CT Golden Years: Hospice Facilities Considered For Senior Alternative Care

Connecticut care givers who would prefer hospice care for elderly relatives but are forced by circumstances to place them in a nursing home may soon have another alternative – hospice care facilities located throughout the state that can provide 24-hour care for a limited number of people who are in the final stages of life.

Hospice care is different from nursing home care – especially for nursing home patients who are on Medicaid Title XIX – in that the hospice patients receive far more personalized attention. That may not set well with some people, but it is true; welfare patients don’t get the same type of care that is offered by hospice organizations.

A proposal now before the Public Health Committee – HB 5499,  Regulations Related to Hospice Care – asks the legislature to set the framework for establishing 24-hour hospice facilities. This appears to be a step beyond the services offered by adult day care centers, which enable working families to keep elderly relatives in the community by providing elder care during working hours.

In adult day care facilities the elderly person is dropped off in the morning to spend all or part of their day in the company of people with skills in elder care who can provide everything from recreation to skilled medical care. After work the elderly client is picked up by family members and is returned to the home environment.

Ron Winter

Hospice care is specialized in that it is directed toward terminal patients, but it offers a full range of services to the extended family as well as the patient. Hospice care can include medical assistance through doctor and nursing visits, nutritional advice, home care assistance, social workers, and religious counseling. Organizations that support HB 5499 want to make this assistance available throughout the state, for dying patients and their families.

The proposed regulations would preserve hospital standard of care  set in Connecticut three decades ago, proponents say, and they also would establish regulatory oversight. The types of services offered by the hospice facilities could be tailored to their respective communities.

Proponents of the new legislation say that the need for specialized care has been clearly demonstrated, but the delay in implementation already has negatively impacts such as the closing of the Rosenthal Hospice Residence in Stamford because the existing regulations do not allow for hospice residences.

Plans to build non-profit hospices in Danbury and Southeastern Connecticut are in jeopardy because the existing regulations do not recognize hospice residences, they say. Supporters say the proposed revised regulations would allow the hospices in Danbury and Southeastern Connecticut to build residences with 12 or fewer beds in areas that would be accessible for families and patients to stay in their communities.

With our elderly population expanding by huge percentages and so much of our state and federal budgets paying for Medicare and Medicaid it seems prudent to explore every possible option t provide alternative and cost effective services.

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4 Comments on "CT Golden Years: Hospice Facilities Considered For Senior Alternative Care"

  1. Are “welfare” recipients at the end of their life, entitled to the same level of care as any one else who elects hospice as alluded to in this article. The fact of the matter is that an elder on Title 19 may have worked hard all of their life, and at the end were placed in this position by having to face the costs of illness. Nursing home residents on Title 19 with hospice certainly do receive better care and in some instances this life extending. Everyone deserves a chance to experience the care that hospice can provide at the end of their life regardless of the setting.

  2. Catharine A. Heningsen | April 9, 2012 at 9:49 pm |

    To the Editor:

    In his article, CT Golden Years: Hospice Facilities Considered For Senior Alternative Care, author Ron Winter has made some very dangerous assertions. For one thing, hospice care is not elder care. Anyone admitted to hospice must be certified by two physicians as both terminally ill and likely to die within six months. It is not, nor is it meant to be, an alternative to elder care for our seniors. Unfortunately, chain for-profit hospices all over the U.S. are under investigation by the Department of Justice and the Office of the Inspector General at the Department of Health and Human Services for deliberately defrauding both Medicare and Medicaid by fraudulently enrolling people who are not terminal into hospice and then gaming the system by continually re-certifying them for hospice care every 60 days. Since hospice care is palliative, as opposed to curative care, those patients are then taken off of medications prescribed to manage existing health conditions. Death is often the result and there are numerous wrongful death suits against for-profit hospice chains for this fraud and abuse.
    >
    > Mr. Winter also incorrectly asserts, “The proposed regulations would preserve hospital standard of care set in Connecticut three decades ago, but they also would establish regulatory oversight.” In fact, nothing could be further from the truth. HB5499 seeks to reduce the regulations governing hospice care to dangerous levels. In point of fact, the proposed hospice residences could be opened under the existing regulations governing hospice care, but instead those seeking to open these residences want the services and benefits they are required to provide for patients reduced as much as possible so that they can keep as much of every Medicare and Medicaid hospice dollar as they can. If HB5499 is passed, these hospice residences will no longer be required to medically evaluate new patients for up to 48 hrs. following admission, they will no longer be required to have a doctor on the premises, or a pharmacist or a pharmacy. It would also obviate all existing state requirements for patient-to-staff ratios for nurses and aides.
    >
    > As far as regulatory oversight, these hospice residences might be inspected by the state on an annual basis–Far less than hospices are inspected currently. That will be far too late for any dying patient being neglected or abused as a result of reduced benefits and staffing levels.
    >
    > Imagine, if you will, entering one of these new hospice residences with bone cancer. Let’s say the pain medication you were given at the hospital prior to transfer is wearing off and you have to wait 48 hrs. just to be medically evaluated. Then, if you’re lucky, the hospice residence can call an outside doctor to prescribe for you without medically evaluating you him/herself and then they can take that order to an outside pharmacy to be filled. How long do you think that it is going to take to get pain relief to a dying patient? Upwards of four hours if everything goes right. Since the regulations proposed under HB5499 will no longer require patient-to-staff ratios, however, you’ll be lucky to get the attention of what staff there might be present in your “residence.” What will happen under HB5499, is that these patients will be sent out the back door in an ambulance and shunted to the nearest ER for care. This is the antithesis of hospice care and it is definitely not care to be desired.
    >
    > Dying people suffer from many emergent health problems which need to be dealt with immediately. It is not uncommon for a dying cancer patient to require dozens of medication interventions in a single day which require an in-house physician and a pharmacist. If HB5499 is passed they’ll die waiting and they’ll die in agony.
    >
    > Connecticut citizens should be calling their legislators and insisting that they do everything in their power to insist that HB5499 not be passed. Anyone who wants to open a hospice residence in this state can already do so under our existing regulations which far better protect patient interests. And the citizens of Connecticut already enjoy better access to hospice care than any other state in the union save one. HB5499 proposes a model of care that is inhumane and not worthy to be called hospice care. The people place their trust in the government to protect them from certain harm. Connecticut legislators have a moral responsibility to protect the terminally ill from the fraud and abuse which will result if HB5499 is passed.
    >
    > Catharine A. Henningsen
    > Fairfield, CT
    >
    > Catharine A. Henningsen is the author of, “Should Shareholder Concerns Govern End-of-Life Care.” She is a well-published business book author and journalist currently writing a book on the rise of the for-profit hospice industry in the U.S. entitled, PREDATORS AT DEATH’S DOOR.
    >

