O.T. Hospice - Odyssey Hospice

My dad has alzheimer's.  He qualified for Hospice care several years ago and has been under the care of odyssey hospice since 2004.  Hospice is a service aimed at comfort, mainly for the last 6 months.  My dad is a tough, sweet guy, so he's chosen to keep hanging on  ;-)        There are clients who have had this care for 5-6 years, in some cases, where the health decline is steady but serious.

Odyssey was sued in a whistleblowing case a couple of years ago for giving services to people who didnt qualify and they had to pay the government millions of dollars     http://hospiceblog.blogspot.com/2006/08/is-odyssey-hospice-tip-of-iceberg.html

I just recently got notice that my dad no longer qualiifies for hospice.  It is ironic b/c the guy is very much bedridden now and he is literally wasting away as the disease progresses.  However they consider his condition "stable". They have a new feature to call and contest it. I did, and the person was very sympathetic, but my dad was denied services.  I then got a three page letter about the denial of services.  This was from the (new?) service firm Lumetra.  In addition, if I wanted to further appeal it, I could have done so by contacting another company, First Coast Service Options (QIC Expedited Reconsiderations) by NOON the following day after being turned down.

I contacted another hospice provider who hasn't been sued by the government for fraud and they did an initial evaluation of my father and will return in a month to chart any changes.  I fully expect my dad to requalify for hospice.  Hospice provides a hoyer lift, hospital bed, oxygen, wheelchair and specialized bathing equipment. A specialist in bathing attends to his skin care to prevent terrible bed sores and leisions.   In addition, when my dad went onto hospice, I was advised to drop his supplemental insurance b/c he would no longer be going to the hospital, getting treatment for illness to "save his life" etc...  Now if something comes up, a hospice nurse will not be swinging by to make him comfortable, he will have to be taken to the ER.  I've got to get him back onto hospice.  He cannot tolerate trips to the ER.

I just wanted to give the heads up in case anyone else is involved with Hospice or will be considering Hospice.  I think the government might just be shifting the burden of end of life care back onto the families, despite past promises.    ~julie

Thank you for sharing your experiences with us. You must be so upset! {{{Julie}}}

I can't understand why an insurer (is your Dad on Medicare?) would force you into costly ER visits, instead of less expensive hospice nurse visits. It doesn't make sense. It's a lose-lose situation: bad for the insurer, and also hard on your Dad.

Or, would your family have to pay for the ER visits (i.e. are they not insured)? That's terrible! ER is extremely expensive :-(.

I'm so sorry to hear about your problem.

Wendy

Wendy,

You are very sweet in giving me encouragement and your compassion.  Thank you  :-)

 He is in a very good small home facility and I signed off on the hospice thinking that his  status of being "stable" was kind of sold to me as a positive thing.  Very soon, his facility notified me that someone was coming to pick up the equipment he uses!  OMG!  he'd been on hospice for quite a while and I literally forgot that they were the ones that supplied all the medical equipment and the skin care givers each week.   I tried to undo it, but it was done.  Fortunately, there is another hospice company available that has clients who are also in end stages of life, but who have been on hospice for 5-6 years and they have evaluated him and will be back soon to reevaluate him for any changes (the "changes" appear to be the main driver for services and must be documented so that government physicians can audit/evaluate the patient via their paperwork).

As luck would have it, the very first weekend that he had been removed from hospice, an unfamiliar weekend caregiver let him fall in the restroom and my father had a very large gash in his forehead that required 7 stitches.  In a hospice situatioin, they would have sent a doctor to the home and stitched him up and then sent a nurse in for wound care until the stitches needed removal, which they would do at home.   However, they had to call the ambulance and he went to the ER where he and I hung out for nearly 6 hours.  He tends to get cold and needs sips of liquid, etc...  that only a family member would be able to anticipate.   I have no idea what/if there are charges.  He gets medicare and I was under the impression that it might be taken care of that way. ER visits are tough on anyone, but I really hate that my dad has to go thru such a process... I was so relieved when he was put on hospice, b/c I was assured he would not be going to the hospital again.

