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Now displaying: September, 2015
Sep 17, 2015

Hospice and End of Life Resources for Palliative Care

 

Welcome Medicare Nation!  Today we continue with Part 2 of our Death Series, as we talk about end of life resources that Hospice provides.  Most people are familiar with Hospice and the services they provide, but I wanted us to take a closer look at Hospice as it relates to Medicare.  Hospice provides several different levels of care, but the focus of our conversation today is routine care and respite care.

 

My guest for today is Judy Lund Person. Judy is with the National Hospice and Palliative Care Association.  She has worked in the national office since 2002 and is considered an expert in Compliance and Regulatory Leadership for Palliative Care. 

 

 

We discuss some very important aspects of Hospice care and Medicare, so for more details on each of these questions below, please listen to the full episode here.

 

 

Who qualifies for Hospice services?

 

Hospice is for patients who have a life expectancy of 6 months or less. Hospice is covered under Part A of Medicare.  The key is that the person would be nearing the end of their life, regardless of their age.  In Judy’s experience, she has seen patients from 2 days old to 100 years old.

 

 

Routine Care:

 

When should hospice be called in?

 

Many families feel that hospice should have been called in sooner.  Judy encourages you to have a conversation with the physician and begin asking when hospice services should begin.  Many times they see patients in the 3-6 months prior to their end of life.  

 

Where can hospice provide care?

 

95% of the care they provide is in a patient’s home, or where they call home.  Hospice does have facilities, but the majority of their patients are in their own homes.

 

What kinds of services are provided?

 

  • Nurse - initial assessment is done
  • Social Worker
  • Chaplain
  • Aide
  • Therapy including art or other
  • Hospice Physician who consults with the attending Physician
  • Patient chooses who they want to be their attending physician, and do as much or as little as the patient wants.

 

It is very much a team approach to providing services.

 

 

How does Medicare work with Hospice?

 

Medicare covers hospice at 100% under Part A. Medications may need to be paid for out of pocket if hospice doesn’t feel a medication is necessary.  Hospice benefits are paid on a daily rate, so it does not matter the amount of services that are provided on a single day, because the rate is the same.

 

The Hospice team provides intermittent visits, depending on the need. Each patient has an individual care plan.

 

Medicare pays for two 90 day periods and then there is an extension of 30 days.  Physicians can re-certify the patient for coverage to continue.  Many patients have hospice for much longer, depending on their need.  Length of coverage is on a case by case basis.  If you are beyond the score of time set forth, all that needs to be done is for your Physician to re-certify that Hospice service is still needed and it will continue to be provided.  There is no need to worry that you will be cut off from services if you outlive the timeframes set forth in the coverage plan.

 

 

Respite Care

 

What is respite care?

 

If you have a short term period where you as a care provider need a break, hospice will provide respite care in a facility, while the family and caregivers get a break.  This service is covered under Medicare Part A.  This is different than routine care, but it is still a covered level of care.

 

 

 

Hospice care is considered palliative care, for the comfort of the patient, not to provide a cure for the disease.

 

Palliative care is comfort care.  Maybe it is pain, shortness of breath or other conditions that are difficult to tolerate.  Hospice specializes in pain management and pain control, while still keeping the patient alert.  They also deal with anxiety and depression that can go along with the terminal condition.

 

Hospice can help with any sort of distressing symptoms.  However, if another issue arises that is unrelated to the hospice issue, the hospice nurse and the care team will consult and determine who can provide treatment and care.

 

In the last year hospice saw 1.6 million patients.  You do not have to have a reimbursement resource to get Hospice care.  Most insurance covers hospice care, and if you don’t have coverage, you can still get Hospice care that is un-reimbursed.

 

Lauren Hill at 19 years old, was a great example of hospice care.  She received hospice services, even though all she wanted to do was play basketball with her college.  So, she was able to play one basketball game, and be an inspiration for her team, her family and everyone that heard her story.  She was able to raise more than 1 million dollars for cancer research because she used this battle as a way to help the cause.

 

Where can you find out more about hospice?

 

www.caringinfo.org has lots of information about hospice, terminal illness and support for families.

 

You can find inspirational stories at www.momentsoflife.org.  Lauren’s story is here and many others that will inspire you.  You can also memorialize your loved one and their struggle on this website.

 

Call 1-800-658-8898 if you need information and want to talk to someone in person.  This is a toll free number from anywhere in the US.

