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Hospice offers palliative care to all terminally ill people regardless
of age, gender, nationality, race, creed, sexual orientation,
disability, diagnosis, availability of a primary caregiver, ability to
pay, or places of residence. Sometimes it's hard for hospice
staff to remember the incredible relief experienced by terminally ill
patients and their family members when they discover the only
requirement for admission to hospice is need. After trying to
qualify for program after program, after using up all their financial resources
and "spending down" to become eligible for Medicaid, after experiencing
tremendous anxiety about the costs of caring for a dying family
member, they are at last referred to hospice.
In almost every other component o the health care system patients must meet an increasing number of requirements to receive care. They must be very wealthy or very poor or very well insured; they must be a resident of a particular community or a certain length of time; they must suffer from a particular disease; and on and on. But in hospice, the main criteria is terminal illness. As hospice programs are faced with providing care for an increasing number of patients with complicated illnesses, some of which are more chronic then terminal, the concept of need based admission presents a challenge. In the United States more than 38 millions people clack health insurance. Others have been impoverished by the costs of treating a serious illness or injury. In this situation hospice programs are constantly challenged by ethical issues. We ask ourselves: How do we provide for the needs of all our patients? IF we admit everyone who needs hospice care, regardless of ability to pay, will our program use up all its financial resources? Will the program close, leaving the entire community without hospice care? If we can only accept a certain number of unfunded patients each year, how do we decide which ones to admit? What are the ethical implications of our decisions? Do we pay our staff less so w can serve more patients? If we pay less, can we attract and retain qualified staff? Although the reimbursement/financial side of managing a hospice program may seem boring and unimportant to many staff members, it is rife with ethical dilemmas and difficult decisions. As hospice staff members, we can do our part to help ensure adequate funds for continued hospice care by providing services in a financially responsible manner and by continually educating the community about hospice care. We need to recognize that each one of us is a public relations expert every time we answer the telephone, greet a visitor in the hospice office, or meet a new patient/family. We are the hospice program. |