Sex Offender Fights Removal From Hospice

See also: Dying, Wheelchair-Bound Sex Offender Must Leave Hospice Care Because There's a Preschool Nearby and especially: RSOL

9-10-16 Florida:

WEST PALM BEACH, Fla. (CN) - A Florida city's sex-offender law faces scrutiny in litigation over whether a wheelchair-bound former doctor, convicted of patient abuse in the 1980s, should be forced out of a hospice due to its proximity to a school.

A Palm Beach County court petition filed Aug. 31 claims Jack Ehrhart, a hospice patient with end-stage Alzheimer's disease, has been threatened with arrest if he does not move out of Heartland of Boynton Beach, a nursing home near a local preschool.

The City of Boynton Beach purportedly issued a notice to Ehrhart and the hospice accusing them of violating an ordinance that prohibits sex offenders from living within 2,500 feet of a school, daycare center or playground.

"Heartland claims to be incurring fines imposed by the city due to plaintiff's status and has threatened to have Boynton Beach Police arrest [him] for a violation of the ordinance," according to the emergency petition, filed by Ehrhart's wife under a power of attorney.

The pleading insists that a criminal prosecution of Ehrhart would have to show he made a "purposeful decision" to maintain residency within the restricted area. His Alzheimer's disease renders him "completely incapable of having the requisite intent or mens rea necessary" to prove as much, the filing states.

Heartland has tried to relocate Ehrhart to another facility, but options are scarce because the former gynecologist remains in the Florida sex-offender registry, on account of his conviction for felony indecent assault in Massachusetts.

What the dying really regret

10-17-2014 National:

Editor's note: Kerry Egan is a hospice chaplain in South Carolina and the author of "Fumbling: A Pilgrimage Tale of Love, Grief, and Spiritual Renewal on the Camino de Santiago."

(CNN) -- "I know I'm supposed to hate my body," the patient said in her soothing Southern drawl.

She pushed away her lunch, a brown lump and pile of orange. Her son spent a lot of money to have low-fat, no-sodium, no-sugar, low-calorie meals delivered to the house while he was at work and she was home alone.

They looked like piles of wet rocks.

"I really could die happy if I was allowed just one more bite of caramel cake," she said with a sigh. The woman was dying of cancer, and I was her chaplain. "I don't suppose you have any?"

"No, sorry. But why are you supposed to hate your body?"

In the business of dying: Questioning the commercialization of hospice

9-16-2012 National:

Does it matter which hospice program you choose for your loved one? Joshua Perry, J.D., M.T.S., and Robert Stone, M.D., gave participants some points to consider when they spoke at the Health Care Ethics Seminar on Sept. 15.

Perry and Stone examined the issues raised by for-profit hospice providers whose business model appears to have at its core an ethical conflict of interest between shareholders doing well and terminal patients dying well. Analyzing the business practices of the for-profit hospice industry, they critically assessed the "commercialization" of hospice care and the move toward "market-driven medicine" at the end of life.

Perry is an assistant professor and life sciences research fellow in the Department of Business Law and Ethics at the Indiana University Kelley School of Business.

Stone is an assistant clinical professor of emergency medicine at Indiana University School of Medicine, the director of Hoosiers for a Commonsense Health Plan and the assistant medical director at Indiana University Health Bloomington Hospital Hospice.

Perry and Stone's findings were published in summer 2011 in the Journal of Law, Medicine, and Ethics; 39(2); 224-34. The link to the PubMed page is: "In the Business of Dying: Questioning the Commercialization of Hospice." The link to full text is in the upper right hand corner. Then click on the volume number, scroll to the article and choose PDF. ..Source.. by IU News Room

IA- Hospice industry decries Medicare cuts

5-23-2009 Iowa:

The president of a group representing the nation's hospice care industry says one of Iowa's two senators is supporting a bid to rescind a rule that cuts federal payments to hospices.

Don Schumacher, president of the National Hospice and Palliative Care Organization, says last year the Bush Administration enacted a rule which cut payments to hospices for treatment of elderly patients who're on Medicare.

"We're trying to make consumers aware all around the country that hospice care, which is one of the most successful choices for care at the end of life, is experiencing some potential difficulty in that as the Bush Administration left office last year they instituted a regulation that's cutting hospice reimbursement by $2.2 billion," Schmacher says.

Specifically, Medicaid payments for hospice care were cut by just over four-and-a-half percent.

"We did an economic survey of our members over the last couple of months and it shows that even without this rate cut the economic picture right now has hospice programs struggling 'cause of the tremendous costs and the reimbursement really, essentially being on the low end as it is," Schmacher says, "and this is an additional cut to us which will cost us dramatically."

Congress reversed the reduction in Medicaid payment rates for hospice care for this year, but Schmacher's group is now lobbying congress to keep hospice care rates the same for the next two years. Iowa Senator Tom Harkin has signed onto a letter, urging the Obama Administration to make the move. Hospice groups are asking Iowa's other senator, Chuck Grassley, to join the effort to keep hospice care payments for Medicare patients the same for the next two years.

"It's quite a bit of change for programs to lose," Schmacher says.

According to Schmacher, it makes economic sense for Medicare patients to choose hospice care.

"A study came out of Duke University two years ago and it shows that for every patient admitted to hospice, we save the Medicare system about $2200 to $2500 when compared with patients of similar disease and life trajectory," Schmacher says. "...Everybody who goes through hospice, for the most part, feels as though they received the opportunity to say good-bye in the most appropriate way possible."

