hi it's Marvin music with medicareschool.com and today we're going to talk about the issue of hospice and Medicare there are two million people every year that are on Medicare that are receiving hospice benefits in fact Medicare spends about 22 billion dollars a year in hospice care so many of you uh will one day possibly need to be on hospice while you're on Medicare and so I have asked an expert in this field to join me in studio today his name is Russ Rogers and we're going to talk about different details of hospice to make sure that you have a clear understanding of um of how hospice works and what the expenses are involved with that and so Russ I want to thank you for coming in today and uh first off just if you don't mind just tell me how you got in this particular business good good uh good afternoon Marvin and appreciate you inviting me here today so um I started in hospice 15 years ago I was approached by a couple gentlemen that thought it was a great business opportunity and the reason it was a great business opportunity is the the the Baby Boomers are starting to die and so um I looked at the numbers and realized they were absolutely right it was a huge business opportunity and so my my original hook to get into hospice was that and then then a strange thing happened I went and I saw our first patient and I saw the impact that hospice makes on their family and the hospice makes in their life and a hospice all of a sudden wasn't about the the the dollars and cents that we earned from Medicare but it was about patient care it was about doing the best for a family in a very critical time of their life and giving people a very great experience all right well I noticed that you all have offices in Kansas Missouri Oklahoma and Colorado and you also do uh palliative care and so would you share with us uh just some of the differences between the hospice care and palliative care sure so palliative care is really hospice light it's of for those people who probably qualify for hospice but just can't accept the fact that they're dying and so palliative care you get a version of all the pieces of the interdisciplinary team which I believe we're going to talk about in a bit but you don't get the level of care that you typically would get so you're exposed to the chapel and the social worker a case manager which is a nurse and a nurse practitioner but you don't receive their time and benefit to the extent that you do in hospice and so it's a it's really a bridge that Medicare put in about four years ago five years ago which allows people to accept the fact that yes we all are dying but don't have to admit that they're dying okay all right some understanding is that for someone to qualify for the full hospice benefits for hospice of Medicare program they do have to have a diagnosis of being terminal and they're expected to you know live six months or less is that correct uh that's absolutely correct now the six months is an average figure and so um some people if you go to your church Marvel and ask how long people live with hospice they're going to say six days and and that's that's not correct but hospices for end-of-life care and so a person needs to recognize that they're at end of life and so that end of life could take six minutes or it could take a year and a half as long as they're in Decline uh the benefit was designed and is funded by Medicare to be a six-month benefit but it's an average benefit so if you were on hospice for a year and I was on for a day we would at the end of the year make it the average of six months sure okay okay and that makes sense now uh as I look through and and and looked at the different uh reasons that people would um uh be on hospice it looked like uh really the top one was Alzheimer's and dimension those kind of cognitive issues is that correct so there are 11 different diagnosis that would qualify someone for hospice and Alzheimer's and Dementia definitely is one and as I mentioned earlier uh a person with Alzheimer's and Dementia because it is a slow acting disease usually takes people longer usually people are in Hospice Care longer than uh than a person with um would say cancer and so um so there are like I said there are 11 different diagnosis for hospice so that's what drives in the average up is those that are that are probably have the cognitive issues because other than that they may be otherwise healthy that's still uncorrect okay that's correct so if if someone goes beyond that six month period of time do they have to go back to another process to to get reviewed and to be eligible again or is it just automatic so there is a process put in place by Medicare where we review the patients uh first time every six months and then after that it's in three month increments but we send a nurse practitioner or a physician out to visit with the patients in the place that they call home and make sure that they're still in the dying process so um they're in the decline process would be a better way to say that sure and um so you mentioned Alzheimer's dementia as a long-term disease state so is COPD product obstructive pulmonary disease because a person can have that prolonged period of time also okay and so if they're on six months and then we have these three month three month increments um is there a limit to those at all there is not okay there is not we we as an agency are required to make sure that our patients have an average time of six months service but if someone continues to decline the they can hang on forever the other point I would like to say here and all of us all this Marvin need hospice and if we're