 

 

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)    

 

Find out more information about Medicare on Diane Daniel’s website!

 

www.CallSamm.com 

 

 

 

Sep 17, 2015

 

Welcome Medicare Nation!  Today my guest is Dr. Fernando Mirarchi, who is the Medical Director of the University of Pittsburgh Medical Center.  He is the  principal investigator of the TRIAD report.  His research has led to a spiral report that presents the confusion and risk around Living Wills and DNR orders.  Dr. Mirachi has written a book and several articles about this topic.  

 

Dr. Mirarchi practices Emergency Medicine, but he is also the Chairman of the Medical Ethics Committee, so he has a special insight into end of life care and the breakdown around it.

 

Having confusion around a Living Will and DNR is a real possibility to the general public and it is a reality that many will be dealing with in the future.  

 

What is a Living Will?

 

A way for a patient to document, in writing, their wishes for their end of life care.  The problem with this definition is, in medicine, everything can be terminal, if not properly treated.  The difference between an Effective and an Enacted Document are also misperceived as to when a document becomes enacted.  “The Living Will” will not prevent care from being provided, in order to save your life.

 

What is a DNR (Do Not Resuscitate)?

 

A document that says that medical providers will not administer CPR, in the event that you are found not breathing and with no pulse.  The name of the document causes confusion, because people think it means you aren’t going to get treatment for a medical condition.  In legal terms, it only means the CPR will not be administered if you are found without a pulse and not breathing.  In order to refuse all types of care if you are critically ill, then you would have to sign a document indicating you don’t want any care administered. Period.

 

What is a POLST Order?

 

This is enacted when you would be in cardiac arrest, and a Provider would have to use this document to immediately chart the treatment for the cardiac arrest.  There are multiple options and this can also cause some confusion as to when it can supersede a DNR.  This process can also cause conflicts because it is a metric by which insurance companies are rewarding Providers financially.  

 

What caused you to do the TRIAD (The Realistic Interpretation of Advanced Directives) Studies?

 

Dr. Mirarchi had a situation first hand, where he was being faced with paperwork that was being misinterpreted, and almost caused him not to save a life.  Luckily, another Physician was around nearby, who understood what the paperwork meant and intervened for a good outcome for the patient.  This and a few other circumstances caused him to write the book, Understanding Your Living Will. (available on Amazon and Atticus Books)

 

 

One of the criticisms of the book was that there was no research backing up the claims in the book.  This thought was what led Dr. Mirarchi to start the TRIAD Studies.  

 

Dr. Mirachi views these decisions as a Patient Safety issue, rather than an end of life decision.

 

He created a checklist to help facilitate the conversation about these decisions from a Medical perspective and also from the patient perspective.  There is a checklist of the Medical Provider and also for the lay person.  Each checklist provides the ABCD for each role.

 

A - Announcing your end of life documents

B - Be clear with regard to treatment with regard to the document.                 

      Understanding whether the issues are terminal or chronic illnesses.

C - Communicate and coordinate with family members.

D - Discussing the next steps and designing the plan for the patient. 

 

You can download the checklist and cut it out and place it in your wallet (link)

 

There is a company called My Directives, which has digitized all of the end of life paperwork, so you can carry the paperwork with you at all times.

 

The checklist for the lay person basically spells out the same information, but in terms that anyone can understand.  

 

The aging population is being unintentionally targeted in an effort to control healthcare costs, so it is important that every patient understand their options and having the ability to make it a two-sided conversation.

 

Resources discussed in the show:

 

National Patient Safety Article

 

http://www.npsf.org/blogpost/1158873/200782/A-New-Nationwide-Patient-Safety-Concern-Related-to-Living-Wills-DNR-Orders-and-POLST-Like-Documents

 

 

Dr. F. Mirarchi’s book

 

“Understanding Your Living Will: What you need to know Before an Emergency”

http://goo.gl/WAv9Bc

 

Advanced Care Directives

https://mydirectives.com/

 

 

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)   

 

Find out more information about Medicare on Diane Daniel’s website!

 

www.CallSamm.com  

 

 

 

Sep 9, 2015

Welcome Medicare Nation!  I have to tell you that today’s show is packed with tons of great information.  The topic of today's show is making end of life decisions and having an advanced care plan for yourself.

