My FIL was swtiched over to hospice way, way too early. He was cathing himself and then needed a cather put in but his visiting nurses could not do it. He refused to go to the hospital and then one day put a gun to his stomach threatening to kill himself. When visiting nurse found out, they said he needed Hospice to be called in. We asked if Hospice is a facilitate to die organization and was told no.
Hospice comes in and does little. No real help to the family, late to visits, etc. The main thing FIL wanted was pain pills. And more pills. And more pills. And they were happy to supply. Then his kidneys got worse and no urine was coming out when he cathed himself and he kept swelling.
Both visiting nurse and hospice nurses could not get a foley cath in. The social worker came in one day, called my husband and asked how much FIL had in the bank that he was going to a nursing home. They leave and FIL calls my husband and says, "I want to go to the hospital."
The nurse at the hospital got the foley cath in, a tremendous amount of urine came out. That has been close to 3 months ago and FIL is in rehab at a nursing home. Our family had hospice removed because we were told he could not have certain tests done.
We have now received a statement that Medicare has paid $0 on his hospital bill (over 18K) because he was a Hospice patient. Is this billed under a supplemental policy or does Hospice receive a bill and then turn it into his insurance? Anyone else experienced this?
Where did that get me? I only got 2 mornings of which they couldnt handle alone and had no one else, said Mom was a 2 person assist, yet I was there to assist so...? Also iif Mom went to the Doctor, YES she could go, but she had to pay. This was the best Hospice around I was told after I had tried one previously but ended up not signing on with them as they had no morning help available and couldnt even say when they could or would come. So, in the VERY end I suppose they might be good but they now take on patients years in advance. My Mom was given (only by Hospice) 6 months to 3 years and 1 year ago. When I questioned that they said they really cannot tell how long someone will live with asz disease but "oh no worries, we just re-evalulate and sign them on again every 6 months."
Joy, You're going to have to fight this, maybe get a lawyer. I think because the Hospice Lady couldnt get a foley in--you had no other choice. And that Social worker, shame on her asking about your FIL's money! All she had to do is have you sign a discharge paper from Hospice and it would have all been paid. I feel so bad for you!
Just today, I was told that the mother of a person I know who was taken to the hospital a couple of weeks ago is now going to have to undergo a second procedure to place a stent in her heart vessels, along with a second anesthesia that will be required, and all because during her first trip to the hospital, when she arrived at 6 a.m. one day, neither the attending Dr nor any of the supportive staff thought it important to call in a cardiologist until 3 a.m. the following morning. By the time the doctor arrived, she had been without care for 23 hours with a known heart insufficiency. The cardio was fuming, took it out on everyone in the ER and not any of them in the ER objected to the cardio's screaming about and throwing things (hmmm - demurily thought it was justified I gather). He needed to do angioplasty and place more than one stent. The mom's body however was weekend from the experience and she nearly went south on the operating table. They patched her up and send her home knowing she would have to come back in a couple of weeks, when she was stronger, for additional surgery. Already really bad, right? Now get this. Even after his justifiable tirade, the cardio is on willing to stand up for the patient and talk with a lawyer!
So, this post was meant to be about hospice although it might grated into other areas. There is nothing wrong with hospice or the concept of hospice. The problem is the people that are working at a particular Hospice. What we all need to do is what is legally referred to as "due diligence". Read here, read other places,familiarize yourself with the experiences other people have had. Develop I set of questions that are pertinent to your patient. Go out amongst the hospice people before you need them and ask your questions. Just like any sales person, ask if the answers they have satisfied you with are in writing in the contract you're both be signing. You won't be having any problems with the good ones, only the bad ones will balk at your examination of their processes.
In many cases, the case managers who do discharges at the hospitals are used to interfacing with the Hospices who are called into the hospital to evaluate for the appropriateness of hospice. These case managers probably cannot give you the one they think is the best but they probably can give you a list of 3 and those are the first that you should start checking on.
Please don't forsake the hospice concept all together. They can be very helpful in your loved ones and stage and you are not necessarily going to get that kind of cooperation from the primary doctor. Hospices are allowed to administer much more anxiety and pain medication fan and non hospice doctor is willing to do because he is differently under the scrutiny of the AMA and the DEA.
I will not use Hospice unless my Mom is dying and in pain and if the Dr wont order her pain meds if she should need them.
It sounds as if the hospice is at fault for not telling you this.
My heart goes out to those families that not only had the heartbreak of losing a loved one while on hospice services, but then they also had horrible services with their hospice organization.
The Medicare regulations that have to be followed are very strict. the Hospice receives a daily rate of payment for each patient and it is often difficult to pay for everything the patient needs within that amount. Some young patients use their primary insurance as long as it has a hospice benefit, otherwise they pay out of pocket on a sliding scale. many hospices hold fundraisers to help defray their costs. Hospices nurses typically are paid less than their hospital counterparts and receive lower benefits. making ends meet is a constant juggling game which explains why certain supplies are sometimes in short supply
The be eligible for hospice the patient must be certified to have a condition that can be expected to lead to death in six months or less. The MD must certifiy this and often will do so as long as they have seen the patient within the last six months. Often a patient's PCP will be a FNP or PA and the MD will never have actually seen the patient. an MD other than the PCP cansign the paperwork as long as they have been seeing the patient and often this will be someone like an Oncologist or renal specialist. Every cost associated with the terminal illness will be covered by hospice at their discretion so if you decide you want to go to the ER for some reason and it is not cleared with hospice first they won't pay.
