Hospice Deep Dive
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Confusion abounds when it comes to hospice care. Many elect it too late, meaning it’s true benefits are not always felt. What does hospice care entail? What should families and caregivers expect from the service? What questions should you ask when finding a hospice and how to think about the proliferation of venture backed hospice companies. Mettle Health founder BJ Miller, MD and Mettle Health counselor Heather Isaacs, Board Certified Chaplain, host an informal and interactive conversation on the detailed aspects of receiving hospice care.
We discuss:
0:00 Introductions
5:56 What are the hospice basics? What is always true: it’s team based, it’s provided anywhere you call “home”, it’s meant for patients and their family, they cover medical equipment like hospital beds, they handle prescriptions and there is a set way to enroll in hospice care.
9:20 There is a misconception that hospice will be present 24/7, but that’s not the model of hospice care - it’s meant to supplement the care provided by the family
10:23 Who qualifies for hospice care? What does the 6 month rule mean? There isn’t a fully scientific way to determine if someone will die in 6 months, this is a timeline determined by Medicare
13:10 Having 2 physicians confer and determine that you are appropriate for hospice care - one is the hospice medical director and one is generally your existing doctor
14:19 Treatment: you have to forgo any efforts to CURE your disease. Do if you have cancer, to sign onto hospice care, you need to stop cancer treatments like chemotherapy.
15:35 Who is on the hospice team and what do they help you do? Medical doctor, nurse, social worker, chaplain, home health aides, volunteers, grief counselors, physical therapist, occupational therapists and others. How often should you expect to see them?
31:52 How do the hospice doctor and your personal doctor work together? Most of the time, the hospice doctor will take over the majority of your care, but this may feel like your primary doctor is abandoning you.
39:40 How can palliative care bridge the gap before you sign on to hospice care?
42:58 The concept of “giving up” when it comes to selecting additional treatment vs. hospice care - Asking “what will this treatment do?”, “what happens if I DON’T elect this treatment?” There is never an absolute right or wrong
48:40 Signing onto hospice does not lock you into this type of care: you can always sign off. What is discharge from hospice? What is revocation from hospice care? Switching teams, and switching hospices
54:56 How is Medicare involved in hospice care? Yes, they are the majority of the provider, but you can always get hospice without Medicare. And if you are uninsured, or undocumented, you should be able to access this care as well
57:03 Different types of hospice: non-profit, for-profit and hospices that have purchased by private equity firms
1:01:22 What are some of the myths around hospice care?
1:07:25 Hospice is an emotional choice for many reasons - no matter what your experience is
1:11:02 Many hospices are not able to accept dementia patients: can palliative care serve those patients?
1:12:23 What is palliative sedation?
1:15:30 How do you know when to enroll in hospice care?
1:22:19 What about people who may not have family or friends and limited funds?
1:24:50 Is it possible that morphine given to an underweight patient might be too much for their system?
01:26:20 How are different types of pain contributing to physical pain? Emotional and psychic pain and trauma are linked and we have a lot to learn about how this presents in a body
1:29:16 How do the duties of clinical professionals interact with the family’s responsibilities? Who does what?
Great resource to continue this conversation: https://www.propublica.org/article/how-to-research-your-hospice-and-avoid-hospice-fraud
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