MORE BLACK-OWNED HOSPICES ARE NEEDED IN THE AFRICAN AMERICAN COMMUNITY

 

An article in Healthline examines the need for more black-owned hospices to serve African Americans. NHPCO says, about “54 percent of white Medicare patients used the Medicare hospice benefits versus roughly 41 percent of Black Medicare patients enrolled in hospice.” Judi Lund Person, NHPCO’s vice president for regulatory and compliance, says progress is being made, “but that the racial disparities go back decades.” Lund Person says that hospice was “considered a white person’s benefit” in the early days. Now, hospices want to be sure their patients reflect the communities they serve.

 

Nevertheless, there is still hesitancy for some in the Black community. Healthline says experts note that “cultural differences, trust, and a lack of information about how hospice care can help” are factors that impact hospice utilization. One expert is Arion M. Lillard-Green, who is an educator with the Hospice Foundation of America. She says families do not have enough information about a patient’s diagnosis and do not understand what to expect. And sometimes the healthcare providers may be uncomfortable with difficult conversations. And, says Lillard-Green, some people feel they must give up hope if they choose hospice care.

 

Emesto Lopez, CEO of Hospice of Washington County in Hagerstown, MD, says the issues of trust are impactful. That lack of trust is deep and goes back to the Tuskegee study, as well as the research around Henrietta Lacks.

 

The article examines Black-owned hospices. One, Heart and Soul Hospice in Nashville, is specifically targeted to serve Black communities. The hospice hopes to open another hospice in Louisville within the next year. No one can say for sure if there are other Black-owned hospices. Keisha Mason, DON of the Heart and Soul Hospice in Nashville, says they have partnered with Meharry Medical College, also in Nashville. “The partnership program helps train future physicians about what hospice is and what it can offer.” Some of the students volunteer with the hospice, and see first-hand how hospice works.

 

The article notes that NHPCO has an Inclusion and Access Toolkit. The toolkit offers suggestions on reaching out to African Americans, their faith-based organizations, and community organization—all in efforts “to get the word out about the help hospice can offer families.” Additionally, many of the experts Healthline talked with, say that “word of mouth from a trusted source makes a difference.” Lund Person tells of hospice organizations she worked with in the past who went to share about their hospice programs with local hair salons and barber shops. “‘They would talk to the hairdressers and barbers about good end-of-life care and suggest how they could bring it up with families while they were doing their hair.” Lillard-Green says an outreach plan means working with primary care physicians, oncologist and nurses —teaching them cultural sensitivity in helping families with end-of-life care plans. (Healthline, 1/16, https://www.healthline.com/health-news/why-black-owned-hospice-services-are-needed-in-the-african-american-community#Whats-the-fix?; NHPCO Inclusion and Access Toolkit cited in the article, 2020, https://www.nhpco.org/nhpco-diversity-advisory-council-releases-inclusion-and-access-toolkit/)

 

 

COLUMNIST GEORGE F. WILL WRITES TWO OPINION COLUMNS IN SUPPORT OF MEDICAL AID IN DYING

 

“Medical aid in dying should not be proscribed by society’s laws or condemned by its mores,” and “Medical aid in dying is for preventing a hideous death, not for truncating an unhappy life,” are opinion essays that appeared in Washington Post  on 1/19 and 1/21. Each editorial includes personal experiences that demonstrate the suffering and pain that some people experience at the end of life.

Connectican Kim Hoffman died on 1/18, in constant fatigue and pain, after enduring surgery, radiation and chemotherapy.  Koffman testified twice to the Connecticut legislature in support of legalization of MAID (Medical assistance in dying.) Will notes that, while 75% of Connecticut voters favor MAID, “the legislature tabled the measure this past year without debating this questions: What is Connecticut’s compelling interest in preventing Hoffman from receiving such assistance?” Hoffman said, “I do want to live.” But not in her “irreversibly ‘whittled down’ condition.” Hoffman observed that the legislature ignored her cause but found time to name pizza “as the state’s official food.”

 

Will also shares the journey of Chris Davis, who died at his home in 2019 at age 29. His final days, says Will, were ones of  “unnecessary horrors.” Davis’s wife, Amanda, shared with Will about the depth of his suffering. He begged to be released from his pain, and “died with tubes draining fluids from his stomach, kidneys and chest.” Amanda Davis, “a gifted photographer,” posted a series of photos, “This is Cancer,” to document the last five days of his life. A link to these graphic and startling photos is the third link cited below. Of these photos, Will says, “Steel yourself before viewing them. But view them. They ground in reality the increasingly urgent debate about medical aid in dying (MAID).”