 

Today’s guest is Dr. Stanley Terman (founder of Caring Advocates for Advanced Care Planning),a board certified Psychiatrist in Carlsbad, CA, and a published author on today’s topic.  Dr. Terman has spent the last 15 years focused on reducing the pain of terminally ill patients.

 

People’s greatest fear is losing control and it means that other people have to make decisions for you.  It becomes difficult for people to be in a situation where they have to make decisions about your life, based on your wishes, not on your finances.  This instills much fear within all of us as we are aging.

 

Advanced care planning has been painted as “death panels”in the media and has fostered the idea that decisions about your care will be made with bias.  If you learn what your choices are now, you can plan and then not have to worry about it later in life.  There is a freedom that comes when you have made these decisions for yourself, and it allows you to continue enjoying your life.  

 

The majority of people in certain groups do not prepare enough for advance care directives:

  1. Religious people 
  2. African Americans

 

Living Wills tend to be more controversial, we understand that some are reluctant to adopt them.  Doctor Terman created a Natural Dying Living Will, which is an extremely flexible document.

 

You are required to fill out a form of this nature in order to document your wishes.  You don’t need to consult an attorney and you don’t need to spend any money.  You can fill out a living will for free.  The Natural Dying Living Will isn’t free, but it gives you  many options and it is flexible.  The document needs to be strong enough to compel Physicians to follow your specific wishes.  The Natural Dying Living Will accomplishes  this with several layers of protections built in, and it has proven effective to get the attention of the physician.  Once you have filled out all of the paper work,  Dr. Terman recommends making a video where you summarize your wishes in a video directive.

 

**You need a Durable Power of Attorney in order to give someone the authority to make the Physicians follow your Living Will.

 

This will ensure you have the 4 P’s

 

1.  Peaceful

2.  Prompt

3.  Private

4.  Passing

 

Caring Advocates provides a laminated business card with a scannable bar code.  When scanned, it immediately pops up the video of your final wishes, and the necessary documents for your living will.  There’s concern about finding documents or getting documents out of safe keeping, in order to submit them to the Doctor

 

When attending a counseling appointment with a Doctor, bring your end of life documents with you to the session. Then your session becomes getting your Doctor’s opinion on the decisions you have made.  Some services like Palliative Sedation are choices you may make, but a Doctor might not support it.  Better to find this out ahead of time.  Having a discussion about this type of treatment and even Respite Sedation are beneficial.  You need to give your Doctor the tools to help sustain life, and these tools can accomplish that.

 

Once you have this paperwork taken care of, including the Durable Power of Attorney, there are clauses that would allow for the changing of Physicians and even for changing the treatment plan.  So this way of handling your paperwork is comprehensive and it can last through the ages, and the changes that can occur.  

 

Plan now, to die later, to live longer.

 

 

You don’t want to miss Doctor Terman’s offer to assess your existing Living Will for the 3 main scenarios that will likely cause your death.  It’s an unbeatable offer!  Listen to the show for all the details!

 

 

Resources Mentioned in the show:

 

www.caringadvocates.org

 

The Natural Dying Living Will

 

Doctor Terman’s Books:

 

  1. A Lethal Choice - The Best Way To Say Goodbye
  2. Peaceful Transitions - An Ironclad Strategy to Die When and How You Want
  3. Peaceful Transitions - Plan Now, Die Later
  4. My Way Cards - Natural Dying Living Will Cards

 

 

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)   

 

Find out more information about Medicare on Diane Daniel’s website!

 

www.CallSamm.com 

 

 

 

Sep 3, 2015

In this week’s episode of Medicare Nation, Diane Daniels interviews Max Richtman, the president of the National Committee to Preserve Social Security and Medicare (NCPSSM). In this episode, Diane and Max discuss Medicare’s 50th anniversary, the role of the NCPSSM, the Supreme Court’s challenge to the Affordable Care Act and HR 3308 - Seniors Have Eyes, Ears, and Teeth Bill.  

Main Questions Asked:

  • Tell us what the National Committee to Preserve Social Security and Medicare does?
  • How do you view the importance of the Supreme Court’s challenge to the Affordable Care Act and Medicare’s 50th anniversary?
  • What is your take on Medicare’s financial condition?
  • How can we balance the two schools of political thought when it comes to Medicare?

Key Lessons Learned:

  • 55 million people depend on Medicare for their healthcare.
  • Billions of dollars are lost each year to fraud, healthcare’s rising costs, and increasing numbers of Americans retiring from the workforce.

