By Walter W. Borginis III, CPA, CGMA
Last November, my father died at age 94. He had spent his last four weeks under the loving care of our hospice program, the VNA Hospice of Philadelphia, which delivered the appropriate services to him in his assisted living facility. Their caring methods and attention to his needs allowed him a peaceful and graceful decline.
Since that time, I have done a lot of thinking about my father’s life and about the overall quality of the services offered by hospice. During his stay in assisted living, I visited him often and we discussed the many things he had done. He had worked for 45 years in a Sunoco oil refinery as a machinist. His only break in service was when he was drafted during World War II. He missed the exemption from the draft for oil refinery workers by only two months.
My dad served four years in the U.S. Army in Europe. Based upon an aptitude test, he had started his basic training with courses related to an assignment in the Judge Advocate General section. Before he could complete that training, however, he received notice that he had volunteered for a combat glider unit. He had not actually volunteered, but he gave it serious thought when he found out the new assignment would pay more. Having a wife to support, he accepted the transfer and went into combat.
He very seldom spoke about his experiences in the war. My stepmother had lost two brothers in the war, so discussions of it were taboo. Still, I know he participated in six major battles in Europe, including landing at Normandy on D-Day. I found this out when he asked me to help obtain his combat medals that had been lost.
From our discussions, I learned that he performed his duties well and was one of the first to return home after the war. Despite his fine service record and extensive battle experience, he quietly returned to work at the refinery and never focused on his military service. He was an ordinary person who had been asked to do extraordinary things in a world at war.
Hospice folks don’t have to go into battle, but I believe the same is true for them. For the most part, they are ordinary people who choose to do extraordinary tasks. Every day they guide patients toward a peaceful end and help their families cope with loss. Dealing with the dying and their loved ones is a special calling that ignores the social taboos associated with the mere discussion of death. Hospice folks provide knowledge and guidance in an area that many are reluctant to think about let alone discuss with strangers. Despite their training in healing, they endure the continual loss of their patients.
And they are an answer to our dysfunctional health care system for the elderly, as I learned from being my father’s primary caregiver. His hospitalizations were frequently the result of the assisted living staff overreacting, especially on weekends when fewer staff members were present. The hospital told me that there was very little they could do to help him since many of his symptoms were indicative of advanced aging. When I saw how disruptive the hospital stays were for my father, I chose hospice as a way to keep in his assisted living home where he really wanted to be.
I cannot say enough good things about the services he received from hospice. They helped him prepare for the inevitable in a positive way. They gave him a whole new set of people to talk to: a social worker, chaplain, nurse, and home health aide. They gave me valuable knowledge about the progression of the dying process, and they were simply extraordinary at a time of great need. I only wish that I had pursued this option earlier so that a couple of futile hospital admissions could have been avoided.
There is no doubt that hospice provides a valuable service to patients and their families. It is also important to note that hospice saves the Medicare program numerous expenses related to the provision of futile care at the end of life. Our medical delivery system is programmed to provide an overwhelming number of health care services up to the very last minute of life. Hospice offers a better alternative to those pointless hospital stays that are so disturbing for elderly patients.
Yet for some reason, it seems like CMS has set its sights on making life extremely difficult for hospices. In the course of the current year, CMS has demanded that hospices begin posting all pharmacy and infusion charges to patient bills on April 1, coordinate prescriptions with patients’ Part D carriers on May 1, complete an OASIS-like patient assessment form called HIS on July 1, contend with a completely new Medicare payment system on October 1, fulfill requirements for a complex cost report for years after October 1 and new standardized patient satisfaction surveys on January 1. It seems like the plan is to tie up a wonderful and necessary program that actually saves money with an endless burden of more paperwork.
Of course, CMS has not made any provisions for the costs of collecting and submitting all of these items, making this another one of those unfunded Medicare mandates we are all too familiar with in health care. The logic of what CMS is thinking completely escapes me, and a couple of questions come to mind. Why would they try to disable a viable program? Don’t they recognize that all this paperwork only reduces the resources available to serve patients like my dad?
At my father’s gravesite, the Army sent two soldiers in full dress uniform to play taps and present me with a carefully folded ceremonial flag. As they handed it to me, they said, “On behalf of the president of the United States, a grateful nation gives its thanks for your father’s service.” I’ll never forget those words, and I would like to paraphrase them in closing. On behalf of a grateful son, I give thanks for the services of hospice. May hospice providers survive the current nightmare of paperwork and keep giving their valuable services to many more.