 

Will cites a British study that reports the degree to which physicians overestimate how long terminal patients may live –by over 500%. This, says Will, gives “those suffering illusory hope.” In examining the experience of Oregon, where MAID has been legal since 1997, Will reports, “A third of those who receive end-of-life medication do not take it but derive comfort from having it at hand.” And in the 25 years Oregon has had this law, “only 4,209 people nationwide have used it to assert their autonomy in ending their lives on their terms. Ninety percent of these [patients] died where most Americans say they want to die: at home, often with loved ones.”

 

Kim Callinan, president and CEO of Compassion and Choices, says MAID “‘creates a shift within our end-of-life care system from a paternalistic model to one that is resoundingly patient-driven.” Callinan also says, that during the past six years, “‘30 national and state medical and professional associations have endorsed or dropped opposition to’ MAID.”

 

Will notes that opponents of MAID worry about a “slippery slope: Persons worried about becoming burdens on their families might find the MAID option coming to imply and obligation.” And what about people with dementia? Or with psychological conditions?

MAID, Will clarifies, “is for those who are already dying and want help. MAID,
Will asserts, “should be considered a supplement to hospice (palliative) care.”
Life itself, says Will, “is lived on a slippery slope.” “The challenge is to minimize dangers that cannot be entirely eliminated from society.”

 

Will closes his writing by noting that Americans 85 and older “are the nation’s most rapidly growing age cohort.”  Will concludes that MAID, medical assistance in dying, “enveloped in proper protocols can and should be a dignity-enhancing response to especially harrowing rendezvous with the inevitable.” At the time this HNN article was written, there were several hundred reader comments on the articles. (Washington Post, 1/19, https://www.washingtonpost.com/opinions/2022/01/19/medical-aid-in-dying-should-not-be-illegal/; Washington Post, 1/21, https://www.washingtonpost.com/opinions/2022/01/21/maid-for-preventing-hideous-death-not-truncating-unhappy-life/; This Is Cancer, June 2019, https://drive.google.com/drive/folders/1nT0BIzTPyacND1Ly7IqZkQnt7PGOzv09)

 

 

HOSPICE NOTES

 

* HHS’s Office of the Inspector General (OIG) says it “plans to conduct a nationwide review of hospice eligibility, focusing on those Medicare hospice beneficiaries who haven’t had an inpatient hospital stay or an ER visit in certain periods prior to their start of hospice care.” Slated to occur in 2023 and end by September of 2023, the audit might take longer. From OIG’s audit over the past few years, they have found hospice liabilities that lead the to conclude that this nationwide audit is important. “The nationwide audit likely will entail requests to hospices nationwide for individual Medicare hospice claims and supporting hospice records.” The records that are submitted will be reviewed by an Independent Medical Review Contractor. Details of the plan are found online at the article below, “OIG Planning Nationwide Audit of Hospice Eligibility—What You Should Know.” The link to OIG is also included. (JDSUPRA, 1/19, https://www.jdsupra.com/legalnews/oig-planning-nationwide-audit-of-7802921/ (and, just for me: https://hospicenews.com/2022/01/18/supreme-court-asks-u-s-solicitor-general-to-weigh-in-hospice-fraud-case/; OIG, January 2022, https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000648.asp)

 

* Geripal offers two podcasts focused on Medicare Advantage. The first podcast, “Medicare Advantage and the ‘Medicare Money Machine,’’ featured Dr. Don Berwick and Dr. Rick Gilfillan. The second podcase it titled “Medicare Advantage, Special Needs Plans, and the Hospice Carve-In,” featuring Dr. Claire Anduda and Dr. Cheryl Phillips. Both podcasts are online at the link below. (Geripal, January 2022, https://geripal.org/tag/podcasts/)

 

* Hospice can help alleviate anxiety, uncertainty around end-of-life care,” is an article in

Washington Post. The article provides basic information about hospice care, choosing and revoking hospice, payment for hospice care, and benefits to patients and families. (Washington Post, 1/22, https://www.washingtonpost.com/health/hospice-care-when-to-use/2022/01/20/a9787866-3347-11ec-a1e5-07223c50280a_story.html)

