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How much would you pay out-of-pocket for a five day hospital stay on Medicare? The majority of people have no idea! The problem with Medicare is there is too much information. An overwhelming amount of information and not enough resources. Medicare Nation solves that problem by educating you on all things Medicare, because there are not enough resources out there! This podcast will educate you about the components of Medicare, the different categories of Medicare Plans and Medicare benefits. On other episodes I’ll interview expert guests in the health and wellness field, about diseases, Medicare issues and current changes to the Medicare program. Medicare Nation is dedicated to answering all your questions about Medicare. Expert information and insights regarding Medicare and you! Further information can be found on www.TheMedicareNation.com Don't Forget to SUBSCRIBE to the show! Give us feedback on Facebook! www.facebook.com/MedicareNation
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Now displaying: Category: Health
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  

 

 

 

Aug 16, 2015

I like to call Medicare Part A “The Accommo- dations” part of Medicare.

If you went on vacation and stayed at your brother’s house in Miami for one week, your brother’s house would be your“accommodations.”  Staying overnight at your brother’s house would also provide you with necessary services –

  1. Bathing
  2. Using the toilet
  3. Eating meals
  4. OTC Medications you may need
  5. A bed to sleep in

Medicare Part A provides similar services – and more, while staying overnight at a

  1. Hospital
  2. Hospice
  3. Skilled Nursing Facility

Medicare Part A has a deductible when you are an inpatient in the hospital. Each year the deductible may change. In the episode, the deductible was $1,216.00. Currently, the deductible is $1,260.00. Starting in 2016, it may change again.

In this episode, you will also learn:

  1. How to qualify for Medicare Part A
  2. If you don’t qualify how to “Buy-In” to Medicare Part A

You will also learn:

  1. The Services covered under Part A
  2. A helpful phrase to help you remember Part A Services

Links mentioned:      www.medicare.gov       www.callsamm.com

Aug 16, 2015

JFK wanted a national healthcare system for our older citizens. He even appeared on national TV to promote the campaign in 1962. I’m certain JFK would have seen his legacy if he hadn’t been brutally assassinated.

When VP Lyndon B. Johnson took over as President, he continued the work JFK started, and on July 30, 1965, Medicare became the law of the land.

Many changes have been made to Medicare over the last 50 years. And today, it’s still “a work in progress.”

Items Mentioned in this podcast

Part A of Medicare

Part B of Medicare

In this episode you will learn:

  1. What is Part A of Medicare
  2. What is Part B of Medicare

Links mentioned

  1. The official Medicare website – medicare.gov
  2. Senior Advisors For Medicare & Medicaid – callsamm.com

Let’s keep up the discussion on Twitter. Follow us @MedicareNation

Visit us on Facebook and tell us what you think – www.facebook.com/MedicareNation

Want to hear a particular guest on Medicare Nation? Let us know on our website

www.TheMedicareNation.com

Aug 16, 2015

This is Medicare Nation. The go-to-resource for your Medicare education.

The problem with Medicare, is there is an overwhelming amount of information and not enough resources to help educate you about Medicare and your benefits.

We solve that problem. Each episode will have a wealth of education about Medicare.

We will take a look at the history of Medicare, the components of Medicare and Medicare benefits. I will also interview guests who are experts in the health and wellness field, who will discuss Medicare related topics on illnesses, nutrition, diseases and injuries. I will update you on changes in Medicare benefits and legislature that is in the news.

Join me as I discuss:

  1. How I solved the Medicare problem
  2. Why I’m so passionate about Medicare

Mentioned Links:

  1. The Medicare Survival Guide –  http://goo.gl/TfLICa
  2. The Official Medicare website – medicare.gov
  3. Senior Advisors For Medicare & Medicaid – callsamm.com

Talk about this episode on Twitter:  @MedicareNation

Visit us on Facebook – www.facebook.com/MedicareNation

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