I DON’T LIKE SENIORS By William Walley at Suddenly Senior

What a shame hospice Corporations have abused the privilege of taking care of those who need hospice care, by soliciting and gaining patients who truly are not in need of hospice care. This pads the corporate coffers of today's hospices.

Administrators are paid big kickbacks for not using Medicare's payouts toward patient care, but instead giving the lowest level of care possible to most patients, and stuffing the dollars into those corporate coffers.

Medicare is not doing anything wrong. They are trying to be good stewards of the money that is supposed to be used to take care of hospice patients.

What most folks don’t know is that hospice is paid per diem, a specific generous amount per day for hospice care, and it is left totally up to the hospice staff to decide how they spend the money on patient care.

As a hospice volunteer at three different hospices, I sat in IDT meetings and heard administrators tell nurses not to use 'expensive medications' on patients and to use as little medicine as possible. It was rare that I saw a patient's pain and anxiety controlled well....or the reverse....they were over-medicated on cheap drugs to the point that they were not able to interact with their families.

hospices pocket the money left unspent on patient care.

At all three places I volunteered, I advocated for the care and unfulfilled needs of my patients, just as if they were my own family...with love and respect and COMPASSION. I also was very, very careful to stay within the hospices protocols, and mention to nursing home Nurses if my patients complained or seemed in pain, but then immediately call my hospice staff to inform them of 'how I found my patients', per protocol.

Yet, at the second hospice, after many events that would sicken anyone, I was informed, behind the scenes that the hospice nursing staff was building a case against me to remove patients from my care...with the blessings of the administrator.

So why was I being pushed out?

Addressing Patient Needs vs. Company Profits

It took me a while, to recognize that hospices didn't like spending money on patient care. I noticed a significant turn around of nurses and thought they couldn't deal with the illnesses of hospice. Instead, I found many were fired or forced to quit because they actually were serving the patients with the compassion of a loving hospice nurse, which meant they would spend dollars in taking care of their patients.

I interfered, unknowingly on a business level, because of advocacy interactions with my patients, their families, the hospice staff nurses and aides, and nursing home nurses and their aides, so I was not longer going to serve patients. All this, because hospice had to respond to certain needs and address them and it would cost them more dollars to take care of the patients.

You see, hospices sell themselves and their services to local medical centers, doctors office, etc. When they get a signed contract with a nursing home, the hospice staff goes in and reviews patient charts and selects those that fit the bill for hospice care. Most are just older people who don't have family that care to look after them. The nursing homes are custodians for many patients because there were no family members to watch over them.

I had patients that would be in the hospice program for about six months, perhaps a year but just could not maintain the criteria and would have to come off the program. Imagine, though, how many dollars hospice had already collected from Medicare for their care, in which they really did little for the patient. These patients never needed hospice in the first place.

I also had many elderly patients, especially who were not given the medications necessary to alleviate their pain by the nursing home staff and they would suffer immensely because the hospice staff did not want to interfere with the nursing home staff, thus risking a contract in the facility.

As an example, I advocated for a dear lady for about a year who would be left in a wheel chair all day. Her head would hang down because she didn't have the strength to hold it up. She would scream when anyone touched her because the ligaments in the back of her neck were so stretched and rigid that the pain was immense when she was laid down, especially on her back, a complete reverse position of her head. I couldn't even get her to eat because her head hung so it was impossible to get a spoon to her mouth. She finally got a 'Gerry Chair' about a week before she died. By then, her neck would not go back and she screamed in pain and the staff would not give her the medications for pain.

I might add, it was against regulations for me to feed a patient, but oh, how many times did I witness as a food tray was taken away without anyone attempting to feed the patient. And then they were logged as eating 100% of their food by the facility. The hospice would stand for it, though I would tell them what I witnessed. Again, let's not do anything 'disrupt a contract' with a facility in the name of compassion!

Patient Disregard Common

Patients would make it to the bathrooms by themselves, fall, pull the emergency cords, and then lay in the floor as no one would come to their aid. I waited many times for an hour at besides as a patients called for an aide to assist them, and finally had to go to the desk myself and ask for an aide to come and assist the patient, or let a nurse know the patient was ringing the 'nurse call' because of a need for pain medications, but no one would respond.

Where is the compassion when I walk down a hallway and can hear my patient screaming and walk in to find my patient has crawled halfway out of the bed because she is trying to get someone to give her medication for pain. Or a breathing treatment so he/she can breathe?

I had one lady that lived a 'living hell' because a nursing home nurse would not give the patient the meds that were on the drug cart. Per protocol, I called my hospice nurse who told me the meds were on the cart for pain and agitation. The patient was getting neither. The hospice nurse had to call the facility and demand that medications be given to the patient. She did not get medications six hours later as she was supposed to and died because of the pain and agitation, as gangrene ate away at her leg. When I went to the IDT meeting at hospice the next day to review the patients death, I listened as a hospice nurse described her death as 'peaceful.'

I was there at the time of her death, and it was anything but peaceful. I spoke out and told the staff, which included a physician...but no one wanted to listen.

The last case I was assigned to was a home patient. It got to a point that it took four or five family members to hold her down to give her meds by mouth, which she would spit back at them. The family thought she was being evil. Little did they know she was literally throwing up the meds because of the type of cancer she had.

Do you really want to give meds by mouth to someone who is going to throw them up? The simple solution was a morphine pump...set to dispense the medicine at a set time...but that cost way too much money.

So patients stay in pain, which causes agitation, then more pain. And families have a tough time because they don't know what to do.

Because of my prodding of hospice, this patient got the medications she needed during her last hours and I was able to wake the family members to spend the last 10 minutes of her life beside her, holding her hand. A peaceful death, only because I got myself in trouble by advocating for the patient and her family.

How sad it is that Elizabeth Kubler-Ross' plan for hospice has been so abused by the very agencies that were designed to be compassionate and loving, and according to law, provide adequate care and medications for a dignified death.

Frankly, it's sad that patients who truly need hospice care may have to wait longer or not be treated effectively because of the abuses that hospice staff's have laid upon the patients by abusing our tax dollars.

If you'd like to investigate and find out more...a suggested website... and not another out there that will tell you WHAT hospice WILL NOT...

Click here: Hospice Patients Alliance: Consumer Advocates

Ron Panzer started this site because, as a hospice nurse, he understands what hospice SHOULD BE...but truly is NOT.

I'm not going to tell you that I didn't feel blessed by my service. I served with all the compassion I could give, and do not regret that I gave it my all, and I still use 'knowledge gained' to try to 'be here' on this ole internet for who those need a 'Listener' in their moments of loss...

Blessings and thanks for allowing me to share.

Name withheld by request