Putting a catheter in a male patient can be very difficult if not impossible because elderly men tend to have enlarged prostates so there is no shame in not being successful at inserting a catheter but it is easy enough to check the patient for an overfull bladder and take him to the hospital where an MD can evaluate and treat. Hospice will usually pay those costs but if he refuses to come home when ready for discharge, hospice has the option to discharge him from their service. Hospice will continue to care for patients in hospital usually for five days when they will have either died or are waiting for nursing home placement. Hospice is able to continue to care for patients in N/H but only if the N/H allows it and many don't. If the patient leaves hospice normal nursing home Medicare/ Medicaid regulations apply.
Patients can be discharged from hospice if their condition improves and later be re-admitted for the same or another condition. The hospice may pay for things like radiation or chemo as long as it is of a palliative nature for example to shrink a brain tumor and relieve symptoms.
As most people know Medicare/Medicaid and any kind of health insurance can be an absolute minefield so question, everything, do your own research and demand answers which is not easy when you are dealing with end of life issues so the best advice is to be proactive when there is a family member with a chronic illness. Good wishes to all those doing and who have made the selfless sacrifice to care for a loved one.
legal cause of action... for ENROLLING your dad under false pretenses
during the time WHILE UNDER Hospice
allowed only TO GIVE palliative
consider this facilitating DEATH, don't you?
you can't do anything to TREAT the Alzheimer's
rules for payment by THE SUPPLEMENTAL INSURANCE company
approve the charge but PAY zero
Since $18,000 is at stake.
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RE: HOSPICE
I would like to add there's a world of difference between groups. Our hospice had nurses on call who were in direct communication with the doctor, managing and upgrading patient medication, I health care worker 2 times a week who helped with showering or gave them a bed bath is the case was, and for my mom who just passed in January, the hospice nurse decided my mom was 'critical care' and provided LVNs round the clock 45 days while she was dying. Plez get a list of Hospice is from the hospital, talk to a couple of discharge case managers who work with the hospuce is all the time (since you often are getting a hospice evaluation in the hospital before discharge), and do some interviewing about their services prior to when you need them. IMHO, on top of everything else, you had a lousy Hospice.
Gather your paperwork, check to see why your dad was in hospice, was it for pain because of cancer, for trying to kill himself (a psych problem). Surely a building up of urine (which produces its own pain as well as becoming a medical emergency) and the inability of a nurse to properly cath him, can't in and of itself becoming cause to make someone hospice appropriate? I no I'm not aware of the entire case but this just sounds off to me.
What you ARE allowed to do under hospice is treat a condition that is NOT the cause of the hospice evaluation. For example, if the patient is in hospice for Alzheimer's and becomes worse, you can't do anything to trade the Alzheimer's. BUT if the patient comes down with pneumonia, you don't have to but you CAN treat the pneumonia. AND it can be done at the hospital. Because we never had this circumstance, I don't know who pays but I presume it would be regular insurance, not Hospice. The rules for payment by disciple national company is generally that it has to be Medicare approved, so if Medicare doesn't approve the charge, the supplemental won't have to pay either. Medicare COULD approve the charge but page ZERO, in which case the supplemental should pick up the rest.
There are some intricate points at play in this case and since &18 thousand is at stake, you may want to consult with a lawyer before you write the Medicare appeal. As I said above, your complaint will have to be the same incase Medicare denies and you have to file a lawsuit, you can't change your stories in midstream.
There was a volunteer that came to give him a bath from Hospice. We considered that the only real help. FIL had a helper that came in every day and expressed concern many times to the hospice nurse about the sores on his legs (diabetic). She would wrap them and while she was doing so would ask the hospice nurse, "is this okay....and can you take a look at this because it looks really infected." The nurse would say, "oh yeah, you're doing it find, looks fine, bye." When FIL went to the hospital , the nurse on duty said he had never taken so much fluid off of a patient. They then asked me if FIL had skin grafts. I said no and asked why. They said, "his legs are so badly infected and in such bad shape, we thought he had skin grafts." We later found out he had MRSA, which has since been treated.
The nurse also would schedule a meeting with my husband and tell him, "I really need to meet with you to discuss important information about the progress of your dad." My husband told her he would have to lay off work for the meeting. He would then get to his dad's house and receive a call that she was going to be an hour or so late. Then she would show up and say, "hi, everything is the same, we are giving him more pain pills." Then walk out.
A chaplin showed up in a mini-skirt and said she was, "whatever religion my FIL needed her to be."
We had a 24 hour number which in our case was essentially an answering service.
They insisted my FIL get a hospital bed which he didn't want. So we had to move the majority of furniture out of the living room. He used it once and then went back to his recliner. They said that since we had a young child around FIL (she is 8) that they would bring in counselors, etc. to help her. Never was mentioned again.
I have helped caregive for 3 other people. All who died without Hospice. These were people who were sick for many years. It was actually easier than the experience we had.
They did tell us it was for a set number of weeks (I am thinking 9 or 12) and then it would have to be renewed. I am thinking he was on hospice 6 weeks or less (I am guessing about a month). They were more of a burdern to us than a help. I know every case is different, but I am understanding there are more families that have felt like we do.
I don't know what went wrong with the last one. I think it must be some kind of paperwork...Difficult to say.
A resgistered nurse practioner ordered Hospice. I am guessing she put the form in front of the doctor on file with the company to sign because my best guess is that this doctor saw my FIL once.
He was on Hospice at the time he went to the hospital and is not on hospice now. Our family has been asked to re-instate hospice and we have refused.
All his other bills have been paid by Meidcare and his supplement policy. This was the only one so far that has been a problem.
If you're father's hospital doctor is Medicare approved and the hospice accept Medicare, you may need to call both and explain the situation. Gather your documents. On that letter from Medicare, it tells you what to do if you disagree. .make copies for you before sending it off.
Worse case,they will reject it again. Then you can try if his supplementary insurance will cover it. You should have a packet from that insurance every year at renewal. It states what is covered and max it will cover each year.