Hospice -- Medicare Part A
This is the official Medicare Hospice Program Description. Many people have heard the word "hospice" and think of it as the name for a "place" where old people go to die! That is partly true, and was more true in years past, not so much now. There are some amazing benefits to considering the Hospice program for yourself, or any loved one. Perhaps the greatest benefit is the absolute commitment by the Hospice staff to relieve you of any pain you have -- this relief takes the form of heavy pain killers -- generally pain killers such as narcotics that would hardly ever be given as part of a curative treatment. A less obvious feature of the Hospice is that both the patient and the care-giver are usually able to face the subject of "death" and come to grips with it. As I have observed this with my own wife, and with others who are close friends, even relative strangers, I can tell you that very few people are comfortable discussing death, or visiting a "dieing person." The remarkable thing about this is that IF you can confront this subject squarely, and have discussions about it -- the patient and care-giver -- you will find that the love between them grows, and the impending grief dissipates. The dissipation of grief will be very much a personal matter -- highly dependent on your religious beliefs, but for Bonnie and me this has been a time of "coming together" in a way that we never had before. I will only say about this experience that there was never a shred of doubt in my mind that Bonnie could choose, freely, whether she wanted or did not want some treatment, or death itself. We are both very comfortable in our relationship with one another, and our joint and common understanding of death, and what lies beyond. This is no mystery to either of us, and there is no dread or fear. One small issue I've had with the Hospice people. They get a fixed amount of money from Medicare for each patient in their care -- the amount does depend on some categorization. The normal HMO or other private insurance company generally has a great deal more money to pay for medical care. If you are in the Hospice, they do not expect to provide very much expensive care -- other than drugs to kill pain -- even if that care is "palliative." If you seek expensive care, not for cure, but for handling discomfort (such as swallowing) they are likely to reject the coverage from inside the Hospice and push you back to the regular insurance coverage. If you leave the Hospice care and return, and do this THREE times, then the fourth time you leave the Hospice care you are forever denied any further Hospice coverage. This was not explained to me as I sought "care" for Bonnie's swallowing problem. While this seemed completely "palliative" to me, the Hospice people saw it as more expensive than Hospice usually covers, so this investigation of her swallowing problem was refused under Hospice, leaving only the standard HMO coverage -- this meant leaving the Hospice system. We did that -- because the important values of entering Hospice had already been achieved -- that is, complete disconnection from any further chemo or radiation, and because we really confronted death and were ready for it. It is easier to do this, I think, if you have been accepted in a Hospice. Even if you then leave the Hospice, you can re-enter three times before you, forever, lose your Hospice privileges. Karl Loren --2--
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