Medicare And Hospice
Does Medicare Cover Hospice?
Many people are still not very familiar with Medicare and hospice. It is actually a fairly new idea. The “end of life movement” began in the ’70s. (The “end of life movement” is separate and distinct from the Euthanasia movement and organizations, like the Hemlock Society.) Medicare did not cover Hospice when Medicare started in 1965. Medicare and hospice were only put together in 1982 as part of the Tax, Equity, and Fiscal Responsibility Act under President Reagan in response to a growing awareness of end of life concerns. The legislation was an attempt to fill the gap in care. Awareness was growing in the country of the importance of what transpired at the end of life.
A Happy Death Is Not A New Idea
I remember when I was a teenager. My father was up before me in the mornings. He would take me to school on his way to work. I would see him praying when I came into the kitchen in the morning. One time I asked him what he was reading. It was a small devotional booklet. He was praying the novena to St. Joseph for a “Happy Death.” I was startled by the subject matter.
Teenagers don’t think much about death unless forced. I had a buddy, Herbert Woltz, killed in a motorcycle accident my senior year in high school. That was my abrupt intro to death.
I asked my father why pray for such a crazy thing as a “happy death”? The two subjects were oxymoronic to me. What’s happy about death? He reminded me that is how the Hail Mary ends. “Pray for us . . . now and at the hour of our death. Amen.”
After birth, he said, death is the most important event in your life. The difference, however, is you’re aware of what’s going on in the end, and you make the most important decisions of your life at “the hour of your death.” Praying for a “Happy Death” is about minimizing the pain and maximizing your moment of entrance into eternity. You’re asking for God and all the heavenly hosts to be at your side to handle the fear, pain, discouragement, and loneliness a person faces when approaching death and the moment of death.
I didn’t think much about what my father shared until many years had gone by and many friends and family members had passed away, including my dad. Medicare and hospice are something with which I have had extensive experience. Now I know why you would want to pay for a “happy death.”
End of Life Care Is Different
As a seminary student in St. Paul, Minnesota in the early 80’s, I was looking for a part-time ministry when I wasn’t at school studying. I found the Hawthorne Dominicans. The Hawthorne Dominicans is a Catholic women’s religious order devoted to the terminally ill. They had a hospice facility near my college, so I would walk down to it and help out on weekends. Most of the patients were cancer patients. My work was minor cleaning, but mainly it was visiting with the patients. Keeping up their spirits. Show them someone cared as they were coming to the end of their lives, and I would join the sisters in prayer and mass for the residents.
While I was there, I got to know the sisters. They were remarkable young ladies. The convent was inside the hospice facility. The nuns lived, prayed, and worked with their dying residents around them twenty-four hours a day. The Hawthorne Dominicans were some of the happiest people I ever met.
Their foundress, Rose Lanthrop-Hawthorne, was the youngest daughter of the famous author, Nathanial Hawthorne, and a convert to Catholicism. In her day, cancer patients were put on an island in New York harbor–Blackwell Island–because it was believed that cancer was contagious. Many people, especially the poor, died in incredible misery, isolation, and squalor.
Medicare and hospice were a century away. Rose, like Mother Teresa of our time, saw the face of Jesus in the poor, and she started a ministry to the dying among the poor immigrants of the New York slums. The Hawthorne Dominicans is a purely American woman’s religious order. Most woman’s religious orders in our country came from Europe originally.
End of Life Care Rediscovered With Hospice & Medicare
The end of life movement in our time found its origin during a 1967 lecture at Yale University by Cicely Saunders. She introduced the idea that the dying needed specialized care that served their unique situation. She later founded St. Christopher’s Hospice in London.
Dr. Elisabeth Kubler-Ross, MD research into death and dying identified five stages terminally ill patients go through. Her popular and groundbreaking book, On Death & Dying, fueled a movement to deal with issues of death and dying.
In 1972 she testified at the first national hearings on death with dignity conducted by the U.S. Senator Special Committee on Aging. Organizations, like The National Hospice and Palliative Care Organization (NHPCO), sprang up to study and promote awareness around the end of life issues. Finally, because of raised public interest and concerns, Medicare added hospice care to the list of services provides in 1982.
Medicare And Hospice Are Huge
In 2014 approximately 2.6 million people died in the US. Of those deaths, 80% were on Medicare. Medicare is the largest insurer for persons during the last year of life. A quarter of the Medicare budget is just for those who are in the last year of life. That number has been consistent for decades. The high cost of health care at the end of life is not surprising considering the number and complexity of health issues, so CMS (Center for Medicare & Medicaid Services) is acutely aware of end of life issues.
Today, hospice is an important benefit for terminally ill Medicare beneficiaries. Currently, nearly half of Medicare beneficiaries receive hospice benefits before their deaths. Medicare is the primary source of payment for hospice care in this country. Yet, hospice still remains somewhat of a mystery, and Medicare beneficiaries know very little about what Medicare does with hospice until they are forced into the situation.
How Does Medicare Cover Hospice?
Hospice is defined as a program of care and support for people who are terminally ill. Terminally ill means a life expectancy of six months or less. The primary goal of hospice in Medicare is to help terminally ill people live a comfortable life and manage their pain and discomfort. Hospice care is palliative care versus skilled nursing and home health care. That is, it is not designed to cure the patient, but rather to aid the person in the dying process. Because hospice care is so intimately involved and in such a big way with Medicare beneficiaries, understanding Medicare and hospice is essential.
Prayer to St. Joseph
O St. Joseph whose protection is so great, so strong, so prompt before the throne of God, I place in you all my interests and desires. O St. Joseph do assist me by your powerful intercession and obtain for me from your Divine Son all spiritual blessings through Jesus Christ, Our Lord; so that having engaged here below your heavenly power I may offer my thanksgiving and homage to the most loving of fathers. O St. Joseph, I never weary contemplating you and Jesus asleep in your arms. I dare not approach while He reposes near your heart. Press Him in my name and kiss His fine head for me, and ask Him to return the kiss when I draw my dying breath. St. Joseph, patron of departing souls, pray for us. Amen.