Gift link
https://wapo.st/3oqbvGd
1 Like
In the case of end-of-life hospice care, Medicare benefits are such that it’s clear the government does consider family caregiving as an expectation, not an exception.
The problem is, what if you don’t have family who can help?
2 Likes
Two options:
Medicare facilities that drain your assets until you qualify for Medicaid, and then move you to a Medicaid facility. If you have a pension, you can stay there until you die.
Or, if your assets are very low and you don’t have a pension, then straight to a Medicaid facility.
And this is available even for people who do have family to help but who don’t want to, as well as people who don’t have family to help at all.
I was thinking specifically of people in hospice care who want to die at home.
The people I know in this situation have to use hospice facilities. I know of several near me.
It’s a system that is far from perfect, but it’s the one we’ve got.
I’m not sure that having kids with the idea that they will take care of you is realistic, either. I know a lot of people with adult kids and some with adult kids/resources who ended up in this system I’m describing.
The Medicare facilities have great marketing departments…
Come to think of it, I actually do know one person who has escaped all of this. She owns her property and lives off of social security. She gets a friend from church to look in on her who serves as her emergency contact. It’s working.
If you lose mobility, this can be much more difficult, but the hospice workers do come by often.
1 Like
Having gone through hospice for almost 2 years with my father, I would not say coming by once a week is coming by “frequently”. Also, facilities are definitely not available or appropriate for all.
3 Likes
My siblings and I are caring for parents and this author, imho, is on some other planet.
3 Likes
While I appreciate the author highlighting the struggles of family caregivers, I don’t think it’s helpful to try to extrapolate what they are doing in Norway where the entire population is less than some of a single US city.
1 Like
I don’t believe Hospice is income or asset dependent. Anyone who needs hospice care can get it at no additional cost to their regular insurance or Medicare,
1 Like
That’s true, but it is a local organization that is affiliated with local social services, so the resources of your loved one’s or your jurisdiction (depending on whose home they are residing in) will determine how often the hospice workers visit, in tandem with the patient’s level of need. That is a combination of medical need and home support.
Medicare covers hospice 100%.
Rather than what the author wrote, I think this editorial is a cautionary tale that illustrates the importance of saving for your eventual elder care over spending on other things (fun retirement activities, education for loved ones, and other luxuries).
While it is true Medicare provides for home hospice care, it is not sufficient to provide the care needed by someone at the end of life.
Medicare will not indefinitely cover the cost of care in a hospice facility (if, for example, a nursing home would provide more appropriate care).
The Times article I linked illustrates this quite well with its profile of the last days of Shatzi Weisberger.
Hospice does not provide 24 hour care at home unless there is an acute crisis that the hospice feel can be managed with LPN/RN care for a very short period. And the medicare requirements about who qualifies for continuous care are very narrow.
Many programs do however contract with facilities for inpatient hospice beds - sometimes in stand alone hospice facilities, at nursing homes, or hospital units. In my professional experience, people without family usually spend their last days in a hospital inpatient unit.
1 Like
Here’s a link that explains it better than the article. It’s designed to work in tandem with social security. In my experience, medicare, like insurance, wants people to die out of hospitals if they can help it because hospitals are the most expensive option. Again, not perfect, but it’s what we’ve got.
I understand that hospice care will not provide total care or even close to it if needed. But it’s the hospice organization in concert with their medical staff that determines the number of days a hospice worker will visit.
Even with that, the hospice folks cannot be expected to do all of the things that might enable someone in hospice care to live alone 24/7. That is a real challenge for some families.
3 Likes
@momofboiler1 exactly, we cross posted.
Hospitals may be the most expensive option, but if 24/7 care is required, it may be the most practical option for most families, as well as the one where Medicare is most likely to foot the bill.
The hospice inpatient costs/reimbursements are much less than a regular hospital stay but definitely more than home care so generally inpatient stays are for people who are deemed to be “actively dying”.
FWIW, I think we do a terrible job in the US of talking about and planning for death. It’s going to happen to all of us at some point, in some way, yet there is still a societal taboo about talking about it openly. Too many people bury their heads in the sand and end up in crisis.
2 Likes
My “actively dying” dying relatives were always sent home to die by Medicare. I wouldn’t expect hospital care when using medicare in the weeks and days before death.
I’ve had to be actively involved in this process multiple times, so this is just my personal experience. They died at home. One was released from the hospital four days before death.
I have a close friend going through it now, and it’s the same as my experience. So it’s not just me.
Certainly not weeks, but someone with days should qualify for inpatient hospice. But… there needs to be medical documentation that the person is actively dying. Unfortunately, often a family’s definition of actively dying is not the Medicare definition. And for many patients, they defy predictions.
4 Likes
I thought in-home hospice required that the recipient have 24 hr. care (provided by the family or other caregivers). Maybe people lie about that, and it’s accepted? I don’t see how the woman who lived alone and had a friend who checked in on her occasionally would have qualified for in-home hospice.
I also think that comparing Norway to the U.S. was wrong.
I don’t know what the answer is. But the expectation that family will be the caregivers for the elderly won’t work. As it is now, it’s usually one adult child who becomes the 24/7/365 caregiver, often giving up their own financial security (job) to do so. And it’s usually a daughter. Or maybe the task force mentioned in the article will decide that’s the way it should always be?