 

 

END-OF-LIFE NOTES

 

* A study by Duke University examines how well health centers from around the world “provide for the physical and mental wellbeing of patients at the end of life.” Of the 81 countries that were ranked by the study, only six countries actually received an A grade, and 36 countries received a D or F grade. The results of the story appeared in the Journal of Pain and Symptom Management. The six countries earning an A grade include the United Kingdom, Ireland, Taiwan, Australia, South Korea and Costa Rico. The US received a C grade and ranked number 43 out of the 81 countries. One expert says the major conclusion of the article “is that most people in the world die badly.” ( Journal of Pain and Symptom Management, 12/21/21, https://www.jpsmjournal.com/article/S0885-3924(21)00673-4/fulltextDuke Global Health Institute, 1/19, https://globalhealth.duke.edu/news/where-best-place-die; Science Daily, 1/19, https://www.sciencedaily.com/releases/2022/01/220118145930.htm#:~:text=Cite%20This%20Page%3A-,Duke%20University.,when%20used%20the%20right%20way.%22

 

* End of Life University offers a podcast titled “Terramation: A Green Option for Death Care.” Presenters Micah Truman and Brie Smith, of ReturnHome.com, examine the option of terramation, “an environmentally friendly option for disposition after death.” (End of Life University, 1/17, https://eolupodcast.com/2022/01/17/ep-334-terramation-a-green-option-for-death-care-with-micah-truman-and-brie-smith/?mc_cid=baa3465879&mc_eid=d0771da91c)

 

* The Delaware House panel passed a bill that would allow doctor-assisted suicide. The committee passed the agreement with an 8-7 vote, opening the possibility for consideration by the full House. The issue has been repeatedly introduced since 2015, but has never received a house vote. The bill has strong support and opposition. Details about the ongoing process are included in the article linked below. (AP, 1/19,

https://apnews.com/article/health-business-dover-delaware-wilmington-cecbd4d474c8b5c5eb274fbe57751f80)

 

* New York Times shares several of the letters that were written in response to a January 6 article, “A Better Way to Face Death.” The letters are online at the link below. (New York Times, 1/22, https://www.nytimes.com/2022/01/22/opinion/letters/advance-directives-death.html)

 

* Willem Jewett once served in the Vermont legislature and helped pass the bill that enables terminally-ill persons to “end their own lives.” On 1/2, Jewett, who had mucosal melanoma, used the legal right to end his own life. In December, 2020, he spoke to legislators of Vermont, encourage them to enact some of his proposed changes to the law, and these were based on his own experience. (AP News, 1/19, https://apnews.com/article/Willem-Jewett-assisted-suicide-death-211fb12ef7ffc5ae3dd5ca4f0476009d)

 

 

OTHER NOTE

 

* Washington Senator Jesse Salomon, (D), along with others, is a co-sponsor of SB 5660, the Washington Psilocybin Wellness and Opportunity Act. The bill “would allow people 21 and up to have a psychedelic experience at a registered facility with supervision. An article in Seattle Times says Washington is “a state where 1 in 5 residents lives with mental illness and thousands have seen their mental health worsen during the ongoing COVID-19 pandemic…” The article is titled “Research shows psychedelic mushrooms can help treat depression. Is legalization on the horizon for Washington?” The article describes Oregon’s legislative work and models the law after Oregon’s. Advocates within the state are working on a ballot initiative as well. The article shares about the history of psilocybin and studies that demonstrate its value. (Seattle Times, 1/23, https://www.seattletimes.com/seattle-news/mental-health/research-shows-psychedelic-mushrooms-can-help-treat-depression-is-legalization-on-the-horizon-for-washington/)

 

* “We all need help working through grief and hardship” examines the depth of grief that many healthcare professionals are experiencing. The article, which appears in STAT, profiles the losses and concerns of several specific healthcare workers, and notes that collective and multiplicative grief impacts most of us. One person made the term “gruilt”—“80% unadulterated grief and 20% guilt.” The authors call for more grief support and “assumptions from our leaders that we might need extra supports beyond a few weeks…” (STAT, 1/24, https://www.statnews.com/2022/01/24/we-all-need-help-working-through-grief-and-hardship/)

 

Hospice Analytics is the national sponsor of Hospice News Network for 2022. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com.