When is hospice euthanasia?

There are formulas for payment for ptient's treatment. The hospital not the dr bills Medicare/medicaid and any insurance company. there is a agreement about what percentage the ins will pay, likewise Medicare and that is what the hospital billed. the patient is asked to pay a standard copayment which people should know in advance. For example I pay $40 for every specialist visit and the hospital or practice knows in advance how much of their bill will be paid. The Drs are normally salaried and have nothing to do with the bills. We have just received a book from Blue Cross which is our Medicare PPO telling us what copayments will be for each procedure. They also provide a list of medications that they will cover and the copayments we can expect for them. If the Ins won't pay they are not in the formulry and the patient has to either pay out of pocket or request a cheaper alternative It is not simple and many elders do not understand how it all works. In the case of hospice they will pay for all drugs related to the admitting diagnosis but not for those for unrelated conditions. For example if the hospice diagnosis is cancer they would not pay for meds for heart failure unless caused by the cancer. your area council on aging can help you understand your choices snd help you make the best choice for any supplemental insurance you choose to buy. there are also many programs in many areas that may help pay for very expensive drugs plus some pharmaceutical companies have programs for discounts for the people with low incomes.all that being said it is definitely a jungle out there and most people can benefit from assistance.
All of this billing information is sent to the patient on a regular basis at least by Blue Cross. The patient or caregiver will have all the information to question bill and use it to file at tax time if they are able to take a tax deduction. Hospital bills are rarely itemized but you can request that if you feel you have been over billed and challenge ridiculous amounts like $50 for a band aid.
By the way to be able to take a tax deduction for 2016 you must be over 65 and the expenses must be at least 7.5% of your total income. Next year the threshold is set to rise to 10% but of course that can easily change.

zythrr, the Cleveland Clinic is a multi-specialty academic hospital located in Cleveland, Ohio that is owned and operated by the Cleveland Clinic Foundation, an Ohio nonprofit corporation. Thus, the hospital didn't "pocket" any money.

Being that your Mom was on life support, that tells me she didn't have a legal Medical directive which would have given you and the hospital her wishes in such an event. Thus the hospital needed to do everything they could to keep your Mom alive. This doesn't sound like Hospice was even used at all.

Z, you are so mis-informed about how hospitals and healthcare billing works, it makes my head spin. I don't believe there is any sense in explaining it to you, the "facts" would make no difference to you.

Again, I'm sorry for the loss of your mom.

Barb, just what I was thinking. Understanding the basics of hospital and hospice payment and reimbursement is one of the fundamental issues to understanding how hospice operates.

Z, for whatever reason, has a very childlike view of the world. His thinking seems to go "If it is necessary, it must be free".

Perhaps he comes from a country where all is provided if you need it. For better or worse, the U.S is a capitalist democracy without universal healthcare.

It can be an enormous challenge to adjust to a new economic system. I hope he comes back to gain some more understanding.

zythrr, I really think you are doing a great disservice here by claiming things about hospice when your mother was not on hospice. None of your explanations substantiate your claim that hospice is all about money.

My daughter works in a nice assisted living facility. One long-term resident was very personable and well-liked by staff and other residents. At the end of his life it was evident to staff that he was suffering greatly. My daughter was very upset when she talked about this. The man's out-of-state son, who hadn't spent a lot of time with his father in this condition, was hesitant about using hospice services. My daughter was so relieved when he finally signed off on hospice. The old gentleman had some comfort in his final days.

zythrr, I solemnly swear to you, for my daughter was NOT about money. She was paid the same whether the man went on hospice or not. The same was true of other staff members who were really hoping to see this man on hospice.

You cannot assume and accuse that every medical person who suggests hospice or removing life support is doing it for reasons of money. And that doesn't even make sense. Wouldn't the institution make MORE money if they kept the patient around as long as possible?

Please don't claim more than you do, or generalize from a single experience you don't even seem to understand.

Correction of typo: Please don't claim to know more than you do, or generalize from a single experience you don't even seem to understand.