NCPSSM

  • Former Congressman James Roosevelt, who was the eldest son of FDR, founded The National Committee.
  • The NCPSSM is dedicated to protecting the Social Security and Medicare programs and is the second largest senior citizen lobbying association in the USA, with about 3.5 million members and supporters.
  • The recent focus has been to improve, enhance, and expand the Social Security and Medicare programs.

Supreme Court’s Challenge to the Affordable Care Act

  • $716 billion was saved out of the Medicare program and the Affordable Care Act.
  • These savings came from reducing payments to providers such as Medicare advantage programs and reimbursements to hospitals.
  • Under the Affordable Care Act, Medicare beneficiaries enjoy preventative care with no out-of-pocket costs. This includes cancer screenings, colonoscopies, mammograms, and diabetes testing.
  • The Medicare program is now solvent until the year 2030.

Medicare’s Financial Condition

  • In light of the Obamacare program, the solvency of the Medicare program was expanded for an additional 13 years.
  • As the Affordable Care Act takes hold and reduces health care costs, it will have an impact on Medicare as well.
  • Max is looking forward to additional years being added to the program by virtue of the restraint on costs that will be received due to the Affordable Care Act.
  • Besides reducing reimbursement rates to providers, it has changed the focus on healthcare payments to be tied to value and not volume.
  • Doctors and their staff have to be current and understand what is needed to reduce cost as so much money is depleted through fraud, waste, and abuse.

Diane’s Advice

  • Look at your Medicare statement every month to ensure it is correct with regards to providers and procedures.
  • If you notice a discrepancy, then call your Medicare Plan immediately and report it.
  • Remember, the patient can play the largest role in finding discrepancies and overcharges. This has a significant impact in reducing waste and fraud.

Politics and Medicare

  • There is a significant divide among politicians in how Medicare should function in the future.
  • We hear from the campaign trail that it is fiscally responsible to reform Medicare, but we also hear expansion of Medicare is the best option.
  • We need to ask ‘what does reform mean?’ To some, ‘reform’ is another’s idea of ending the Medicare program.
  • The reason we have a Medicare program in the first place is because insurers didn’t want to insure seniors as it was deemed too expensive.
  • The value of a voucher will not keep up with the increased cost and inflation in healthcare. It will become less valuable over time and less able to provide coverage.
  • Using vouchers is a way to rescind Medicare law and go back to a time when people were on their own and a lot more seniors were living in poverty.

HR 3308 Seniors Have Eyes, Ears, and Teeth Act

  • Congressman Alan Grayson from Florida recently introduced the Eyes, Ears, and Teeth bill.
  • The NCPSSM wrote a letter endorsing the bill that will, for the first time, add coverage under Medicare for vision, hearing, and dental.

Medicare and Hearing

  • One third of people in the 65–74 age group experience hearing loss.
  • Half of people over the age of 75 have hearing loss issues.
  • Congresswoman Debbie Dingle introduced The Medicare Hearing Aid Coverage Act of 2015 that will take a portion of that coverage and add Medicare coverage for hearing testing and hearing aids
  • There is a lot of opposition from the medical industry as providers don’t want to deal with the Medicare regulations even though there would be a massive increase in volume.
  • Dr. Franklin Lin from Johns Hopkins has developed groundbreaking research that makes a link between hearing loss and dementia and Alzheimer’s.
  • Having Medicare cover hearing loss and come up with the financial resources to provide that coverage would pale in comparison to the cost of treating Alzheimer’s patients.

Thank you for listening! If you enjoyed this podcast, please subscribe and leave a 5 star rating and review in iTunes! (Click here)

www.CallSamm.com

Episode Resources

NCPSSM

1–800–966–1935

Congressman Allan Grayson presents to the House of Representatives

HR 3308 – Seniors Have Eyes, Ears and Teeth Bill

Congresswoman Debbie Dingell presents to the House of Representatives

HR 1653 - The Medicare Hearing Aid Coverage Act of 2015

Medicare

Federal Trade Commission

Click To Tweet - Spread the news!

Are you aware of The Eyes, Ears and Teeth Bill? Find out what it means for you. @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

What is Medicare’s current financial condition? Find out w/ @NCPSSM @medicarenation http://tinyurl.com/ow3ea9l

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