  3. Ron Winter | April 10, 2012 at 9:07 am |

    Catherine thank you for your comments and your point of view. A few issues, however: I don’t believe I said that hospice care is only for the elderly although this column is a regular feature of this website and it does focus on issues facing the elderly.

    As I stated in the third graph: “Hospice care is specialized in that it is directed toward terminal patients, but it offers a full range of services to the extended family as well as the patient.”

    This obviously includes far more than elderly patients, but again, this is a weekly column that focuses on elder issues.

    Also, you say I am inaccurate in my “assertions” and other statements but I should point out that my column was a review of the testimony presented before the legislature and clearly notes that the issues as presented came from proponents of the legislation not me personally.

    Nonetheless your comments and input are welcome and much appreciated. Good luck with your books on the issues facing America’s elderly!

  4. Catharine A. Heningsen | April 11, 2012 at 3:48 pm |

    Mr Winter-

    Where I take exception in your presentation of what HB5499 would change is twofold. One, hospice care cannot legally be used for anyone who has not been certified by two physicians as “terminal.” As such, it is not an alternative to other forms of elder care. Your article seems to suggest, for instance, that hospice may soon be an alternative for those taking elders to adult day care and that simply is not the case.

    My second objection is that HB5499 does not continue the standards from thirty years ago, but rather seeks to abolish them entirely and reduce regulation of hospice to the bare minimum allowable under Medicare. It also does not establish the form of oversight, which remains in a “to be determined” category. One thing which may be of interest to your audience is the fact that very few of the hospices operating in this state obtain accreditation from the Joint Commission in Chicago. In fact the only hospice I am aware of which is accredited by the Joint Commission is Connecticut Hospice in Branford, which offers hospice care throughout the state through its satellite offices. You will not likely find the chain hospices seeking Joint Commission accreditation because it costs money to be accredited and it involves much higher standards of care than the for-profits are willing to provide. Again, as per my previous remarks, the for-profits entire game is to take as much of every hospice benefit dollar as they can away from the patients, whose benefit it is, and put it in the pockets of their shareholders. You will not find them, therefore, spending any more money on patient care than they are required to provide by law. This is another reason that the radically reduced regulation HB5499 proposes is so very dangerous. There will be very little left “on the books” legally to protect the vulnerable, terminally ill who cannot be expected to fend of fraud in their final hours.

    Another glaring regulatory problem that HB5499 raises is that it also seeks to remove the current mandate that these hospices conform to the Public Health Code and to replace the Public Health Code requirements with new regulation under the Department of Health. Among other things, the regulations stipulated under the Public Health Code are what ensure, for instance, that heat and air conditioning are adequate, that hot water is not able to scald patients and that the facilities are not overrun with cockroaches. We enter a very scary terrain when we seek to abolish all of these regulations against a promise that regulations will be determined at some future date.

    Finally, I was present for the entire day of hearings on HB5499 and cannot see where you would have taken away the information on regulation, oversight or elder care. I am aware that there is quite a good deal of propaganda in play from the for-profits in order to beef up their arguments for HB5499, but as far as I’m aware, your information did not come directly from the testimony presented to the Public Health Committee. Perhaps you could enlighten me on the sources of your written information?

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