Although this research helps describe how the hospice industry is evolving, it cannot reliably describe how any one hospice will perform. There are good for-profit hospices just as there hospice brokers are bad not-for-profit hospices. In Jim’s case, the not-for-profit agency that we selected after careful vetting engaged in a few practices that troubled me, sometimes a little, sometimes a lot.
One such practice jarred me from the start. It involved medication management, a practice that varies among hospices. Our hospice in the first week of service switched all of Jim’s medicines from a 1- to 3-month supply to a 2-week supply. This change resulted in my having to vigilantly monitor and more frequently reorder Jim’s medicines, for fear we would run out of one or another. On the plus side, the hospice arranged for home delivery of Jim’s meds. What bothered me is that we were not given a choice in delivery schedules, possibly because this change was cost effective for the hospice. A 2-week delivery schedule aligns well with the median length of stay for hospice patients: 18 days in 2013 (Medicare Payment Advisory Commission, 2015).
I concur that it would be fiscally irresponsible to waste money on medications that might never be used. I also agree that hospice providers should work to prevent such waste, for doing so helps preserve resources for the benefit of all patients. I wonder, however, if both my needs as a caregiver and the budgetary needs of the hospice could have been better served through greater attention to individualizing care. A conversation about the delivery schedule would have helped. Additionally, none of us involved in Jim’s care, including the hospice providers, believed death was imminent in that first month. Given this, a month-long transition to the abbreviated delivery schedule might have been a viable and fiscally responsible option.
I also was baffled by the abundance of personal and health care items that the hospice sent us. Initially, I was impressed. Soon after Jim returned home from the hospital, we received a box full of facial and body cleansers, hand sanitizers, absorbent pads, incontinence briefs, protective gowns, healing ointments, shaving cream, and more. I felt fortified by these supplies—until we started to use them. In general, their quality was poor. The incontinence briefs, for instance, were ill fitting and looked more like diapers than underpants. Jim tried one and almost immediately asked whether he could switch to the “old ones,” which fit better, and so worked better, and whose design maintained Jim’s sense of dignity. They also were the most expensive brand available at our local drugstore. We paid out of pocket. They were well worth their price.
Site Title 