Comments on GeriPal - Geriatrics and Palliative Care Blog: Hospice Upheaval

I am glad to see others concerned on this issue. I...

2010-07-09T19:13:47.349-07:00

I am glad to see others concerned on this issue. I have been in Hospice over 15 years and bought a small DME company in 2006. Our business is 90% Hospice. Recently, larger more competitive companies have been coming in underbidding us which has required several switch outs. (I hope they can provide the same quality service).
I've found the best way to handle this is for the acquiring DME to perform the breakdown and removal of equipment and placement of theirs. Arrangements should be made ahead of time between the DME's for exchange of their equipment. Good communication is a must. The switch out is not the patients or facilities deal and must be done in a polite, friendly, un-obtrusive way. Without exception, the transition is supposed to be smooth with no adverse affects. No more than two people should handle the job and those individuals need to be experienced and trained DME technicians.

It is really a very good articles, informative als...

2010-04-16T23:07:08.770-07:00

It is really a very good articles, informative also loved your comments, and agree with you that Hospice Services and Home Health Services need to consider this disruption.Thanks

Dear Author www.geripal.org ! Can be.

2009-12-02T16:12:28.876-08:00

Dear Author www.geripal.org !
Can be.

Hi Helen, Loved your comments, and agree with you...

2009-11-23T17:53:20.685-08:00

Hi Helen,

Loved your comments, and agree with you that Hospice Services and Home Health Services need to consider this disruption. I forwarded your thoughts to the Hospice where I work as a Medical Director, and will see what our policy is....If it's causing this much disruption, we need to change it!

Carol Jessop, M.D.

The flip side of this issue is, of course, that th...

2009-11-23T04:42:45.923-08:00

The flip side of this issue is, of course, that there are many instances when patients are not enrolled on hospice and remain on the home health benefit, primarily to avoid the HME issue. It takes skillful and adroit coordination and management to provide the patient (and family) with a smooth transition from the home health to hospice benefit - because most hospices are small and stretched financially, there usually is insufficient staff and time to provide this coordination. This issue is, unfortunately, one of many that adversely affect hospice patients and families because of the subscale hospice industry. In other words, most hospices are too small (not enough volume) to deliver services efficiently and with proficiency.

Hi Helen I have had a similar expereince and I to...

2009-11-19T19:23:23.319-08:00

Hi Helen

I have had a similar expereince and I too felt badly for not taking the DME upheaval into consideration. I think it's a learning opportunity for all of us.

Heather Shaw

Thanks for the heads up. I had never thought abou...

2009-11-19T15:37:38.106-08:00

Thanks for the heads up. I had never thought about this before.

When we admit a new patient that already has DME i...

2009-11-19T15:27:45.746-08:00

When we admit a new patient that already has DME in the home, we usually try to get a contract with that DME company, so long as the patient is pleased with the equipment. Sometimes that DME company won't give us a contract or won't charge a reasonable rate and in that instance, we do have to switch the equipment out. If that happens, we prepare the family for what this will mean and do what we can to make this a smooth operation. Some families want the old stuff out and new stuff in on the same day, others don't so we try to be sensitive to that.

Thank you, Chek, for your international perspectiv...

2009-11-19T12:45:18.180-08:00

Thank you, Chek, for your international perspective. In this case, the patient actually had excellent transitions of care because I and my Bridge team followed her at home, hospital, SNF and back home. The agencies we partnered with for home health and hospice are both agencies that provide excellent care and communicate with me regularly in person or phone. It is more the LOGISTICS and reality-check that her DME had to be changed over to whatever companies the hospice agency contracts with that created the upheaval yesterday. I agree that in the process we (myself, hospice, the DME companies) did NOT demonstrate patient-centered palliative-valued care. Addressing this system failure is what I will engage in with the hospice.

We have a similar problem in Singapore. When a pat...

2009-11-19T11:49:41.651-08:00

We have a similar problem in Singapore. When a patient transitions from one service provider (home care, acute care) to another. A lot of information especially personal preferences, psychosocial status gets lost in this transition or translation.

I was thinking that sometimes we reduce patients to a series of check boxes of steps we have to go through. It gets the job done by audit standards but one may miss information on quality of life choices.