The Hospice and Palliative Care Association of Iowa represents 74 hospice agencies providing end-of-life care at 103 different facilities in Iowa. Schumacher leads the national group which represents about 80 percent of the hospices in the United States. ..Source.. by O.Kay Henderson

Medicare's Hospice Benefit

4-17-2009 Washington DC:

Summary:
Hospice care provides an interdisciplinary approach to services for Medicare beneficiaries with a terminal illness. This care specializes in the relief of the pain and symptoms associated with a terminal illness and in the provision of supportive and counseling services to patients and their families during the final stages of a patient's illness and death.

The benefit covers a broad range of services, including prescription drugs for pain control and symptom management, skilled nursing care, physician services, home health aide services, homemaker services, patient counseling, and family bereavement counseling. Services are provided primarily in the patient's home, but may also be provided in institutional settings, such as nursing homes.

Hospice care is provided in lieu of most other Medicare services related to the curative treatment of the terminal illness. For a person to be considered terminally ill and eligible for Medicare's hospice benefit, the beneficiary's attending physician and the medical director of the hospice (or physician member of the hospice team) must certify that the individual has a life expectancy of six months or less.

Beneficiaries electing hospice are covered for two 90-day periods, followed by an unlimited number of 60-day periods. Medicare payments to hospices in 2007 totaled $10.1 billion, having more than tripled since 2000. Medicare spending for hospice is expected to continue growing and to more than double by 2018, reaching a projected $21 billion and outpacing the projected growth rates for Medicare payments in hospitals, skilled nursing facilities, physician services, and home health care.

Growth in spending to date has been driven, in part, by increased utilization of hospice as well as spending per hospice user. For example, spending per user grew between 2004 and 2005 by 8%. Growth in spending per user may be in part a result of increasing lengths of stay among certain hospice providers.

The number of hospices participating in Medicare also grew by 33.4% during the four-year period from 2003 to 2007. As of 2007, for-profit hospices constituted the majority of these hospices, and since 2000, made up over 90% of hospices participating in Medicare. Medicare pays hospices using a prospective payment system containing four categories of daily rates, which are predetermined, fixed amounts intended to pay for the costs of care for a hospice beneficiary, on average.

These amounts are adjusted annually by the hospice market basket. Hospice payments are also adjusted for geographical differences. Total payments to hospices may not exceed an aggregate per beneficiary cap amount. Some analysts have expressed concerns about Medicare margins earned by certain types of hospice providers, the growing number of hospices exceeding the aggregate per beneficiary cap, increasing lengths of stay, and the three-year phase out of the budget neutrality factor authorized under regulation in August of 2008. All of these topics are discussed in this report, which will be updated as necessary.

For the full report: by Medicare

Administration Move Jeopardizes Hospice Care

8-25-2008 National:

Hospice providers and terminally ill patients prepare for worst, Congress
urged to act quickly

WASHINGTON, Aug. 1 The Centers for Medicaid and Medicare Services (CMS) announced today that it will cut Medicare reimbursement rates for hospice, forcing many hospice providers across the country to either significantly scale back the care they provide to terminally ill patients or to shut their doors altogether. The final rule, published in The Federal Register, is effective October 1, 2008.

"Let's be clear, the Administration's cuts will seriously hurt the most vulnerable -- the terminally ill," said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization (NHPCO), which represents 4,000 hospices nationwide. "By issuing this rule, CMS is taking an end run around Congress and its longstanding role protecting hospice."

"The government's reason for its decision that would effectively cut rates -- the need to save money -- simply isn't true," noted Jonathan Keyserling, executive director of the Alliance for Care at the End of Life, an affiliate organization of the National Hospice and Palliative Care Organization. "Research has shown that hospice saves the Medicare system money, is highly rated by family members of hospice patients, and enables the patient to die at home in most cases," says Keyserling. "This rule defies logic, and will have a direct, negative impact on care at the bedside."

According to an independent 2007 Duke University study, hospice saves Medicare an average of $2,300 per patient, amounting to a total savings of about $2 billion a year.

Considered to be the model for high-quality care for terminally ill patients, hospice focuses on caring, not curing, and, in most cases, is provided in the patient's home. Hospice professionals are experts in providing pain and symptom management to the dying. Additional services include emotional and spiritual support to patients and their family caregivers as well as caregiver training. More than 1.3 million dying Americans received care from the nation's hospice providers last year, a number that continues to rise.

A Gallup poll found that nine out of 10 Americans, if faced with a terminal illness, would want to remain in their homes and receive the services that hospice provides. In fact, more than 80 percent of hospice care in the U.S. is provided in the home. And patient satisfaction with hospice approaches 100 percent as shown by data collected from family caregivers.

Congress Should Preserve Hospice

Congress has historically rejected Administration requests to reduce the level of hospice reimbursement, realizing the harmful impact such cuts would have on care at the bedside. "And this time is no different," says Keyserling. "Congress should intervene to stop the Administration's cut to hospice care, before the rule goes into effect."

Today, sentiment on Capitol Hill largely remains the same -- a bicameral and bipartisan group of more than 90 members of Congress has sent a letter to Health and Human Services Secretary Mike Leavitt in opposition to the proposed rule.

"It is in our nation's fiscal and moral interest that high-quality hospice care remains an option for all who need these unique services and support," said Keyserling.

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO's mission is to lead and mobilize social change for improved care at the end of life, www.nhpco.org.

The Alliance for Care at the End of Life is a 501(c) 4 organization created by the National Hospice and Palliative Care Organization (NHPCO) to provide a more aggressive and comprehensive advocacy voice to serve the entire field and, ultimately, one of America's most vulnerable populations -- those nearing the end of life, www.afceol.org. ..News Source.. by National Hospice and Palliative Care Organization