Thanks for your words of concern and if anyone has any questions about how it is to oversee the care of a loved one for years, financial pitfalls, how to get a diagnosis and placement etc... I would be happy to share.   I even have some darker stories how my brother and sister were stopped from stealing his money .  Yikes!   ~j

{{{Julie}}} You have certainly been through a lot, with your father. You seem to be handling the stress very well. How is he handling it?

I would appreciate anything that you would care to share.

My husband's mother is no longer well. She almost died, two years ago, of liver failure (she doesn't drink alcohol -- it came out of the blue).

After a week of hospitalization, the doctor recommended placing MIL in a nursing home. However, she demanded to be brought home. She owns a motel, so "home" is a room in the motel, which also has a restaurant. DH's very intelligent, hardworking sister runs the motel. We brought MIL "home." DH, SIL and I worked round-the-clock, for 2 weeks, trying to get MIL better, before she relapsed, and had to be hospitalized again. Then she went to a nursing home.

After the nursing home, MIL "graduated" to an assisted living facility. MIL is from tough Finnish stock (you'd never know how tough she is, because she is so sweet :-) ). She has recovered to the point that she is able to walk around, feed herself, etc. When she was sick, she couldn't even lift her head.

MIL is not terminal. In fact, she seems well enough to continue indefinitely. However, the health crisis, two years ago, took us by surprise. There is no saying whether it, or another health crisis, will recur.

Any advice that you give will help me prepare for the future. I know how hard it must be, for you to relive the past, but, if you don't mind, your experience will help me.

Thank you,

Wendy

I too have an elder care story to tell. Part of my skeptical attitude toward all things "official" and "bureacratic" comes from my caring for my mother for three years while she was in a nursing home. This occurred in Massachusetts 1993-96 and I was a naive layman with no experience dealing with either the Healthcare or the Legal System. I did a lot of research on both at that time and what I found horrified me.

One of the first books I read at a Probate and Family Court Law Library run by the MA government was a tome titled THE LAWYER'S GUIDE TO MEDICARE. I had read a few "civilian" books about MEDICARE by that time but this book was a real shocker. I can only describe it as a "nudge, nudge, wink, wink" guide to scammming MEDICARE. It described in detail methods to hide assets and get MEDICARE to pay fraudulent legal bills. This book really sat me up in my chair as to the state of affairs in the US since it was written by a Law Professor!

My mother stayed at the same nursing home for three years. One of the first things I had read was that normally, the patient will remain at the same home that is selected. So, I did a lot of research on that and made sure it was the best I could find under the circumstances. One of those circumstances is that Nursing Homes licensed for MEDICARE are basically a license to print money since they are tapped right into the US Treasury. I would suspect that the granting of these licenses is the subject of much political activity of a negative type. ( I will just say ex-Senate Majority Leader Bill Frist and HCA.) This also goes for "rehablilitation hospitals" where my mother went for a month and received very little effective care for exorbitant fees.

One general rule at that time was that if the patient had less than $2000 in assets MEDICARE paid everything! If more than that those assets were used until the $2000 was reached. So the techniques described in THE LAWYER'S GUIDE TO MEDICARE are used by many to get a free ride. These many, of course, tend to be the wealthy and well connected who can utilize sophisticated estate planning techniques.

One of the techniques used by the nursing home to raise additional revenue was quite a shocker. My mother had to be hospitalized two times outside of the nursing home. When that happens, the nursing home gave me the choice: do you want to reserve your mother's place if she returns from the hospital? If not, we do not guarantee that she can return to the facility. So, for each day that you pay, you may or may not be paying for a place that might have been empty anyway. Only the nursing home knows their occupancy rate. This is classic double billing.

Another shocker was that the nursing home dealt with only one drug supplier. At one point, they changed the supplier and the cost of a drug my mother was taking was tripled!

