Hospice is philosophy care given to improve the quality of life of a terminally ill patient. It is comprised of four levels categorized according to the frequency and health of a patient. Firstly, routine home care involves scheduled care where members of the interdisciplinary team provide patients’ necessities. Secondly, the continuous care level incorporates the services provided to severely symptomatic patients requiring temporal attention for more than eight hours in a patient’s home. Thirdly, general patient care is intensive and provided to the severely symptomatic who require permanent care. Respite care is the fourth level which is short and infrequent, caters to family needs, and for less than five days in the benefit term.
In 2021, the percentage of hospice days is 58% for profit-focused hospices and 31% for non-profit ones (“Medicare program,” 2021). Based on Services for Medicare and Medicaid Services (2021), every hospice level has a set payment rate. For 2021, routine home care is charged at $195.36 for up to sixty days and $154.42 for more than sixty days. The rate for continuous home care is $1,404.44 and $58.52 when charged hourly. On the other hand, Inpatient respite care has a $452.08 while the General inpatient care rate is $1,025.23. The above charges only apply to the hospices that submit the quality data the government requires.
According to Chung et al. (2015), hospices that do not provide GIP are small, profit-focused, or newer than those that provide GIP. Most mid and small-size hospices cannot provide continuous and inpatient care as they are relatively expensive compared to routine maintenance. Arguably, for any business to run smoothly, it has to make profits to offset its costs. In addition, small hospices are faced with the challenge of inadequate health workers. Cheung, the daughter of the deceased, explained that she was told that there was no available employee to attend to her mother, Choi (Whoriskey & Keating, 2014). The effect of inadequate employees and the need for profits is worsened because some hospices cannot secure contracts with medical facilities. Thus, such hospices cannot refer patients in need of GIP to receive the necessary services.
The lack of capacity to provide GIP to patients can lead to immense consequences. In particular, inadequate health employees leave patients unattended, for example, 85-year-old Choi. A nurse cannot provide critical care to delocalized patients simultaneously. Similarly, the high cost associated with continuous and inpatient care reduces the willingness of hospice employees to attend to severely symptomatic patients. As a result, hospice officers neglect their primary duties to ensure the continuity of their organization. To improve the services rendered by hospices, the federal government should revisit its GIP regulations. It can raise the minimum requirements such as the required number of employees and hospital contract certificate requirements to ensure quality. Hence, federal involvement could lead to the development of reliable hospices.
The article by Chung et al. (2015) on the status of hospital contracts and various care levels of hospice agencies introduces an essential topic of hospice agencies’ inefficiency. It illustrates how most hospices neglect their primary role of improving the terminally-ill patients’ quality of life. The article exposes the fact that hospices are unable to provide referrals to other facilities. Ideally, the presence of a contract with hospitals or skilled nursing facilities (SNF) would facilitate referrals, and patients would receive GIP. The article describes the challenges most patients undergo under hospice care. The last days of some patients are made of magnified pain, while the memories of survivors are traumatic. In summary, the work by Chung et al. (2015) acts as a voice for the hospice agencies unable to provide the necessary services and the victims of unsatisfactory hospice care.
Chung, K., Richards, N., & Burke, S. (2015). Hospice agencies’ hospital contract status and differing levels of hospice care. American Journal of Hospice and Palliative Medicine®, 32(3), 341-349.
Medicare Program; hospice wage index and payment rate update, hospice conditions of participation updates, hospice and home health quality reporting program requirements, 86, Fed. Reg. 19705. (2021).
Services for Medicare and Medicaid Services. (2020). Update to hospice payment rates, hospice cap, hospice wage index, and hospice pricer for FY 2021.
Whoriskey, P., & Keating, D. (2014). Terminal neglect? How some hospices decline to treat the dying. Washington Post.