DELTONA, Fla. – A Volusia County family is left scrambling after their loved one is abruptly dropped from hospice care.
To qualify for hospice, patients must have a life expectancy of six months or less. However, for dementia patients, the prognosis can be unpredictable.
Hospice care can be extended as long as the patient continues to meet Medicare requirements. Unfortunately, these requirements are why Amy Yates lost coverage for her 91-year-old grandmother.
“The experience overall has been a roller coaster, but hospice care has really been such a big support system for caring for her,” Yates said.
Her grandmother has been in hospice care for the past two years.
“She can’t leave the house anymore to go to doctor’s appointments. It gives us access to CNA care so we can bathe her because she won’t bathe for us. It gives the ability to get her comfort care medication because that’s all she can be on right now with breathing and pain, and all of her equipment, her hospital bed, her oxygen machine,” Yates explained.
However, that help would soon go away after Yates received a notice stating that in 24 hours, Medicare would no longer pay for her grandmother’s hospice services. The deadline to appeal the decision was also the next day.
“I think it’s she hasn’t died fast enough, and it’s costing them money that they don’t want to spend,” Yates told News 6.
What Yates’ family is dealing with is what Medicare calls live discharge, and they are not alone. The Hospice Foundation of America reports that 17% of people in 2022 who were admitted to hospice care were discharged; about 6% of the total caseload was discharged because they no longer met Medicare requirements for care under the hospice benefit.
“If a person in their disease process hasn’t shown any improvement or decline, if they’re at a steady plateau, there’s really no reason to keep them on services because Medicare won’t pay for that,” said Jen Brown, RN, who has worked in healthcare for more than 20 years.
Brown owns Nurse Pop Ins & Senior Concierge, a company that helps seniors and families in Central Florida find independent and assisted living, as well as memory care.
“Every hospice company is under the same rules and regulations of Medicare. Medicare covers the entire cost of hospice service and so Medicare comes in and does audits. They do routine audits. If it indicates, according to the notes, that there is no reason to be on hospice, they won’t continue covering,” Brown told News 6.
She explained that once patients like Yates’ grandmother are admitted into hospice, they are re-evaluated every 60 days.
Yates brought up concerns that the doctor who signed off on the discharge never met her grandmother in person.
“That’s the case in most circumstances. The doctor doesn’t see the patient. A lot of times, they do team collaboration and talk to the nurses, aides, and social workers. They kind of do a case conference, per se,” Brown clarified.
News 6 reached out to Medicare about the Yates’ case. A spokesperson emailed this statement:
Due to privacy laws, the agency cannot discuss particulars of individual cases. However, anyone with questions or concerns about their Medicare benefits is encouraged to call 1-800-MEDICARE (1-800-633-4227) for personalized assistance. If a person with Medicare needs additional help, they can ask the 1-800-MEDICARE representative to escalate their issue to the Medicare Beneficiary Ombudsman. The Medicare Beneficiary Ombudsman helps people with Medicare and their representatives with questions and/or complaints, ensuring information is available to help:
• People make health care decisions that are right for them; and
• People understand rights and protections.
“Dementia patients deserve dignity, not discharge. They cannot fight for themselves”, said Yates.
Yates and her family appealed the decision, but they lost the appeal. The family reapplied for hospice, and her grandmother has been admitted to a new facility.
After her family’s experience, Yates started a Facebook resource group for other caregivers.
If you have a loved one in hospice care, Brown suggested to continue to communicate with the hospice team on his or her progress so you will not be surprised at a certain determination. She encouraged people to ask these questions:
- Can you give me an assessment of my loved one?
- Does it look like they are at a plateau?
- Does it look like they are going to meet the requirement to continue on hospice services?