wise we'll use the hospice benefit but 11 of the people that go on hospice graduate they get better and come off hospice service okay and there's a couple real reasons for that one we're managing their daily care and so we're making sure that they're doing exactly what a doctor orders and the second thing is we're giving them attention and the attention is something that's greatly needed with our senior with our seniors all right well that's that's wonderful now let's talk a little bit about the location of getting the hospice benefit uh seems to me that most people do get it at home but that's not their only option and would you kind of walk us through the different scenarios that someone could be utilizing their hospice benefits sure the hospice benefit is available anywhere you call home and so it could be a community a Skilled Nursing Facility an assisted living facility it could be your home it it uh it could be in your daughter or son's home but if you talk to most people and ask them how they want to die how they picture their death they'll say I want to be in my recliner with the dog laid at my feet the grandkids run around the river or the road in my hand I want to die at home and that's that's what 98 of the people say but it's it's not practical um a portion of our a portion of our community needs to be in a care facility and so hospice is an aid to the Care Facility wherever they call home okay okay sounds good now uh let's show someone he is diagnosed with a severe case of COPD and less than six months to live uh explain to us uh how how that care looks like I read where you have these interdisciplinary teams and a lot of people that are involved with that but walk us through that so that uh when someone's getting this care what what's involved with that Medicare Marvin does require an interdisciplinary team that looks similar in all hospices and the interdisciplinary team consists of a physician that oversees all the patient care for all the all the patients it um consists of a case manager which is a registered nurse has to be an RN but an RN can't have an LPN work with her as part of that case load it includes a chaplain which takes care of spiritual care it includes a social worker which takes care of of things like durable power of attorney takes care of living wills takes care of all those all those process things also helps them with in case they need their they need to go into a hospice house or they need to go into a community to help the social worker would help with that and then then a hospice Aid which is a person that does all the stuff around the house they'll help with Lighthouse work they'll bathe they're the really the hands on the on the patient more than the rest of us and then finally the final piece of the interdisciplinary team is a volunteer and a volunteer um is someone that will come and set and play cards with with you or Mom or Dad as the as the time is appropriate and so that's the base required by Medicare and so you ask about as someone progresses through in your case in the case you mentioned COPD the the care originally starts with a case manager which is that RN or LPN seeing the patient once or twice a week and as the patient's disease State progresses that case manager will see them more often in the case manager will ask for an aid to see them more often and at times when they feel the need for Spiritual help the last for the chaplain to see them more often so the closer that patient gets to death the more times they are seen by the interdisciplinary team the interdisciplinary team is required to once every 14 days get together and communicate with each other about what they're seeing from the patient and how we're managing the patient and the patient's care all right all right and so it looks like we have this this routine uh care going on in the home I also read about uh where there are times when there's care beyond just visits where someone actually is staying there for maybe a whole day or half the day or whatever is that mean that that person progressing then we just need to have somebody there available is that the purpose of that yes and so there are there are four different levels of hospice care that that are provided by all hospitals providers but uh at the time of death um some some people do not have family uh require a thing called Continuous Care which means someone's there 24 7. or they require a thing called visual care which is also someone there 24 7 but the caregiver in Continuous Care that your caregiver has to be a nurse 50 of the time okay individual care you or I could just sit there it's a companion okay okay another knee benefit I I think is this whole idea of the respite care and so I I don't know how many people take advantage of that but I thought maybe they don't understand so to me it looks like something that would be wonderful for the caregiver to to get some some relief and some assistance so explain that if you how that benefit can be used it is a wonderful benefit and um I'm going to use my mom and dad as an example um my wife would argue that that mom died of congestive heart failure but mom had to mention Alzheimer's for 15 years and my dad promised to take care of her through through sickness and health and so um mom died of Alzheimer's congestive heart failure but Dad my sisters and I say even though he was a perfect sound mind we we believe Alzheimer's killed him also and the reason was dad was her primary caregiver dad took care of her 24 7. and dad didn't want help and so respite care is a wonderful issue where you can take your loved one and take them to