My mother was on hospice seven months. Not only were we never billed one cent, hospice took over the cost of the pain meds my mother was already on, the rent for her wheelchair that we had been paying as well as the rent on the hospital bed we had also been using prior to hospice. So if it's about money - hospice save my mother money. For the record - the same was true for my father who received hospice care for three months about four years ago. I'd think my total ten months of experience dealing with hospice services should account for something in this absurd argument that a hospice patient has to pay for their care. That's just a load of crap.

My Grandma-in-law, has actually had me thinking about this all week. Last week she went to the doctor, and he said that she needed to start thinking about her end of life options. From how she understood it (she has some O2 related memory issues) she could just check herself into the hospital at anytime, go off her medications and basically be given morphine to alleviate symptoms until she died. At this point her meds and sheer willpower are the only things keeping her alive. So I called her doctor and she was right to a certain degree, but, he is a very ethical guy and he would have to agree to have her admitted.

As for hospice, like actual hospice, which we do not have where we live for some odd reason. Yes, in some cases it is close to euthanasia. BUT, they alleviate suffering. Hospice is not about treatment, hospice is to give a dieing patient the best quality of life they can have in their last days, weeks and months.

I have watched 3 family members die in hospice care. They go above and beyond, and in many cases (for in home hospice care) family members are in charge of the medications while the nurses are away. Actually when my Grandfather was dying of lung cancer, it was my Grandma who was far to liberal with the morphine, after 3 years in agony she could not take it anymore and did not want him to be in pain. Every time he so much as moaned she gave him morphine, I would do the exact same thing if it were my husband, I should also add that she was a Registered Nurse.

I support Death with Dignity (and all fo its other names, changes by state) and feel that terminal patients should have a choice.

Jennings I believe PCGs are now required to talk about end of life care these days.
I know mine has discussed it with me in terms of whether or not I wish to continue with the many Dr visits and procedures I have been subjected to in the past year. my decision was that as I continue to improve I wished to continue and decide on a case by case decision. i was also asked by the health care care nurse who wanted to have a conversation with their palliative care team. I told her that I had no need to see them because I had worked in that discipline for ten years. so just from my experience it seems to have become usual practice to offer this option.
I am not terminal and completely understand the reasoning. I also think that other people if they are capable of understanding the benefits should be given the choice but unfortunately with the deliberate spreading of false information patients may be afraid of hospice. Our local, very good hospice, is very underutilize

Rainmom, Hospice patients so have to pay for their care if they are not old enough for Medicare or it is not a benefit of their regular insurance. They are charged on a sliding scale depending on the services they receive and their income level. I don't know if Medicaid covers it if they are below 65. Someone else may know the answer to that.

From americanhospice DOT org:

FAQ: How is Hospice Care Paid For?
Patients with a terminal illness do not usually have to pay for hospice care.

Hospice care costs are covered by Medicare (through the Medicare Hospice Benefit), Medicaid (in most states), and The Veteran’s Health Administration.

Medicare and Medicaid:


Currently, most hospice patients have their costs covered by Medicare, through the Medicare Hospice Benefit. Learn more about the Medicare Hospice Benefit.
Medicaid also pays for hospice care in most states. People become eligible for Medicaid when their income and assets are low.
Medicaid provides benefits that are very similar to the Medicare Hospice Benefits.


Veterans’ Benefits:

The Veteran’s Health Administration also covers hospice care. If you think you may be eligible, you can read further information for veteran’s benefits.
The Veteran’s Health Administration provides benefits that are very similar to the Medicare Hospice Benefits.
Health Insurance.

Many private insurance companies provide some coverage for hospice care. Check with your insurer to determine whether hospice care is covered and under what circumstances. Among private insurers, there are variations in qualifications and covered benefits.
Individuals who do not have insurance.

If you do not have insurance coverage and cannot otherwise afford the service, a hospice may provide care free of charge or on a sliding scale basis.
This financial assistance is provided through donations, gifts, grants or other community sources. Call your local hospices to learn if they are able and willing to offer care for free or reduced cost in your case. View our contact information for hospices in your area.
Whether a patient is eligible for hospice benefits may vary depending on who is covering the cost of care. Currently, most hospice care in the US is covered by the Medicare Hospice Benefit, which requires:

patients to be diagnosed with a terminal illness, and
be 65 years or older, and
have the patient’s doctor and a hospice medical director certify that the patient has six months or less to live.
Many other hospice benefit programs follow these same guidelines set by Medicare.

fregflyer and jeannegibbs

Thank you for your comments. If you get a chance, do a google search of Dr Laura K Shoemaker. She is listed on one of the bills submitted to one of the insurance companies.

