Waiting to die, and the patients are asked to wait?


https://www.nytimes.com/2021/10/16/health/coronavirus-hospice-staff.html



 

In a stressed health care system, some routine procedures or elective surgeries can be deferred without much harm. But more than half of the 2.3 million Medicare beneficiaries who die annually rely on hospice care, Medicare reported. To qualify for hospice, patients are deemed to be within six months of death.

Because many put off enrolling — American patients spend only a median of 18 days in hospice — even short waits can mean the loss of valuable care, from pain relief to help with household tasks.


 

Speaking from experience, #hospice and #pallitive care are critical in end-of-life and/or near-death patient care.


Our nurses are tired. The #pandemic has them overworked, underappreciated, and in some cases underpaid. Now vaccine #mandates are also having a negative impact on the number of #staff available in hospitals, nursing homes, and hospices. Some nurses are just leaving the field entirely to try other avenues to make a living.


Hospice nurses are also usually paid significantly less than traveling nurses or hospital nurses. Even with some significant sign-on bonuses for RNs and LPNs, they have to turn patients away in many states.


To qualify for hospice according to #Medicare, you need to be diagnosed to die within six months of dying. I can tell you from experience it is a tough conversation, and you have to sign up for it.


It seems now, given the current #healthcare environment and staff shortages, the "enrollment" part may have to be earlier than you think or are emotionally ready. This breaks my heart because while some patients may be at ease with this decision, you do not want to be rushed into if you are still holding on to hope. It's a decision that is usually made much closer to their passing than a six-month plan. For God's sake, when my mom was in hospice every day, the visiting nurse told us, "today would be the day," and it was a solid week of waiting, and she passed eight months post her diagnosis of cancer. We certainly were not thinking about #hospice when we were running on threads of hope of beating the rotten cancer that she had. Death was not even in our vocabulary.



For some, patients will choose to die at home and have a visiting nurse like my mom did, while others may choose to be admitted into a facility for palliative care.


In most cases, the patient and family have come to grips with the impending mortality. I say most cases only if the patient is not cognitively able to make their own choice.


It is a job I could never do. I guess; eventually, you would get numb to it as EMTs, law enforcement, trauma centers, and emergency room staff do, but watching people suffer and die has got to take its toll on you both physically and mentally. Hospice care is specialized medical care that focuses on providing comfort and support for the terminally ill. It's about helping patients live as fully and comfortably as possible, even during their last days.


According to the link above, the shortage is due to many reasons, including pandemic fatigue. A person can only take so much sadness and stress until even the strong will break.


I hope that hospice facilities and traveling staff resources improve as this is a service we owe to our dying. Hospices can help the family move through these final stages of life with dignity, respect - all while being there for them during what will likely be some very tough times ahead.




Melissa Mullamphy ©

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