a community and have them stay at the community for five days while the while the person giving care in this case my father could go home and rest and it is a it is an unlimited benefit that it comes in five days okay okay so someone could use that five days maybe once a month or once every other month is there some kind of rules on no there's there's no limit tell off making use Russ if someone is um Elsa now for hospice benefits but they're they're dealing with other issues such as you know diabetes and and other health related issues that are really not the cause of them being on hospice how how is all that going to work together then so so the first thing that happens when someone is requesting hospice Service uh we we require Again by Medicare a doctor's order uh from their physician or from our physician saying that this patient is potentially hospice appropriate we will send a nurse out to do an evaluation and it's it's it's a question and answer physical and so they'll take they'll take Vital Signs and they'll they'll have them get up and walk and they'll measure blood flow and they'll measure oxygen flow and they'll understand do they do they definitely qualify for hospice care and if they qualify for hospice care we put them on Hospital service and start the clock if they don't qualify for hospice care we go back to a thing called the cares program which is connecting it appropriate resources and educating the patient and so we help and then I say we that that's Missouri palliative Hospice Care Kansas paying the hospice care Colorado Oklahoma we connect them with the appropriate resources that that will service them because because not people are not either physically ready or mentally ready but once um once they are ready we look at the diagnosis that we believe will ultimately be their device can end so you mentioned a person with with uh diabetes and so diabetes typically won't be their their device but but we will look for those that diagnosis that will be their device and so from that standpoint it anything that is really related to that diagnosis will be 100 covered by Medicare you know the Medicare benefit okay okay so they can still get their their their medications and those kinds of things that are needed to treat other issues Beyond just the COPD or whatever they're they're dealing with well and Marvin I should really talk about just for a second what is so wonderful about the hospice benefit I mentioned the interdisciplinary team which is a great piece of this but the the things that people don't understand in the hospice benefit is [Music] um the oh wait I just went that's all right pause here we go all right the the things that are most important under the hospice benefit includes things that are not part of that interdisciplinary team so they include meds and Med guidance they include um they include a level of incontinence supplies some suppliers some some hospice companies give a few some hospice companies give a lot they include all those pieces of the interdisciplinary team but they also include durable medical equipment DME equipment and again using mom and dad as an example they weren't on hospice care so Dad went out bought a hospital bed he went out and bought a walker he went out and bought a a bedside commode and a shower chair and all those things are provided under the hospice benefit and so people don't recognize that those pieces are included also as I mentioned a second ago all the meds related to that patient care are provided so the med cost for that family the DME costs for that family the trips to the nursing homes for that are the trips to the hospital for that family all go away because of hospice care all right all right so uh obviously a tremendous amount of care being provided and then let's talk about who's who's paying the bills for that yes and so if you could share that with us we would appreciate that absolutely and so this benefit is 100 covered by Medicare and so it's part of your Medicare benefit I I usually when I'm talking to people a little older than me because I'm starting to get there too but I when I'm talking to people a little older to me I remind them that every time they had FICA taken out of their check they were making a contribution so ultimately they've paid for the benefit already right by by having their benefits take another check when they were working all right all right well that's good Russ as a company we actually help people with their Medicare plans and some choose to get supplemental plans and and Drug plans so uh when they're on hospice benefits most of that is going to be paid through Medicare A but if they do have a supplemental plan then that supplemental plan is going to pick up the balance of that and so it is exactly as you said uh that's going to be you know fully covered when people have Advantage Plans it's very interesting they are no longer covered by the advantage plan they actually get to go back on original Medicare uh and uh then Medicare will is going to be the primary payer for hospice so we know that when people are on either supplemental planner Advantage plan Medicare is going to treat them very very well and so what you know which is wonderful now just see if you'll clarify for me are there some things that that will not be covered uh when someone gets hospice benefits absolutely so the hospice benefit is the basics meds durable medical equipment um nursing care and those pieces but things outside of the basics like a an electric chair uh like a lift chair things that are more uh luxurious as opposed to the basics are not covered in the Medicare