State avoids hospice cut

MORGAN CITY, La. -- A reversal in the administration’s plans to shutter Louisiana’s Medicaid hospice program in February means the state will continue to provide end-of-life care to people on their death beds who can’t afford private insurance.

“We’re relieved that DHH has intervened to maintain the availability of hospice services to the poor. Hospice is an underutilized and vital health care service that should be available to all. It is not only important to the patient, but it provides support to the families and their caregivers at the most important time in their lives when they need it the most,” said Glenn Blair, Morgan City native and executive director of Journey Hospice in Houma.

Journey Hospice serves all of St. Mary Parish, and 15 to 20 percent of its patients in the parish receive hospice paid for by Medicaid.

Patricia Williams, 79, of Patterson, began receiving hospice home care six months ago from Journey Hospice after experiencing heart problems. Williams said her experience with hospice has been great.

“I don’t know what I would do without them,” she said.

Her nurse, Grace Guthrie of Thibodaux, said hospice nurses are there for symptom control.

“Our primary goal is comfort care,” Guthrie said.

Department of Health and Hospitals Secretary Bruce Greenstein said his department will use federal grant funding to continue the services for the poor and terminally ill.

Gov. Bobby Jindal made a series of budget reductions in mid-December to help close a nearly $166 million deficit in the current fiscal year that ends June 30. Many of the cuts fell on the Department of Health and Hospitals.

Greenstein said when cuts are required to the Medicaid program, only a few optional benefits can be reduced without violating requirements for the state’s participation in the program it runs with the federal government. Hospice is an optional program the health department said has been available since 2002.

By using the grant funding, DHH will keep the program running while still saving $1.1 million in state funding this year and an estimated $3.1 million in state funding for the 2013-14 budget year.

The health department intends to make changes to the hospice services to shrink the costs of the care and improve the program, Greenstein said.

Rep. Sam Jones, D-Franklin, said the governor’s cuts seem to be part of a larger philosophical decision to “do a takedown of our charity hospitals.”

“Of all the cuts that have been made unilaterally by the governor, I guess this one was the most shocking to basically abandon people at the end of their life by taking away support from them and their families. What we learned was that if the hospice support was taken away most of the folks would end up going to the hospitals and actually cost more,” Jones said.

Hospice provides skilled nursing to patients with a 24-hour nurse on call, certified nursing assistant services to help with bathing and dressing, and spiritual and psychosocial services. It also provides bereavement services for families after the loved one has passed away, Blair said.

Further, volunteers help with running errands and visiting with the patient. Hospice provides medicine related to the patient’s diagnoses as well as medical equipment such as oxygen, hospital beds or wheelchairs. Without Medicaid, patients who do not qualify for Medicare would not have access to these services, Blair said.

The cuts would have made Louisiana one of only two states that don’t pay for hospice care through its Medicaid program, and the plan faced strong resistance from state senators, who were seeking ways to avoid shuttering hospice to new adult recipients on Feb. 1.

Oklahoma is the only state that doesn’t offer hospice care to adults through Medicaid, according to the nonpartisan Kaiser Family Foundation.

The legislature goes into session April 8. “Until then we are basically powerless to stop the administration from doing unilateral cuts. It’s tragic and shameful and, as we’ve seen with the reversal of this, it was unnecessary. No civilization with any compassion abandons people on their deathbed,” Jones said.

More than 5,800 people received hospice services through Louisiana’s Medicaid program in the last budget year, according to the health department. Many of those, however, were eligible to receive the end-of-life care through Medicare. About 1,400 received the services in their homes and wouldn’t have been eligible through Medicare.

Among the planned changes is a focus on community-based, at-home care, Greenstein said. Nursing home residents will not be eligible for hospice care through Medicaid, though most can get it through Medicare, he said.

Some states preclude hospice in nursing homes because they have around-the-clock care. There, they provide access to nurses, aides and a social worker. However, spiritual care and bereavement are not available to people in nursing homes, Blair said.

Additional reporting from The Associated Press.

St. Mary Now & Franklin Banner-Tribune

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