JustCare

Tag: Hospice

  • Older adults are far more likely to die from the flu

    Older adults are far more likely to die from the flu

    A new CDC study provides yet another reason for older adults to get the flu vaccine. Specifically, it finds that the older you are the more you should be concerned about getting the flu. It also finds that the oldest Americans are far more likely to end up in hospital and die from the flu than younger Americans.

    The 46 million people over 65 experience about nine in ten flu-related deaths and at least half of flu-related hospitalizations. The likelihood of risk increases for people after 65, when they become frailer and less functional. Medicare covers the flu shot in full as part of its package of preventive care benefits to protect older adults from contracting the flu.

    Researchers looked at health outcomes for 19,760 people age 65 and older. They found that people 85 and older were at least twice as likely to be hospitalized and as much as six times more likely to be hospitalized as people between 65 and 74. The greatest likelihood of hospitalization came during the height of the flu season.

    The likelihood of flu-related death or transfer to hospice, end-of-life care, is greater for older people living in nursing homes and other congregate care facilities as well as for people with neurologic disorders, cardiovascular disease, renal disease, chronic lung disease, and immunosuppression. People with asthma, who got the flu shot, and who received antiviral therapy were less likely to die or be hospitalized.

    People over 85 were also far more likely to develop pneumonia and die or go into hospice care (8.7 percent) than people 65-74 (3.8 percent.) People over 85 were less likely to have fever and other flu symptoms, so testing is important.

    The high-dose and adjuvented influenza vaccines may be helpful in preventing flu for older adults.

    Here’s more from Just Care:

  • For your peace of mind and for the people you love, plan in advance for your care

    For your peace of mind and for the people you love, plan in advance for your care

    No matter how old you are, planning for your future care needs is one important gift you can give yourself and your family. Advance care planning helps ensure that your care wishes are honored if you are not able to speak for yourself.

    No one knows when they may suffer a serious illness or injury and find themselves unable to speak for themselves. That’s why advance care planning is extremely important for people of all ages. Medicare covers advance care planning as part of your Annual Wellness Visit with your primary care physician.

    If you should become seriously ill, advance care planning helps you understand and consider your care options—either curative care or hospice care. And you’ll also explore with your doctor whether you would prefer to die at home or in the hospital. You’ll ensure that the care you get is the care you want, even if you’re not able to reveal your wishes.

    Advance care planning should also include completing written advance directives—a health care proxy and living will. These legal documents help ensure your treatment wishes are honored. This advance care planning is separate from your doctor’s visit. Advance directives–a health care proxy and a living will–ensure your designated agent can speak on your behalf and honor your care wishes. Through a living will, you make clear your health care wishes should you not be able to express them. Through a health care proxy, you name someone you trust to speak on your behalf if you cannot speak for yourself.

    Only three out of ten Americans have advance directives. Many people don’t realize they need them.  And, even if you want one, it’s easy to put off completing the advance care plan.  So, if you don’t yet have a living will or health care proxy, here are three steps to take on your own, when you’re spending time with family. Ideally, you should have a living will and health care proxy before a hospital stay.

    1. Talk to your parents and kids about the kind of care you would want if something were to happen to you and you could not decide for yourself the care you need. Consider as well whether you would want hospice care, which Medicare covers.
    2. Pick someone whom you trust to make decisions for you if you can’t make them yourself, your “health care proxy.”
    3. Complete a written health care proxy and living will, and share them with the person you have chosen to make decisions on your behalf, your family and loved ones, as well as with your doctors. You might also consider giving your health care proxy or someone else you trust a power of attorney. You should consult an elder care lawyer if you can.

    For a free advance directive from Caring Connections, click here. Click here for advice from Dr. Atul Gawande about planning for end-of-life care.

    Here’s more from Just Care:

  • For-profit nursing homes more likely to deny residents hospice care at the end of life

    For-profit nursing homes more likely to deny residents hospice care at the end of life

    A new study published in the Journal of American Medical Directors Association finds that for-profit nursing homes are increasingly offering their most vulnerable residents high-cost therapy at the end of life rather than hospice care. If someone you love is terminally ill in a nursing home, you may want to speak with the nursing home about different treatment options.

    Because hospice care provides comfort at the end of life and does not involve curative treatments, nursing homes make far less money on providing hospice care to their residents than other treatments such as physical therapy. Not surprisingly, researchers found that for-profit nursing homes in particular tend to steer away from delivering hospice care. Rather, these nursing homes provide a large number of therapy services—high volume at great intensity—to their dying residents, which generates more income.