Sure, hospice is different depending on the individual and maybe it's not about the money in some instances. In this case, that was definitely not the case, since there was no chance of survival. Hospice was really a waste, since my mom never regained consciousness after 5 days of treatment.

BarbBrooklyn-Thank you for the condolences.

I know these people need to make a living. I'm not upset about that, just be honest with people, that's it.

fregflyer

To answer more about your post. ICU head said she was "dead" when she was brought back to ICU, which was the 23 ( she passed 29). She was on life support, because of the effects of the Sepsis. Here is what Sepsis had done

She had congestive heart failure, tacychardia, atrial fibrulation, unspecified intestinal obstruction, sepsis, shortness of breath, chronic pulmonary edema, hypotension, malig neoplasm of liver, acute kidney failure, acidosis, acute respiratory failure with hypercapnia, enterocolitus due to clostridium difficlie. This was just too much for her body to fight.

Since she was going to die, anyway, there was no need for Hospice which was used for only 3 days.

No doubt Hospice has come to rely on the insurance just as the medical folks have. But they never charged my dad a thing, and they were there to do everything. As soon as we put dad on Hospice they provided him with a hospital bed, all his Oxygen, coordinated with us his doctor visits, they ordered and gave his medications, and, when he died on Thanksgiving Eve, they came and stayed till the funeral home was able to come and get dad at nearly 1:AM in the morning. WE LOVED HOSPICE

Kathy,
You know what was done to you're mom. You saw it with your own eyes and your natural instincts warned you. Don't let anyone make you feel bad for talking about it. You are not wrong. Your experiences are real. What happened to your mom is real. Don't ever let anyone make you feel like it is insignificant.

Hospice is murdering people. I have seen it too. There are people here commenting that they don't sedate 24/7.... That is a lie! I have seen it. They did this to a relative. She was walking, talking, eating, drinking,going to the bathroom. Hospice came in and sedated her with morphine the first day. They kept her like that for seven days. She died on the seventh day of dehydration not a disease. If you go without good and water for seven days, you died of dehydration! Period !

There's a lot of trolls from the hospice industry commenting here. They are doing damage control for hospice. Trying to keep the cat in the bag. Trying to keep people's perception of hospice a good one full of compassion and angelic nurses... This couldn't be any further from the truth. They are angels of death.

There are comments here stating hospice doesn't use drug cocktails, such as morphine+Ativan... Also a lie. Why don't you hospice angels talk about how deadly Ativan (alone) is to the elderly? Or anyone with dementia? You can google it. It's a medical fact.

Why don't you talk about how deadly morphine is to someone with respiratory troubles? Morphine does not help the breathing. It shuts it down. And hospice knows this. All medical professionals do. Google "morphine respiration".

Why don't you talk about your death squads? Or the closers? Yeah I have inside information. I know the sick things you do.

Keep talking Kathy.

Patients pass away on the same time table whether using Hospice or not.

It all depends on if you want your love ones to pass while in terrible pain, or to pass peacefully.... again it is the same time table.

By the way, Prolife, when one is seriously ill, the patient can still be walking, talking, eating, etc. because there is that spurt of energy just before death happens. Then when the organs are shutting down it becomes very painful. Every patient would want something to take away that pain.

No, I do not work for the Hospice Care groups. 

Prolife,

Hospice is keeping my mom out of horrendous pain due to spinal compression fractures. Her bones are crumbling. She is lucid and engaging with friends and family. She eats what she can when SHE wants to and drinks liquids. No one is witholding food or water. No one is trying to accelerate her death. Her morphine dose is tiny but it does the trick to keep her pretty much pain free.

My father died of a glioblastoma (aggressive brain tumor) six years ago and I don't know how he and my family would've managed without hospice care.

The fact that you are calling people 'hospice trolls' paints you in a not so great light. We're just regular people that appreciate the care hospice gave our loved ones and also us.

