Blog Post by Maggie Peck-Alberton, L.C.S.W., Serenity Hospice
Maggie has been a medical social worker for over 30 years in the Portland and Salem areas. For most of this time, Maggie has worked in hospice organizations, but she has also worked as a hospital discharge planner. One of Maggie’s great hobbies is sewing, and in her spare time, she loves to sew various items for charitable organizations including veterans, churches, and the boy scouts.
The Best Medicare Benefit
The cost of healthcare is on everyone’s mind. One cannot pick up a newspaper or listen to a news broadcast without being reminded that healthcare costs are growing. I would like to focus on one bright light, in this dark mess, that has been a success for both Medicare and its consumers…and that would be the hospice benefit.
Hospice started in Great Britain in the late ‘60s and traveled to the U.S. during the era of new social programs, the late ‘60s and early ‘70s. Hospice is a type of medical care that provides comfort and support to both the patient and their caregiver(s), whether that be family, friends, or paid caregivers. Many areas of the nation have in-patient facilities, whereas the Portland Metro area only has one in-patient facility, that being Hopewell House in SW Portland. Hospice care in the area is primarily “home based,” describing wherever “home” may be (the patient’s home, a relative’s home, or a care facility). While the hospice benefit does not pay for the room and board costs of a patient’s care, it does cover other services that help a patient to remain comfortable in their desired environment.
Hospice is currently the only benefit that Medicare pays at 100%, without a co-pay or without participation of the patient’s Medicare supplemental insurance. The services it covers include:
- Physician services (hospice physicians)
- Nursing care (nurse visits once per week or more often as necessary)
- Medical supplies and appliances that can be rented
- Medications approved by hospice for symptom management and pain relief
- Short-term in-patient care for pain symptom control
- Spiritual counseling as desired
- Bereavement counseling as desired for up to 13 months after the death of the patient
- Physical, occupational, and speech therapy as ordered by physician
- Medical social services
- Dietary and other counseling
- Volunteer services
The Portland metro area and the Willamette Valley are fortunate to benefit from a hospice organization that provides additional services. Serenity Hospice and Palliative Care was started in August, 2006, by two Army Veterans who sought to better serve veterans and their spouses. It has since expanded to include all terminally ill patients. Serenity Hospice brings additional services to patients without cost, to ease their discomfort and to support “the whole person” (physical, emotional, and spiritual). The following complimentary therapies are available to Serenity Hospice patients:
- Massage therapy
- Acupuncture
- Acupressure
- Acutonics
- Aromatherapy
- Reiki
- Craniosacral therapy
- Reflexology
- Music thanatology
Many families of patients reflect back to the comfort their loved one received from these non-traditional therapies that are not usually offered free of charge by other hospices.
Why is hospice the best Medicare benefit? In my opinion, Medicare saves money by paying a hospice a daily rate to cover all of the medical care related to a patient’s terminal diagnosis and to manage the service delivery. If a patient was at home and dying without hospice care and the symptoms became too severe, what typically happens is that the patient is transported by ambulance to the emergency room. The transportation alone to the E.R. would pay for days of hospice coverage, not to mention the work-up costs of acute care medicine. Medicare does not want to hospitalize patients who can receive qualified and competent care at a less costly level. In the example above, the patient transported by ambulance to the emergency room would probably be treated for acute pain and discharged to a nursing facility that could provide less costly care, at the patient’s expense.
Most patients who are dying want to be at home, amongst their family and friends, their beloved pets, and with their own possessions. No one wants to be in a cold and clinical environment, as it may be frightening and not comforting. Hospice strives to provide comfort care, and as I refer to it, “tuck in” a patient in the warmth of supportive services. It is not uncommon for Serenity Hospice patients to have family and friends gathered at a patient’s bedside, with clergy attending to the spiritual needs, the nurse managing the symptoms and explaining what is happening to the family, and the music thanatologist playing soft harp or guitar music in the background.
As social workers, we try to be present to attend to the bereavement issues and to offer services as needed in the coming year. All of these services provide quality to the dying process and help prepare the survivors for life after the patient’s death. For Medicare, it limits the cost of care as most studies reveal a person uses the most health care dollars in the last six months of life.
So, it is a “win-win” situation. The patient benefits from additional care that facilitates dying at home in comfort, and the accountants of Medicare are pleased that the money was well spent (quality of care) and the costs were contained.
If you know anyone who is facing a life-threatening illness, begin the dialogue of what their wishes are, and begin to think of how this person could stay at home and be well cared for. If you need further information, feel free to consult Home Instead Senior Care at 503-530-1527 or Serenity Hospice at 503-639-0600.
Maggie Peck-Alberton, L.C.S.W.
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