 | Tom Welk
DMin is Director of Pastoral Care & Professional Education at Harry Hynes Memorial Hospice. He also teaches at the University of Kansas School of Medicine-Wichita. He has certification with the American Association of Pastoral Counselors in Clinical Pastoral Education. His memberships include Park Ridge Center for Study of Health, Faith, and Ethics, and St. Louis University Center for Health Care Ethics, Charter Board Member Kansas Health Ethics, Inc., and Ethics Committee Member for National Hospice Organization. He has received the President's Award of Excellence for Public and Community Awareness, for the "Dying Well" project from The National Hospice Organization. Tom's group presentations include: Association of Kansas Hospices, Midwest Congress on Aging, and Kansas Health Ethics Conference. Tom Welk can be contacted by fax at (316) 265-6066, by e-mail at: twelk@hynesmemorial.org, or at his office at (316)219-1791. |
Hospice
2002-06-01 14:07:00
About Hospice Care
Answer: Hospice services provide care for those who are terminally ill. A terminally ill individual is considered to have six months or less to live. In order to be admitted to hospice care a doctor must confirm this limited life expectancy.This limited prognosis can be due to any illness, including among others cancer, ALS, heart disease, Alzheimer's, AIDS, lung disease, birth defects. Admission to hospice care depends on prognosis, not diagnosis, i.e., on the expected time remaining, not the disease involved.The emphasis in hospice care is maximizing the time that is available. The hospice philosophy is on living life to the fullest. Hospice supports the patient and family to address the goals that are important to them.A team works with the patient/family to develop a plan of care to meet these goals. This plan includes physical support to control pain and manage symptoms; emotional and psychological support to address fear and anxiety; family support, easing the stress on family/loved ones brought on by the terminal illness; and spiritual support to help with the ultimate questions of life.This care is provided by a highly trained team consisting of physicians, nurses, health care aides, social workers, chaplains and volunteers. Services are delivered in a variety of settings (home, nursing home, assisted living, inpatient unit).Reimbursement for these services is provided by Medicare, Medicaid and most insurance companies. Under the Medicare/Medicaid Hospice Benefit a certified hospice program is paid a set daily rate, from which the hospice is responsible for paying all the bills related to the terminal condition. This includes medications (a maximum of $5.00 co-pay per prescription may be charged to the patient), all medical equipment, medical supplies, plus all staff visits. In the Wichita area the daily reimbursement provided a Medicare/Medicaid certified hospice program is a little over $100.00. Frequently, the costs incurred in providing high quality care to an eligible patient exceed this reimbursement. Obviously, this necessitates a balancing act for the hospice provider.The crucial question is, "How can the hospice provide high quality care and at the same time balance the budget?" A community based, not-for-profit agency relies on community donations to help the organization give good care and meet costs. Volunteers donate thousands of hours to visit patients and help the organization in countless ways.All organizations must watch expenses. For example, the vast majority of hospices do not cover palliative (comfort) radiation and/or chemotherapy, since these therapies far exceed the daily Medicare/Medicaid reimbursement rate. Large, well managed organizations with excellent community support are able to cover these therapies and a full range of other services.The Wichita area has approximately seven hospice programs. Only one of these is a non-profit, community based organization. When choosing a hospice program to take care of the challenging needs of a terminally ill loved one, consumers may be well advised to ask questions regarding the type of organization of the particular hospice.
