Printer-friendly format

St. Bernards groundbreaking ceremony Tuesday, Sept. 9.

He didn't have long to live, and all he wanted to do was drive his tractor again. St. Bernards Hospice gave him the pain management medication he needed to do that.

Another patient wanted to go fishing but was too weak to leave his home; the hospice gave him a stocked kiddie swimming pool so he could fish off his back porch. In another instance, the hospice staged an early high school graduation ceremony so a dying mother could see her daughter receive her high school diploma.

"That's what hospice is about: Identifying goals and helping patients to live," said Tammy Hawkins, hospice director. "We're not about death and dying. We're helping patients live when they don't have very many days left to live."

Arkansas hospice providers such as St. Bernards are serving more clients than ever, but their margins are threatened by reduced Medicare payments and higher fuel prices.

The lower Medicare payments are the result of a three-year phaseout of the federal Centers for Medicaid and Medicare Services' budget neutrality adjustment. That's the formula that equalizes hospice reimbursements according to the costs of providing services, not including wages.

Losing the adjustment will be a setback for hospice providers, who already operate on thin profit margins, according to Jon Radulovic of the National Hospice and Palliative Care Organization.

Moreover, the NHPCO says the move won't help Medicare reduce overall costs because hospices save the health care system an average of $2,300 per patient by keeping them out of a hospital environment.

Joseph Chan, MD, executive director of St. Edward Mercy Home, Hospice and Palliative Care in Fort Smith, explained that the hospice saves costs for its parent hospital, St. Edward Mercy Health System, by decreasing admissions, dispensing cost-effective pain medications, decreasing emergency interventions, and providing a mechanism for patients and families to opt out of future resuscitation efforts.

Rising gasoline prices have hit hospices hard. Agencies often send three or four professionals to care for a patient three or four times a week, with carpooling not really feasible because the professionals serve different patients at different times.

Circle of Life in Springdale saw its most recent two-week payroll reimbursement soar to $8,300, an increase of $1,600 following the last federal mileage rate increase, according to Carol Andrews, financial director. The hospice is also spending $1,000 a month for fuel for trucks delivering medical equipment to homes.

Hospice providers are dealing with the financial environment by cutting costs where they can and by seeking community support. Circle of Life, for example, has divided its medical personnel into "north" and "south" teams to reduce its miles driven, and it's increasing its grant writing and development efforts.

The financial challenges come at a time when Arkansas hospice providers have been constructing inpatient facilities to provide emergency, pain management and respite care that can't be provided in homes and nursing homes. St. Edward opened a 12-bed facility this year, while Life Touch Hospice in El Dorado opened a 16-bed inpatient facility in March 2007. Hospice of the Ozarks in Mountain Home and Circle of Life both opened facilities in 2005. St. Bernards Hospice in Jonesboro is raising $5.5 million for an inpatient facility that initially will have 12 beds.

The hospice movement has become an integral part of the nation's healthcare system. About 4,200 hospices annually serve 1.3 million terminally ill patients – double its patient load since 1999.

According to Jane Evans, executive director of the Arkansas State Hospice and Palliative Care Association, 33 percent of deaths nationwide occur in a hospice environment, while in Arkansas, the percentage is 28 percent. Thirty companies, 24 of them not-for-profit, serve patients in 58 offices statewide.

Hospice providers say they offer a valuable, holistic health care solution for patients and their families. Teams of physicians, nurses, social workers, chaplains and volunteers relieve suffering and heal ruptured family relationships. Services range from pain management to providing 11th-hour companionship for those who are dying alone.

According to Chan, the hospice model is changing the larger medical culture by providing holistic care encompassing a patient's physical, mental, social and spiritual health, with doctors' visits lasting as long as necessary. "In our clinic model, the patients pretty much negotiate the time that is best for them, and we accommodate them with our appointments. … It's going back to the basics of medicine," he said.

Hospice providers say a major part of their job is educating physicians on the benefits of their services — a task made harder because theirs is the only non-curative medical specialty. For some medical professionals who are trained to do everything possible to find a cure, referring a patient to a hospice is an admission of defeat. "It's very difficult for physicians to say, I think, that I can do no more," Hawkins said. "Sometimes I think physicians don't feel comfortable discussing death with patients, and they have a hard time saying, 'Maybe it's time that we look at hospice.'"

Hospice providers say that when physicians wait until patients are near death, it reduces the time their team can work with them and their families. "Don't get me wrong, we can make a difference in two hours, but we can make a bigger difference in two weeks, and we can make a tremendous difference in two months," Macy Braswell of Life Touch Hospice said.

Meanwhile, hospice providers say they must combat misperceptions in the community — that patients must have cancer, be on Medicare, or be bedridden.

According to Evans, a registered nurse who has worked in patient care, it takes a special person to work in a field where there is no hope for a cure. She said it's fulfilling to be involved in a family's most intimate moments, and that spending so much time around the dying is a reminder of how lucky she is to be alive.

All the hospices contacted for this story said they do everything possible for their patients to be comfortable and fulfilled in their last days.

As for the finances, "I think with a lot of prayers, the program continues," Chan said. "And I tell you, I think if you're doing the right thing in healthcare, you survive."

Tags:

None

Login and voice your opinion!

Do you know someone else who would like to see this?
Your Email:
Their Email:
Comment:	(Will be included with e-mail)
Secret Code	In the box below, enter the Secret Code exactly as it appears above *