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Socioeconomic concerns around End-of-Life Care

Socioeconomic concerns around End-of-Life Care. Mary Ellen McGreevey Director of Social Services. Critical Issues. Overall High of Cost of Health Care Increasing number of uninsured Increased co-pay requirements Inadequate Medicare/Medicaid Reimbursement. Inadequate Reimbursement.

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Socioeconomic concerns around End-of-Life Care

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  1. Socioeconomic concerns around End-of-Life Care Mary Ellen McGreevey Director of Social Services

  2. Critical Issues • Overall High of Cost of Health Care • Increasing number of uninsured • Increased co-pay requirements • Inadequate Medicare/Medicaid Reimbursement

  3. Inadequate Reimbursement • Medicare/Medicaid reimbursement in not adequate to cover the costs of care for hospice patients • FY 2000 report by Millman and Robertson “…shortfalls pose significant financial threats to the hospice programs across the country” • Role of development director is critical to not-for-profit hospices

  4. Inadequate Reimbursement • Medicare originally established the Hospice Benefit to cover a 70-day length of service • Current length of stay is 45 days • Over the past 4 years it has been as low as 15-20 days

  5. Inadequate coverage • Antiretroviral and other life-sustaining drugs are non-covered items • Other palliative measures such as chemotherapy and radiation are too costly for hospices to support • This encourages “closer to death” enrollments

  6. Inadequate increase in reimbursement rates • Readmissions to hospitals (and therefore cost of patient care) are reduced through hospice • However, in almost 20 years, hospice reimbursement has only doubled • The average daily reimbursement increased only 3.42% from FY 2002 to FY 2003

  7. Average Daily Reimbursement • Increased only 3.42% from FY 2002 to FY 2003

  8. Impact on the uninsured • Most patients present too late fro treatment • Most need access to a county hospital • Prior to hospice there is no medication coverage

  9. Impact on the Uninsured • The terminal disease reduces or terminates their employment “you work until the cancer eats you up” • Risk for becoming homeless • Homeless move from streets into a nursing home or family home • Decreased opportunity to attend to “unfinished business”

  10. Non-English Speaking population is at risk • Housing multiple families together • Undocumented status • Lack of income • Ineligible for city/state benefits • Inadequate or no life insurance • Desire to be buried in their country of origin

  11. Strengths of Non-English speaking populations • Family • Church • Community sense of responsibility to bury with respect, dignity and patient’s last wishes

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