program and would be picked up by your uh Your Advantage Programs Russ says I I read your company mission statement was very impressive and one thing you all talked about was actually uh care for veterans and so can you tell us how that works sure and and Marvin hospice's uh make choices and hospices choose to to focus on certain things and with the high percent of veterans uh dying right now all around us in the hyper set of veterans needs we have chosen to focus on our veterans population and so what that means for us at at Missouri or Kansas or Colorado or Oklahoma's care is that we have taken time to train our employees and how to how to care for veterans National hospice and palliative care has a we honor veterans program and the we honor veterans program has five levels to it and the five levels are basically how much training do your staff get on dealing with veterans dealing with um dealing with the individual veterans needs and so we have we have placed all of our locations or we have trained our locations to level four in we honor veterans and so that's one piece where we understand the veteran need greater than the average hospice we do veterans programs where three times a year we recognize Veterans of Memorial Day Fourth of July and Veterans say where we give them a token of our appreciation a a plaque or a a certificate for their wall and we do we honor them when a veteran stop when a veteran dies we we honor that Veteran by covering the body with a flag as it's being escorted out of there of the place that they call home we have done pinning Services we've partnered with the VFW in American Legion to make sure that our veterans are treated with the dignity and respect they've earned as they're going through the dying process well as I read through your company information I I sensed a real interest in in not just uh providing care but you care about people's uh spiritual lives and you want to you really do want to um uh you know minister to them and I I noticed that you said everything you do in your company you have a Christian philosophy of business which we we try to do the very same thing we think that's very very important so I want you to address that and then really lastly I know there's over 5 000 different hospice companies uh and so there's a lot of choices for people uh when they make this huge decision so if you would mind as we close out today just going to tell me what really makes you all you know really distinct why would someone choose you and what is it that people need to be looking at to make sure that they really have this this this right fit for a hospice a company and then also address the issue about operating uh with Christian principles so I've already used three times talked about our mission statement and the last six words of our mission statement are under the guidance of Christian principles and Christian principles means you treat others with dignity and respect Christian principles means you pay your bills on time Christian principles mean you do what you say you're going to do and so we are very proud of the fact that it's that our mission statement ends with under the guidance of Christian principles because it's how it's How we operate our businesses it's very present in every decision we make we make the decision what is best for the patient and so um you ask about what separates hospices and and you are absolutely correct there are over 5000 hospices in the United States all of them are very good I I will start there but some of them are exceptional and so if I were looking for a hospice for my mom or dad or um I would start by going to Google and understanding where they are from a resource standpoint I would also go on the Medicare websites and understand where they are from a Medicare standpoint because Medicare rates us Google rates us and so I would understand exactly where we are but there are things that hospices have a choice to do you and I talked about the basics the basics of a DME the basis of a case manager a hospice aide the basics of medication but I would find out what hospices do that's over and above the basics so we we have a passion for wound care and wound care is very expensive and the hospice benefit as an example requires that people address wounds but it doesn't require that people take care of wounds and we work hard at curing wounds I've already I've already talked about the the veterans program if that's important to you I would research that probably the number one question I would ask if I were looking for a a hospice is what is your nurse to Patient ratio because if a hospice has a nurse that has a caseload of 25 to 30 patients which is very common they're not going to get the same level of care as a hospice that has a caseload of 10 to 12 patients which is where we keep our case loads and so then I would ask how much time do you or employees spend with Mom or Dad because the more time as I mentioned earlier the time we get with our seniors is time that's very valuable to say yes and so if a hospice is providing uh is is providing very short time or doesn't care about tracking the time their their patients aren't going to get the Cure as a hospice that is looking at we're going to spend 45 minutes to an hour with every discipline that goes in and sees that patient okay that's very impressive well Russ I have enjoyed this early uh you have taught me a lot and um uh it looks like to me your company hospice serve would serve people well especially in this particular region and um we do appreciate your time well thank you very much you enjoyed it too yeah foreign [Music]