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Jewish World Review May 4, 2005 / 25 Nissan, 5765 Medicare causing cancer-stricken Mom more pain By Jan L. Warner & Jan Collins
http://www.JewishWorldReview.com |
Q: My 86-year-old mother was diagnosed with terminal lung cancer early
this year. She decided not to receive treatment other than pain control
because she had been on dialysis for six years due to end-stage kidney
disease and was totally worn out.
Her cancer doctor told us he expected that she would live three to four
months, referred her to hospice, and sent her home. We then got word
from hospice that they could not take Mom unless she agreed to stop
dialysis. If she stops dialysis, her kidney doctor says she will be dead
in 10 days. We have tried to contact the Medicare people, but can't get
a straight answer. So Mom is continuing dialysis to stay alive, but is
not getting hospice pain management for her cancer. Can you tell me what
to do? This is ridiculous.
A: "Hospice" is a type of care geared toward making the dying process as
comfortable and pain-free as possible, using what is called
"palliative," or comfort, care. Hospice can't provide "curative" care —
that is, procedures and care that promote recovery. To be eligible to
receive hospice, a physician must certify that the individual is
terminally ill with six months or less to live, and the individual must
sign an election form stating that he or she understands that the care
to be provided will be for comfort, not for cure, and opts out of the
curative provisions of the Medicare program.
Once a person qualifies for hospice, Medicare will provide coverage for
"reasonable and necessary" services to provide comfort care and to
manage the effects of terminal illness and related conditions.
Therefore, your mother and your family — and any individual with a
modicum of sense — could reasonably expect that your mother would be
provided pain management for her cancer and dialysis for her kidney
disease until she died. Right? Wrong!
There is neither rhyme nor reason when it comes to dealing with the
bureaucracy known as Medicare. Dialysis is the procedure by which waste
and excess fluids are removed from the bodies of individuals with
end-stage renal disease, and is clearly not a cure for kidney disease,
but it is a way to keep such an individual alive. Crazy as it may sound,
however, dialysis is not covered under the hospice umbrella of care,
even though dialysis is not considered "curative."
Why? Hospice providers receive a "per diem," or daily rate per person,
to supply care to terminally ill Medicare beneficiaries. From this daily
rate, the hospice must provide all care, and the bottom line is that the
daily rate paid by Medicare is insufficient to pay for dialysis.
Therefore, even though your mother is otherwise eligible to receive
Medicare coverage for hospice, she — and others with terminal illness
who receive life-sustaining, but not curative treatments — will not
receive the benefit because of the structure of the Medicare payment
scheme.
Who to call? For starters, you may want to contact The Centers for
Medicare & Medicaid Services (www.cms.hhs.gov), but that will probably
be a waste of time.
We suggest that you call, write, and e-mail your congressmen and
senators, and get your friends and neighbors to do the same. Tell your
elected representatives how the bureaucracy is playing ping-pong with
your mother's life and welfare. Why should your mother be required to
live out the rest of her life in pain in order not to die an agonizing
death by stopping her dialysis? Given the fact that your Congress and
president stepped up regarding the feeding tube issue of Florida
resident Terri Schiavo, surely they are interested in the helping tens
of thousands of Americans like your mother who are being trampled by the
system they helped create.
Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.
JAN L. WARNER received his A.B. and J.D. degrees from the University of South Carolina and earned a Master of Legal Letters (L.L.M.) in Taxation from the Emory University School of Law in Atlanta, Georgia. He is a frequent lecturer at legal education and public information programs throughout the United States. His articles have been published in national and state legal publications. Jan Collins began co-authoring Flying SoloŽ in 1989. She has more than 27 years of experience as a journalist, writer, and editor. To comment or ask a question, please click here. © 2005, Jan Warner |
Mitch Albom | |||||||||||