    Over the last few years, a number of studies have found that for-profit nursing homes may not be providing as good care as non-profit nursing homes. A Kaiser Family Foundation report highlighted the many issues with chain nursing homes, which people should beware of. Another study found that Medicare Advantage plans were more likely to steer their patients to for-profit chain nursing homes. Yet another study revealed that Medicare’s nursing home ratings can be misleading and that you should not assume a five-star rating means good care.

    The JAMDA researchers studied care provided to nursing home residents in New York State in the 30 days before they died. There is every reason to believe that nursing homes in other states behave similarly to those in New York. The financial incentives are identical.

    Here’s more from Just Care:

  • Barbara Bush chooses comfort care at end of life

    Barbara Bush chooses comfort care at end of life

    Nearing the end of her life, Barbara Bush opted for comfort care, sometimes called “palliative” care.  She chose not to seek medical interventions to treat her congestive heart failure and chronic obstructive pulmonary disease. Rather, she opted for an improved quality of life, with minimal pain. By sharing her decision publicly, she is helping to open up conversations about the value of palliative care that many people are not yet having.

    People with Medicare at the end of life always have the choice between medical interventions that attempt to cure a condition and hospice care, which includes palliative care, if they plan ahead. Planning ahead means talking to the people you love about the kind of treatments you would want if you were unable to speak for yourself. Life happens, so these conversations are important for adults of all ages. Considering these choices while you are healthy, sharing your thoughts with the people you love and putting them in writing allows you to ensure your health wishes are honored.

    To be clear, choosing palliative care means getting treatment that keeps you as pain-free as possible. It does not mean ending all medical treatment. In Bush’s case, it could mean receiving morphine to address struggles with breathing that come with COPD and diuretics to eliminate extra lung fluid. It likely means foregoing a breathing machine.

    Bush had seen the value of palliative care directly. She had once volunteered for the Washington Home, a residence for patients with chronic illnesses. And, Bush had launched its hospice program.

    The question you should consider is whether and under what circumstances would  you prefer care to ease pain, along with social and emotional supports over aggressive medical interventions. And you should ask the people you love the same question so that their end-of-life wishes are honored. You should also consider completing an advance directive, a legal document that allows you to put your end-of-life wishes in writing in a living will and to appoint a health care proxy, a person you know and trust to honor your wishes and direct your care if you cannot speak for yourself.

    Here’s more from Just Care:

  • Three things to consider about end-of-life care

    Three things to consider about end-of-life care

    If you’re caring for someone at the end of life–with a life expectancy of no longer than six months–Medicare covers either curative care or palliative end-of-life care. It’s important to understand your loved one’s preferences. Here are three things to consider about end-of-life care.
    1. Would the person you are caring for prefer care to ease pain, along with social and emotional supports over aggressive medical interventions?  If so, Medicare will cover palliative nursing and therapy care, as well as home health aides, medical social services, durable medical equipment and drugs, through a Medicare-certified hospice agency.  There is only a small copay. This care is usually provided at home, but sometimes is available through a facility. To receive this coverage, the patient must forego Medicare coverage for medical interventions to treat the terminal condition. (Medical interventions to treat conditions unrelated to the terminal condition continue to be covered.) Also, the patient can end hospice coverage at any time and receive Medicare coverage for curative care to treat his or her condition whenever the patient chooses.
    2. Is care available to the person when the hospice team is not on site? The Medicare hospice benefit covers only a few hours a day of care.  As a general rule, the hospice agency will only accept patients who have someone to care for them when they are not on site.
    3. How do you find a Medicare-certified hospice agency?  Your local hospital should have a list of agencies in your community.  Ask the patient’s doctor to reach out to the hospice on behalf of the patient. The Centers for Medicare and Medicaid Services just launched an online tool for comparing different hospice agencies, Hospice Compare. Kaiser Health News reports that right now it’s of no real value because it doesn’t do a good job of distinguishing among hospice agencies and suggests that nine out of ten hospices are very good. That said, Hospice Compare does let you know about hospice agencies you can contact in your community.  And, the Hospice Foundation of America offers a list of questions you should ask of hospice agencies before choosing one.

    Note: The hospice benefit includes some benefits for family caregivers, including respite care and bereavement services. Respite care will allow a family caregiver to take a break from caring for a loved one who is terminally ill.  And, after a loved one passes, a hospice may cover grief and loss counseling for family caregivers, support groups and memorial services. Counseling coverage for the family member can last up to a year after a loved one’s death.

    Here’s more from Just Care:

  • Why you should ask your loved ones about end of life care

    Why you should ask your loved ones about end of life care

    Few of us think to ask loved ones about their end-of-life preferences. We may assume that the people we love don’t want to discuss these issues. But, it’s important that we understand and respect their views about the kinds of medical interventions they would want and who they would want to speak for them if they were unable to speak for themselves. So, please consider talking with your loved ones about end of life care, both your own desires and theirs.