I'm also not employed in any way in the medical profession. I'm just a loving daughter that cared for my father and continues to care for my mother with the help of hospice.

Yes I admit to working for Hospice as a RN for ten years but I really resent being referred to as a TROLL or MURDERER.
Bad things happen in the best of organizations.
In the midst of dying and grief which are huge life changing experiences it is not uncommon for those left behind to try and find someone to blame.
People need to remember that the patient and or their caregiver always have the final say regarding any and all treatment.
Ask questions, express your concerns and if you can't live with your decisions change your mind and let the professionals do their job which is to provide pain relief and comfort at the end of life.
Whenever this subject is revived I say to myself I will never reply again but it always gets me riled up so I do.
I am still receiving treatment for many possibly life threatening illnesses but when the time comes and my body wants to be at peace for whatever time I have left the first call I will make is to my friends at hospice in the sure knowledge they will provide me with tender loving care

Veronica91,

I wish you the best in your treatment and continued years in good health. I can tell by your words that you are a kind and good person. Thank you for all the great info you provide for the rest of us on this journey.

Many ((hugs)) to you!

Really do you think Hospice does this? My mom is 96 and has Dementia for a number of years now - the only problem I have is her wanting to use her legs less and less - I really need her to keep being able to stand for me so I can use my hands when dressing or undressing her and for her to hold onto the walker handles (she tends to pull backward while I'm trying to manage the walker straight away) and walk slowly from her bedroom to the bathroom. Mom has been upstairs in her bedroom now for just about a whole year - the stairs became impossible for her and for me to guide her up and down them. She is comfortable to JUST sit in her chair through the day with the radio playing - then again sitting In a chair has pretty much been what she has ever done. During my working years she would just sit in her living room recliner with blinds and curtains closed making it very dark inside the house. Now that she is upstairs I make sure to keep everything open so she has lots of light. Anyhow, got off the track here - Hospice not sure my mom is ready for that YET, her primary Dr. doesn't think so as she eats fine and retains her weight etc but if and when that time comes.....you talk about Hospice people keeping their cares on meds - my mom isn't on any drugs. Would they then keep her off them while in their care. Mom , years back was on a mild blood pressure med and for many years on 3 different eye drops but the eye drops became a hassle about 3 years back and at this stage of the game we just stopped using them These were the only drugs mom was on.

Veronica is spot on. Hospice is a scary term. To many it means "end of life" but I was assured when my husband choose to go on hospice on his own (and was done fighting the cancer) that he could come off of and go on to hospice at any time he chose. They are angels to me. they stayed with me 24/7 for over a week when my husbands drug induced agitation had him wandering all over the house, falling out of bed, urinating on my son and myself ,, I was totally at my wits end. And in the end he did get put on a dilauded drip for his final journey. But all of this was his choosing. I cant say enough about the wonderful caregivers from hospice that gently helped my husband on his journey ,, and really saved my life.

Didgens, I agree with you. My Mom (final stage dementia)was on home Hospice for about 3 weeks prior to her death. They were wonderful and so supportive! They did not change any of her medications, just nurse visits, assistance with showering & dressing and supplying everything she needed for home care along with massage therapy. Mom was not started on morphine until 12 hrs before she passed when she was getting restless and complaining of pain (I'm sure from organ failure). I gave her 3 doses of morphine for the pain; one small dose every hour for 3 hours. She fell asleep, snoring a bit and looked so comfortable. Although she never awoke thereafter, I know she died peacefully in her sleep with her family by her side. Hospice did not kill her and the morphine did not kill her and for sure she was not euthanized. Mom was on hospice cuz she was already in the active dying process. This is what some posters don't get. I thank Hospice for making her last day a comfortable, peaceful and a pain free experience. She deserved nothing less.

