,610 Vermonters received hospice care in 2010. Why?

As a nurse working in home health and hospice in Vermont for over 30 years, I find many people are reluctant to discuss hospice or offer it as a choice unless the client or family asks first. Many Vermonters- including physicians and nurses- have misconceptions about hospice:

* Many in Vermont believe that a person must be actively dying to be signed on to Hospice. NOT TRUE! Medicare has set specific criteria for each hospice diagnosis. Clients may have many weeks or months or longer of active function and still meet hospice eligibility criteria.

* Many health care providers believe that clients on hospice may not have antibiotics for infections, or receive regular medications for their medical problems - NOT TRUE! For example-when a hospice client with emphysema gets a respiratory infection, or a urinary tract infection - they may choose to be treated with antibiotics. There is no contraindication for this in hospice care.

* Many people believe a hospice client must die in 6 months or less - NOT TRUE! Hospice is an indefinite benefit- and has no limits as long as the client continues to show decline, even a very gradual decline. Research has shown that hospice clients may often live longer and have a higher quality of life than a person with the same medical condition who is not on hospice.

* Many people believe you must have cancer to receive hospice - NOT TRUE! Any illness that is serious and life threatening may be the hospice diagnosis, including Alzheimer's, heart disease, lung disease, stroke, and many others. Less than half of all hospice clients have cancer.

* Many physicians believe that if they refer a client to hospice - they will not be able to bill Medicare for their care of that client - NOT TRUE! The client's own attending physician is the one physician who can continue to bill Medicare for hospice related care. Other physicians may be contracted by the hospice program, if needed to consult for the hospice diagnosis. But any physician treating a hospice client for other medical problems unrelated to their hospice diagnosis can bill for that care too.

Hospice program eligibility criteria: two physicians - the individual's own physician and the hospice medical director, must certify that the individual has a serious illness which if it ran its normal course, could take their life within six months and the client or health care proxy chooses comfort care not aggressive/curative treatment. There is no requirement to be "homebound," or to have "skilled care" or other rules that apply to the home health benefit only. Hospice clients may live in their own homes, in a nursing home, or in residential care; hospice can follow you where you live.

Hospice clients may change their minds and sign off of hospice to resume regular Medicare, with no penalty. In some cases hospice actually must discharge clients who improve with good hospice care if they stop declining.

They can choose hospice again when it is appropriate care for them in the future.

Hospice care is the most comprehensive service available for those who are eligible.

What does hospice care offer clients and families? Nurses visit hospice clients as needed and are on-call 24 hours/day, 7 days/week to manage symptoms, medications and to coach family to ensure the client is comfortable.

Nurse Aides can visit to help bathe, dress and care for the hospice client and do light housekeeping.

Social workers help families cope with the struggle of caring for loved ones and help them to access resources to support them at home or to plan for other placement when and if needed.

Medications, Oxygen, Medical equipment - hospital beds, commode, walker, etc.

Volunteers visit and support the family - to give them a break, or run errands.

Spiritual care and support for clients and family members facing end of life issues and * Bereavement support for families and loved ones.

The hospice MD is available to consult with the client's MD and can visit the client if desired.

Palliative treatment may be approved by hospice to include minor surgery, and occasionally palliative radiation or chemotherapy if it is the best way to manage pain.

Short hospital stays for symptom management may be appropriate.

Hospice goals are focused on the client and family's goals. Our job is to help each client and their loved ones have as many good days as possible! Hospice under Medicare is a 100 percent covered service- no deductible or co-pay.

Every insurance plan in Vermont (Medicare Medicaid and Private insurance)- has a hospice plan. But for those who may not have insurance, * Every hospice program in Vermont offers hospice care to all in need; no one will be turned away because of inability to pay.

In Vermont, up until 2010, there had been only one provider of hospice care in any given Vermont geographic area. There are now two Medicare certified hospice programs, designated by the State of Vermont to serve clients in every part of Vermont. Just as one physician may not be the right physician for every person, one hospice program may not be the right fit for every client or family.

If you think you or your loved one may be eligible for hospice care- call both of your local hospice programs; there are many, many right ways to provide hospice and each program will be different. You can choose the hospice program that is right for you and your family.

Phyllis Tarbell is the director of Vermont Rutland Hospice (VRH) based in Rutland. For more information, call 802-282-4122 or 442-9589.


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