    Beyond talking about end of life wishes, make sure that your loved ones put their wishes in writing in what are called “advance directives.”  Advance directives are documents that detail a person’s end-of-life wishes. There are two important documents: a living will, which concerns treatment preferences if serious interventions are needed to keep you alive, and a health care proxy or power of attorney, which names a person to speak on your behalf if you are unable to speak for yourself. You can download these legal documents for free here.

    Without a health care proxy, a trusted family member may not be able to speak with your doctor on your behalf. Federal law protects your privacy. But, as a result, your wishes may not be honored. That’s why a health care proxy is so important.

    A recent meta-study in Health Affairs of 150 studies published between 2011 and 2016, covering nearly 796,000 adults, finds that only one in three adults have advance directives. Not even four in ten people with chronic conditions had health care proxies or living wills.

    Here are six reasons why you and your loved ones should create advance directives. And, to learn more about advance directives, watch this Jon Stewart video with Dr. Atul Gawande.

    http://www.cc.com/video-clips/hz2xb6/the-daily-show-with-jon-stewart-atul-gawande

    Dr. Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End, offers the following advice.

    • Ask your loved ones about their end-of-life priorities. Do it repeatedly over time since their views are likely to change. And, have them complete an advance directive.
    • Find out what they consider their health condition to be.
    • Understand what they would like to see happen if their condition worsens, what they are most afraid of and the tradeoffs they would want to make.

    People at the end of life who know about hospice care often choose it because it focuses on alleviating pain and ensuring people’s comfort.  In many cases, Medicare pays for hospice care at home.  To read a piece Dr. Gawande wrote about a friend at the end of life, click here.  For help finding care at the end of life, visit the eldercare locator.

    Here’s more from Just Care:

  • Pre-hospice care allows people to stay in their homes

    Pre-hospice care allows people to stay in their homes

    An article in Kaiser Health News describes the value of pre-hospice care for people with a multitude of health conditions who would otherwise be spending the last years of their lives going in and out of hospital. Pre-hospice care allows people to stay home (age in place) and enjoy a better quality of life, as most would prefer to do, in the final years of their lives. At the same time, it saves our health care system billions of dollars.

    Pre-hospice services, sometimes described as home-based palliative care services, are relatively new. Sharp HealthCare, a non-profit Medicare managed care plan in San Diego, offers people with multiple conditions a Transitions program, pre-hospice services provided to them at home. Through this program, social workers and nurses spend time with people in their homes and help them better care for themselves and plan for a time when they are unable to speak for themselves.

    Pre-hospice services differ from hospice services in that they are not designed for people deemed to have six months or less to live. They are rather for people who still may want and need curative services and who also would benefit from care coordination and management. The Transitions program gives people access to a 24-hour nurse hotline so they can avoid calling 911 and receiving ambulance services when they are not warranted.

    While pre-hospice services are now available in a number of places, the big obstacle to a large roll-out of pre-hospice services is that Medicare generally does not pay for them. Under the ACA, there are some opportunities for health plans and hospitals to innovate and receive payments for care that improves patient health and saves money, such as pre-hospice care. But, those opportunities are at risk if Congress replaces critical elements of the ACA.

    Here’s more from Just Care:

  • What to do after someone you love dies

    What to do after someone you love dies

    Losing someone you love can be extraordinarily wrenching. And, taking care of all the things that need getting done can be tough. As always, having a buddy–a friend, family member or trusted aide–to help you can be invaluable, easing the stress and keeping you focused. Here’s what to do after someone you love dies.

    1. If your loved one dies at home, you will need someone to pronounce the person dead. Hospice staff can make the pronouncement if the person is getting hospice care. Otherwise, you’ll need to call 911. Be sure to have the person’s living will on hand if it has a do not resuscitate request.
    2. Contact family and friends and anyone else close to the person. Make sure that someone tends to pets, reads mail and, if appropriate, cleans out the refrigerator. Discuss your loved one’s preferences–e.g. a headstone, cemetery–whether you want a gathering after the funeral and how to let people know about it.
    3. Contact the funeral home to move the body and arrange for burial or cremation. (Here are six tips for choosing a funeral home if your loved one had not already done so.) Write an obituary to send to the local paper. Be sure to get at least a dozen copies of the death certificate, from the funeral home or your state’s office of Vital Statistics, to send to banks, government agencies and others who require it. Keep in mind that once you notify these agencies, they will freeze your loved one’s accounts.
    4. Locate the person’s will and take it to the appropriate office to be probated. Your loved one’s attorney, if there is one, should be able to help. The executor of the person’s estate will be in charge.
    5. Keep a file with all of the person’s records, including will, birth certificate, death certificates, insurance policies, automobile titles, mortgages, leases, credit card accounts, bank accounts, investment accounts, bills to pay. Keep in mind that the person might need to file an income tax return.
    6. Contact your loved one’s bank, Social Security, life insurance company, and any other entities from which your loved one got benefits, as well as all clubs and memberships. (Note that Social Security should pay survivor benefits to a surviving spouse.) You should also notify the three credit bureaus of the death to prevent identity theft and request information about all of the person’s debts.
    7. Contact the electric company, phone, TV, and internet services, and other service providers to cancel email accounts and stop other services, if appropriate. Also contact the registry of motor vehicles to change titles on any vehicles in your loved one’s name. Cancel your loved one’s driver’s license. You might also notify the board of elections.