Another time I received a call from someone who said they were my mother's "audiologist". My mother had never had any trouble with her hearing. I did some research on this and found out that a private company was allowed into the facility to examine patients and sell their wares. I was never consulted on this. It sure looked like a revenue raiser for both the hearing aid company and the nursing home via fees paid to them.

On four occasions, ambulances were used and I thought the fees for these rides were exorbitant.

I can only imagine a room full of Healthcare Beancounters examining every nook and cranny of Operations and devising schemes and methods to maximize profits. In short, I am rather amazed that more Americans working in this vast system are not whistleblowing. Like many institutions in American society, one must ask if the corruption and venality are not beyond critical mass. (One might simply substitute the Mortgage Industry with its crooked appraisers, mortgage brokers willing to falsify paperwork, Wall Street ready to slice, dice, bury the paper and regulators turning a blind eye to all. It would seem that much ot the American Economy is predatory.)

You also state:
"I even have some darker stories how my brother and sister were stopped from stealing his money ."
Welcome to the club! In my case, I was at the same time as the above trying to fend off my two ATTORNEY brothers who were ready, willing and able to loot the till. My greatest worry was that my brothers would sell my mother's house so that if she did recover, she would have had no home to return to. This all played out over the years in Probate Court. I can only describe that as having been a living hell. There may be Justice somewhere occasionally in America but it does not darken Probate's door. To be avoided if at all possible.

The people involved in the Healthcare and Legal Systems have a Fiduciary Responsibility ( The moral, and sometimes legal, responsibility one party has to another in relationship to specific duties, such as those held by investment advisors or trustees.) to the citizens they represent. Well, the Professions do not live up to their Fiduciary Responsibility any more. Act accordingly.

Wendy and Peter,

I can appreciate your personal stories.  As Peter's story shows, there is a lot of money grabbing going on by individuals and situations which you might never suspect... and that can be a nasty suprise as you are dealing with someone in a health crisis.

My father has been ill with this disease for over 10 years.  When it was first diagnosed, they said... your father will live another 7-12 years.  And so far they are right.  So my dad has had some mini-crises (like the stitches) from time to time, but his decline has been in progress for many years.  The trick for me is to make sure I get him in the best facility for care, as possible as his needs changed.  He is now at this very quiet "home" near my house with 5 other residents and a couple of caregivers who are very dedicated.  The weekend staff changed, and when that happens, there are sometimes accidents .... So i try to find out about staff changes and give extra time to hang out and help them understand my dad's needs.  Hooking up with other residents' family members has also been a good strategy.  I love getting a call from one of them saying.... I stopped by today and I saw your dad doing such and such...  And I know they appreciate it when I return the favor.  In one instance, I got a heads up call that our facility would be closing down the alzheimer's wing and we would all have to find placements for our loved ones.   That call gave me a chance to start looking into a new place, while fighting with the facility to give us all more time to look.

The best resource was the Alzheimer's association.  Even if your loved one is totally sharp, the Alzheimer's association has free consultations with counselors who know EVERYTHING about eldercare issues and have a variety of community resources that you may not have even known about.  They also have moderated meetings in the community (like AA or other support groups) that meet on a monthly basis where you can get support and ideas from other families who are dealing with caring for a loved one.

The book "The 36 hour day"  was a helpful book for me in the begining.  It had a lot of the issues spelled out and i just remember referring to it a lot.  Things have settled down now, so as soon as I get this Hospice thing hooked back up, it will be quiet again until the next mini crisis  ;-)

It's a lot like having a very small child.  You have to constantly communicate with whoever is supervising them, you have to make sure they are safe, you have to know if they are getting themselves into trouble/in over their head etc....   I hope this helps a bit  ~julie

You keep saying "Medicare," but you are talking about nursing homes. Do you mean "Medicaid"?

Wendy

As I posted, this was eleven years ago so the details have faded. My mother had insurance through Blue Cross. Part of her nursing home stay was covered by Medicare. In any case, it was a massive bureaucratic nightmare, paper pushing par excellence and one wonders if anyone ever examines the papers paying out Billion$. The Pentagon must have been the "business model" for Healhcare.