End game How the visionary hospice movement became a for-profit hustle

[shrike3]

My apologies if this has been posted before.

https://www.propublica.org/article/hospice-healthcare-aseracare-medicare

Over the years, Marsha Farmer had learned what to look for. As she drove the back roads of rural Alabama, she kept an eye out for dilapidated homes and trailers with wheelchair ramps. Some days, she’d ride the one-car ferry across the river to Lower Peach Tree and other secluded hamlets where a few houses lacked running water and bare soil was visible beneath the floorboards. Other times, she’d scan church prayer lists for the names of families with ailing members.

Farmer was selling hospice, which, strictly speaking, is for the dying. To qualify, patients must agree to forgo curative care and be certified by doctors as having less than six months to live. But at AseraCare, a national chain where Farmer worked, she solicited recruits regardless of whether they were near death. She canvassed birthday parties at housing projects and went door to door promoting the program to loggers and textile workers. She sent colleagues to cadge rides on the Meals on Wheels van or to chat up veterans at the American Legion bar. “We’d find run-down places where people were more on the poverty line,” she told me. “You’re looking for uneducated people, if you will, because you’re able to provide something to them and meet a need.”

Farmer, who has doe eyes and a nonchalant smile, often wore scrubs on her sales routes, despite not having a medical background. That way, she said, “I would automatically be seen as a help.” She tried not to mention death in her opening pitch, or even hospice if she could avoid it. Instead, she described an amazing government benefit that offered medications, nursing visits, nutritional supplements and light housekeeping — all for free. “Why not try us just for a few days?” she’d ask families, glancing down at her watch as she’d been trained to do, to pressure them into a quick decision.

Once a prospective patient expressed interest, a nurse would assess whether any of the person’s conditions fit — or could be made to fit — a fatal prognosis. The Black Belt, a swath of the Deep South that includes parts of Alabama, has some of the highest rates of heart disease, diabetes and emphysema in the country. On paper, Farmer knew, it was possible to finesse chronic symptoms, like shortness of breath, into proof of terminal decline.

[niyad]

1. It is incredibly important. Hospice has been invaluable in a number of cases

that I know. But I am all too familiar with the money-grubbing side of it.

[NQAS]

2. My only experience...

My mother died in July. She was 92.

She was in an assisted care facility since January and was doing fine, until she wasn’t

The facility said she was going to hospice, which I thought meant she would be moved. I wasn’t happy about that, and they explained that hospice would come to her. She stayed in her own room and had round the clock hospice nurses (?) for the last few weeks. I visited her the day before she died and was impressed by the compassion displayed. And when they called the next day - I had gone home, 1,000 miles away - they said that a nurse was with her when she die. We asked that the nurse stay with her until the funeral home came. I guess it’s a Jewish thing (I’m seriously lapsed). And i spoke to the nurse a few days later.

Okay. Were they telling the truth? I want to believe they were, and that was a bit of a comfort. I was told that there was no additional cost, though I can’t confirm that because my sister took care of all of that. I can’t recall the name of the hospice provider. I had no idea that third party hospice was a thing. Not once did I have the sense of a scam or a money grab or anything other than what it appeared to be.

Btw, this was in Florida.

[Ilsa]

3. Light housekeeping my ass.

Aides bathe and dress the client, that's all.

Fucking VA took back the one and only check they sent for care.

[moniss]

4. My mother

stayed at home until the end when dealing with lung cancer. The people around her successfully cut me off from seeing her. But I still made long calls talking with her every day for almost a year straight. As it came close to the end I was horribly alarmed when her phone had suddenly been "transferred" to a "hospice" service. I immediately called her attorney and alerted him that an in-person visit was crucial. He arranged the meeting for the next day. When I arrived at the appointed time she had died just before. I went in to see her one last time and I was horrified. As she lay in bed I could see that her head had shrunk to about half-size, her arms were just bones with skin. The "hospice" lady was there along with a neighbor and a man who had gained influence over her. I asked them why they did not call me if she had deteriorated to such a condition. No response as they all looked sheepish. Her doctors were another story.

She had been receiving chemo on a regular basis throughout according to her records. In fact they gave her 2 treatments just in the last 9 days before she died. There is no justification for putting someone through expensive and debilitating treatments when they are that far gone and the doctors knew damned well the end was a matter of days if not hours. She certainly didn't get that way overnight. I have seen relatives die of cancer before so I do know some basics. The doctors just apparently wanted to keep racking Medicare with the bills for every dime they could squeeze. The "hospice" provider (not a nurse etc.) got a 5 figure check from the estate for coming and "being there" for 14 hours before she passed away. She already had the neighbor and the sketchy man sitting there but I guess one more dodger around the fire was called for.

Like so many things there are scammers in the medical field at all levels and then there are good people. It's a crap shoot at best and it is very difficult when people succumb to the scammers and all that loved ones can do is watch as it happens.

[MiniMe]

5. My mother was in Hospice at the end of her life

She had cancer, and the hospice provided nursing care and assistance to me, which I greatly appreciated. They sent somebody over to sit with Mom while I went out and went grocery shopping and things like that. And they provided nursing care for her. Hospice was wonderful for my Mom and for me. We were referred to hospice by her doctors, there was no requirement that we forgo any cure. But at that point, Mom was tired of being poked and prodded, and wanted to die in peace. She had been through surgery and chemo, and was done with it. Sigh.

[cbabe]

6. More and more health care/hospice is owned by

the Catholic Church. Decisions concerning end of life care are made by local bishops.

Medical staff wanting to keep their jobs must follow the bishop’s dictates.

Carefully check who owns the facility you are trusting.

[shrike3]

7. Catholics have been involved with hospice since its beginning.

From the above article:

The philosophy of hospice was imported to the United States in the 1960s by Dame Cicely Saunders, an English doctor and social worker who’d grown appalled by the “wretched habits of big, busy hospitals where everyone tiptoes past the bed and the dying soon learn to pretend to be asleep.” Her counterpractice, which she refined at a Catholic clinic for the poor in East London, was to treat a dying patient’s “total pain” — his physical suffering, spiritual needs and existential disquiet. In a pilot program, Saunders prescribed terminally ill patients cocktails of morphine, cocaine and alcohol — whiskey, gin or brandy, depending on which they preferred. Early results were striking. Before-and-after photos of cancer patients showed formerly anguished figures knitting scarves and raising toasts.

My very, very Catholic aunt was a hospice nurse for forty years, and her religion never conflicted with her job in any way.

Assisted suicide is something different, of course. Naturally, anyone wanting such an option should obviously not pursue it within the confines of Catholic hospice.