As Fast As I Can

I'm busy again.  My cousin got to town late in the afternoon.  I gave her all the appropriate tools and instructions and then took her up to see my mother.  I will get my mother home later today after she has been released by the doctor.  There is a lot to do.  

I just read this in the Times this morning.  People keep telling me that such and such and so and so will pay for my mother's care, but I keep finding out that this is not the case.  This piece was written by a doctor who had to use hospice.

When my siblings and I decided to put our father in hospice care at his home in the spring of 2021, his Alzheimer’s was near end-stage. He could barely get out of bed or dress or feed himself. Hospice care seemed to be the best way for him to end his life with dignity.

Nearly all Medicare hospice patients receive care in their residence. So, as is standard, we enlisted the services of a Medicare-approved hospice agency.

We soon encountered a harsh reality, however. Dying at home isn’t easy, even with hospice care. The hospice system, we learned, requires family involvement in the dying process to a degree that even we, as a family of doctors, weren’t comfortable with. We were responsible for bathing my father and helping him use the toilet, changing his clothes and, most daunting, administering morphine and other sedatives to treat his pain and anxiety. A nurse was scheduled to come to the house only for about an hour twice a week. Getting an aide to help with basic activities of daily living was nearly impossible.

The main problem was funding. In 2024, the average per-patient Medicare payment to hospice agencies was about $200 a day, with an annual cap of $33,500. That outlay would barely pay for a part-time aide, yet it is also needed to cover medications, medical equipment and nurse visits. So hospice agencies are forced to shift the bulk of responsibilities to families as the dying process unfolds over weeks or months.

 Compounding all these issues is the fact that dying in America is increasingly corporatized. Today, about three-quarters of hospice agencies are for-profit, and many are owned by private equity companies. It is hardly a stretch to imagine that many of these companies skimp on care to protect their bottom line.

This does seem to be the case.   

I've been surrounded by the aged and dying for a long time now.  Every doctor's appointment, every hospital visit, every rehab stay.  It does not make me cheery.  

Now I must get busy.  The day is a beauty, but I won't get to enjoy it much.  I must run, run, run, as fast as I can. . . .