I am a hospice physician. I would like to say that you are not eligible for hospice services unless you have a prognosis of less then 6 months. We consider the patient and the patient's family as the unit of care. We provide the a nurse, nurse's aide, chaplain or spiritual counselor, social worker and a physician to each patient and their families. We provide 24 hours day, 7 day a week access to care through a phone number you can call and any of the previously mentioned providers can be called to come out and see the patient or the family. We also provide 13 months of bereavement care for the family. Hospice comes to wherever the patient is located nursing home, home, personal care home, or assisted living centers. We are an extra layer of care. A RN nurse is assigned to visit the patient at least once a week and then a LVN nurse usually comes a second time in the week (At least in our hospice). Then a home health aide is assigned to come out and bathe a patient at least twice a week. Most want at least 3 times a week. If the patient is having a hard time they can receive a RN or LVN visit daily especially in the last few days of life. Also there is a free to the family 5 days of respite care for putting stable at home patients in a nursing home for five days of rest so family members can rest. The there is continuous care for uncontrolled symptom management and in patient hospice care for symptoms that can not be managed by in home continuous care. The last two mentioned are for very specific symptom management and it is highly regulated by Medicare. It is not to be used for normal end of life care. You also get a social worker to help you with end of life care from anxiety in family and patient to planning a funeral or placement in a nursing home. They make an initial visit and then as needed visits. The spiritual care worker helps patients and families deal with spiritual issues around the end of life. They meet you where you are and can sit and pray with the patient and his family or coordinate spiritual care with your chosen faith. They visit initially and then as needed and you can refuse their visit. All medications related to the primary hospice diagnosis are covered by the hospice as well as medications related to pain, constipation, nausea & vomiting, anxiety & agitation. Most people who are in the last 6 months do experience pain and so yes we are aggressive at managing pain because it is not fair to die in pain even if you can not verbalize that you are in pain. The elderly often express pain in worsening delirium which means they see, hear and react to things other people can not see, hear and react to. As you age all your organs age including your stomach and your ability to metabolize medications in your stomach decreases. So giving your loved one more medications actually makes the patients stomach work harder at digesting them. So this means that a lot of the drugs and vitamins actually are not getting metabolized and are diminishing the amount of any of the drugs that are getting into the patients blood supply. It has been shown with study after study that the elderly medically fragile (anybody in a nursing home and almost anyone who is older then 65 depending on the person) need to be on less then 9 medications and that means over the counter medications and vitamins too. And most people in the last 6 months of life have lost enough weight that they no longer have hypertension and diabetes type II and therefore either need less of those medications and/or no longer need those medications. Most people who initially come on hospice have a "honeymoon period" when we stop excessive medications and the patient actually wakes up and is more cognizant and aware of there surroundings. We do not start pain medications unless there is some symptoms or source of pain. Most people in the last few weeks of life have pain as their body start to shut down and their muscles contract. We do not want you loved one to die. We just want to make sure your loved one is actually cared for appropriately. If you do not want to believe that I will talk about the economics of hospice. We actually do not want to kill your loved one because that would mean we can no longer be reimbursed for their care. (Medicare pays a set amount for every day you are on hospice. It covers the pay of all the caregivers, the director of nursing, the administrator, the pharmacy costs, the secretaries, the answering service, the physician etc. ) We have patients with varying length of stays some come on and die with in a day others come on and die 3 years later. Our hospice (Silverado Hospice) has a physician visit the patient with in 7 days of admission, to make sure the patient is appropriate and indeed has a life expectancy of less then 6 months if the disease was to run it's normal course. (This visit is not required by healthcare law) After the first 6 months patients are seen by a physician ever 2 months to re-certify that the patient's has a life expectancy of less then 6 months is the disease was to run it's normal course. (these visits are required by law) If the patient's illness has stabilized then the patient is discharged from hospice for extended prognosis. (life expectancy greater then 6 months) Our hospice location in and it has a census of about 150-160 patients with about 50 admissions per month and 50 deaths per month. We usually have 3-4 patients that we discharge per month for extended prognosis. We are happy to readmit them when their illness progresses again and that happens quite a bit, usually 3-12 months later. Medicare has strict guidelines that must be followed so the patient has to show decline each re-certification period (within each 60 day period). So that is what hospice actually does. We do not hasten death in anyway.

Yes, hospice care is Euthanasia. As far as I can tell it started sometime in the 70's.

In fact, the first hospice in America was started by a pro-Euthanasia activist named Florence Wald.

On the Hospice Patients Alliance website, you can find a timeline of the merging of the Euthanasia Society of America with the National Hospice and Palliative Care Organization. The two are one in the same.

Hospice does Euthanasia by what's called "the third way". Such as by denying food and water. They sedate the patient. The patient has no access to food and water and therefore dehydrates to death. Sometimes the patient is outright overdosed with lethal drug cocktails. In other instances their breathing is shut down by drugs, such as morphine. It's stealth euthanasia.

There is a growing movement to expose these murders. Many of us are speaking out to inform the public. Speaking out saves lives. Please join our movement. Look for our groups on Facebook, such as "Murdered by Hospice".

Don't pay attention to the attacks you are receiving on this forum. Ignore the gas lighting. Many of these people are trolls from the hospice Industry doing damage control. Tell your story.

You, my dear Prolife, are the troll. The rest of us are caring for, or have cared for, our dying parents, children, spouses and relatives. We've been grateful for the loving care that Hospice providers have given.

Are there bad actors in the Hospice industry? Are there bad doctors, lawyers, teachers, priests, rabbis, psychologists, nurses, social workers, IT professionals? Sure. Every industry has bad actors.

If you've ever had a loved one dying of cancer in the era before hospice, when morphine was not given because the patient might get addicted (been there, not doing it again, not to anyone I love), you know the value of hospice and the comfort that morphine and other painkillers bring to the table. I'm not giving up on this benefit.

Take your message elsewhere, please.

Aye Aye, BarbBrooklyn, I completely Agreed!! I thank God for the Hospice team who just recently helped my FIL through his end of life struggles with Lung Cancer. They were Angels in my book, and there was no way possible that we would have been able to fulfill his wishes to die at home, with his loving family around him, instead of a Nursing home.

Hospice was able to keep him comfortable through his pain, delirium and agitation, that so often comes at the end of life, and they were always but a phone call away to answer any questions and guide us through the process.

My FIL truly loved his "Hospice girls", especially his bath aide, who always gave him a good massage at the end of every bath, and whose good sense of humour and kindness he looked forward to twice a week.

Please Dear God, should it be necessary, let there be Hospice when its my time to go, as losing a loved one is hard enough, families truly need all the help they can get. People who've been through this know how very difficult it Really is!!! This was my 2nd time needing Hospice with a dying Parent, so I know!!! Cancer Sucks!!!!!

I can verify that there is a tendency to assume people want to be kept sedated and to get it over with in some programs, and they may be more likely to want to move in this direction for a patient with dementia and agitated behavior. But they are ABSOLUTELY supposed to individualize and respect your actual wishes. I saw a case with a good church friend where they totally did everything right, she had some sweet times and lots of visits and music, though with my mom I had to be a little pushy at times.

1. People in hospice who request food and/or water are given it.

2. Many people who are dying cannot swallow (dysphagia). They are given ice chips or wet sponges for comfort purposes.

3. Most people who are dying lose their appetite, in addition to having dysphagia.

4. Most people's bodies cannot process food or water as their organs shut down in the dying process. 

5. Intravenous water (saline) and feeding tubes are artificial means of keeping someone alive. If a family wants their loved one to be kept alive through artificial means, then they need to remove them from hospice and put them in a hospital or care facility.

6. Keeping someone alive through painful, artificial methods is cruel, and goes directly against the religious screed that says "only god decides" when it's time for someone to die.  It also goes against the principles of hospice.

7. Prolife, STOP LYING TO PEOPLE. You are the gaslighter here.

Death is not an easy thing to witness most of the time.  I'm sorry people have been made uncomfortable by witnessing the natural process of death, and it's understandable to want to lash out at SOMEBODY in your grief.  But come on, people.  This is what death is like.  Anybody who's even watched an elderly cat die at home knows this.  We are incredibly lucky, in our western nations of wealth and luxury, to have health care providers easing the discomfort of death.  Be grateful your loved ones have access to sedation and painkillers and a reasonably comfortable place to be as they leave this world.  People are suffering everywhere, all the time.

(P.S. - saying "only god decides" is pretty convenient rhetoric to fall back on, when it suits one's purposes.  But I don't see any religiously principled people trying to shut down the entire health care system, which circumvents natural death on a daily basis.)