A response to the NY Times article from a hospice Director of Nursing. Link to the original article: https://mobile.nytimes.com/2018/01/06/opinion/sunday/hospice-good-death.html?referer=https://www.google.com/
Thank you for sharing this article with me. I have read it several times over the last few days and have been thinking of the best way to respond. This article raises many questions and concerns for me as a hospice professional. I do want to start by saying that hospice is highly regulated by CMS (Centers for Medicare and Medicaid Services), we also have over sight by the OIG (Office of the Inspector General). I do not believe that most hospices are running amuck with little government oversight as the article seems to imply.
We have seen a shift in our area (Northern Colorado) in the last few years with larger corporations purchasing smaller hospices. I have not heard great things about this shift, which makes me very happy that I work for a small privately owned hospice.
Another concern that I have with this article is the statement about for profit hospices. I spent the first nine years of my career working in a nonprofit hospital. I believe that people misinterpret the word nonprofit to mean that particular business is charitable and not out to make money. That is not the case at all; it simply means that a certain percentage of the profits must be used for the betterment of that business. Nonprofit healthcare companies typically pay their leadership team exorbitant salaries while the bedside personnel are under paid and overworked. Ultimately the patient and family suffer from lack of care when bedside personnel are stretched too thin. You can see this throughout the healthcare system. One of our competitors was in the news in the last few years with these issues it ultimately lead to the dismissal of one of their Administrators.
Front Range Hospice is a privately owned hospice, however, that does not mean that we do not provide charity care. We also have a nonprofit memorial fund that is used to help patients and their families to obtain things that they cannot afford. We use our memorial fund for things such as propane to heat homes, books, slippers, art and craft materials, anything necessary to help improve the quality of life for the patients that we serve.
Our CEO Pam Ware believes strongly in always doing the right thing. We follow Medicare regulations to a tee and we strive to provide excellent end of life care to all that we serve. We know that there are no do- overs in end of life care, so we work to get it right every time. I believe to the core of my being that hospice is a far better alternative than dying in a hospital with unnecessary interventions being performed. I have seen both ways, I have performed those unnecessary interventions and watched people miss the last precious few moments of their loves one’s life. I have also sat at the bedside and watched a young Wife lie in bed holding her Husband as he took his last breaths in the comfort of his own home. There is no question in my mind that the second scenario is a more kind and dignified way to pass from this world. Death is a beautiful, natural process. A patient’s Wife once told me, “Our Mother’s birth us into this world and we birth ourselves out of it.”
Hospice allows a person to pass at home in the care of their loved ones, with dignity and comfort. We cannot always anticipate every issue that may arise for each patient, but we are experts in end of life care. Our staff is highly trained and most end of life journeys do have many similarities, so we typically know what to expect based on normal disease progression. We provide comfort medications to each patient to ensure that we avoid as many “crisis” situations as possible. When a crisis does arise, we are experts at symptom management and can typically get any symptom under control very quickly, without relying on IV medications. Our team of nurses, social workers, chaplains, community liaisons and home health aides provide education on the dying process and what to expect to all patients and their caregivers and support for any and all emotional or spiritual issues that arise along the way. We ask each individual to define what excellent end of life care means to them and we strive to help them obtain their goals throughout their end of life journey. I believe that overall, hospice professionals are the most caring, compassionate group of individuals you will ever have the pleasure to meet. We laugh with, cry with and love our patients and their families and the last thing any of us want to see someone passing with uncontrolled pain.
Jesse Harmon, RN
Director of Nursing, Front Range Hospice and Palliative Care