Fighting to Honor a Father’s Last Wish: To Die at Home

As an EMT&#x2F;Paramedic, the single best thing I’ve been able to do for patients is take them home (or really, somewhere, ANYwhere other than a hospital or nursing home) to die, in peace, in comfort, and with dignity.<p>We spend more to keep people alive, often in misery, in the last two years of their lives than we often do in the two decades preceding it. Quality of life doesn’t have an ICD9&#x2F;10 code, though.<p>I’ve pushed back at doctors and nurses, similarly, who have discharged patients to home, having blithely signed the form that “patient requires transport in fully-equipped ALS (advanced life support) ambulance” (and the bill that goes with it), when the patient is able to walk without assistance, has no complaints or pain, and is generally and hemodynamically stable.<p>It’s obnoxious.

&quot;Home care agencies abruptly dropped or refused high-needs cases like her father’s as unprofitable&quot;<p>This story is really, really glossing over what is happening in home health hospice as a whole. For profit hospice organizations are crippling the non profit organizations by taking all the cheap and easy patients offering them slightly better services than the non profits, while dumping all the expensive and unprofitable patients on the non profits who typically try to take every patient regardless of their ability to pay, regardless of Medicaid and Medicare. These non profits are being killed off one by one because of it.<p>Yet another example of finance style arbitrage damaging the lives of Americans.

My mother is a hospice nurse and it has given me a viewpoint I don&#x27;t think I would have ever considered before. Americans (and probably most people) seem to ignore end of life decisions because it is scary, and it can be, but it is important. So incredibly important, to the person leaving this earth to be respected and to the people they leave behind to not have awful experiences like this.<p>It seems to be changing a little, slowly, but as this article seems to demonstrate there will be a huge amount of push back from a for profit industry. And once you die the checks stop so I don&#x27;t see an incentive for them to do better.

Many of American healthcare problems will dissolve if US government allowed Indian doctors to come to US and start practice on a cap free H1B.

My brother worked as a sales rep for over 10 years in home health and hospice. He has told me many war stories. Per the article, a lot of companies avoid patients who are short-term (less than a week to live) because the companies stand to lose money. He refused to do this and would regularly take on patients that represented a $10-15K loss.<p>By doing so he formed close bonds with doctors and discharge planners who would turn to him when no one else was willing to take a patient. These relationships led to a lot of referrals and he grew his territory to one of the strongest.<p>The company was later bought and new management enforced much harsher oversight on patient profitability metrics. Needless to say, he quit. Certainly something needs to change.

I see that there is a problem here, but the article seems unduly vague about what it actually is. Could someone explain?<p>What I mean: This man wanted to go home. For some reason, he could not. Was it because he was <i>physically prevented</i> from going home? Was it because, if he went home, insurance and&#x2F;or govt. assistance would be made unavailable, and so with the policies that were in place, he <i>could not afford</i> to go home? Or was it something else?

If the money is owned by the same organisation that gets to spend it, the money is spent wisely. If it costs one fifth to arrange for a daily care at home versus at a nursing home, then that&#x27;s four fifths saved for something else in the total bill. However, if the one who gets to pay and the one who gets to spend are different parties then both try to optimise from their own perspective and generally end up with contradicting goals.