    For more information, visit Consumer Reports and AARP.

    Here’s more from Just Care:

  • Six states allow assisted suicide, death with dignity

    Six states allow assisted suicide, death with dignity

    We all have different views about what death with dignity means. For some of us, it means choosing when we want to die if we are terminally ill. Colorado just passed a law legalizing assisted suicide. Now, six states allow assisted suicide.

    California, Oregon, Vermont and Washington have passed laws legalizing assisted suicide for people at the end of life.  And the state Supreme Court in Montana has ruled assisted suicide legal in the state.

    The laws in each state differ slightly.  In Oregon, which has permitted assisted suicide since 1994, individuals must be at least 18, competent, able to speak for themselves, and two physicians must certify that they have six months or less to live. Before a physician can prescribe lethal medication for them, individuals must also twice verbally express a desire to die, at least 15 days apart. And, they must make a written request to die signed by two witnesses.

    If a doctor believes that the person requesting to die is depressed or cognitively impaired, the doctor must refer the person to a psychiatrist or psychologist.  And it is a felony to force a person who is terminally ill to make a request to die.

    The language of a Colorado law that just passed, Proposition 106, tracks the terms of the Oregon law. But, some people still believe that the language does not adequately ensure that people requesting to die truly want to die. Others say that hospice care is not always able to relieve suffering, and it’s in the interest of patients with terminal illnesses who are suffering to have the choice to relieve that suffering.

    Here’s more from Just Care:

  • Hospices misleading patients, overbilling Medicare

    Hospices misleading patients, overbilling Medicare

    A new report by the Office of the Inspector General (OIG) reveals that some hospices are misleading patients and defrauding Medicare. Hospices did not inform patients as required that when they elect hospice services they forego Medicare coverage of curative services. Hospices also did not engage doctors in some cases to the extent necessary to determine appropriately whether patients were terminally ill.

    Medicare only covers hospice care for patients who are terminally ill, people whose doctors certify that they have six months or less to live, and who choose palliative care to keep them comfortable over care that treats their terminal condition other than hospice care. Under the hospice benefit, patients may receive a variety of services, including doctor’s care, nursing care, medical social services, medical supplies and drugs.

    Most people with Medicare receive hospice care in their homes. In most instances, Medicare does not cover round-the-clock care, so patients generally need additional caregiving services from family, friends or paid caregivers. There is no set number of hours Medicare pays for.

    The OIG found a high number of cases in which patients should not have been enrolled in hospice. OIG also found many instances in which hospices did not disclose to patients and their families that electing hospice care means giving up coverage for care that treats their condition.

    Inappropriate billing of Medicare totalled more than $250 million for hospice general inpatient care. The OIG found that hospices billed inappropriately for this care 31 percent of the time–both when patients did not need it and when the hospices did not provide this level of care. And, the OIG found in another study that hospices typically provided fewer than five hours of care a week for the $1100 Medicare paid them.

    To date some hospice owners have been convicted of fraud and sent to jail for many years for submitting false hospice claims to Medicare. The OIG report did not specify which specific hospices they had found to be overbilling Medicare or committing other fraud; today, nearly two-thirds of Medicare hospices are for-profit.

    A separate Washington Post investigation found that a large number of hospice patients, particularly in for-profit hospices, were leaving hospice care alive, an indicator that something is amiss. Health may improve for a small fraction of people while receiving hospice care, but something is off when more than three in ten people are leaving hospice care alive, as the Washington Post found to be the case in Mississippi (41 percent) and Alabama (35 percent).

    An increasing number of people with Medicare are opting for hospice. In 2013, there were 3,925 Medicare-certified hospice agencies, 2,411 of which were for-profit hospices. And, Medicare spent $15.1 million on hospice care for 1.3 million older adults and people with disabilities.

    Here’s more from Just Care: