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http://www.npr.org/sections/health-shots/2017/08/11/542607941/nearly-1-in-5-hospice-patients-discharged-while-still-alive

When I first saw the headline for this NPR story, I thought it was a good news story! One in five patients being discharged from hospice! That’s amazing!

But when I dug into the article, I realized how wrong I was. You see, in the US, most hospice operate on a for-profit basis. They are looking for ways to improve the bottom line by moving out patients who might need costly medical procedures – re-admitting them after they’ve been treated. As well, there’s evidence to suggest that they may be over-admitting patients who might not be within 6 months of death, thereby insuring that they fill all their beds. This doesn’t sound like good news to me!

Hospices in the United States began much like those in Canada – through the pioneering efforts of people following the example of Dame Cicely Saunders, founder of St. Christopher’s Hospice in London.  Once Medicare began to pay for the “hospice benefit,” for-profit enterprises (including venture capitalists) began purchasing and establishing hospices. The result of this is described in the attached article.

We are not perfect here in Canada – hospices are not adequately funded by Medicare and millions of dollars must be raised by each not-for-profit hospice just to survive. Costs are kept down by the use of thousands upon thousands of volunteers – providing enormous savings in staff salaries and invaluable services of all kind. As many people have noted, volunteers are the heart and soul of hospice and the benefits we provide are immeasurable.

Volunteers are essential to American hospices as well, of course. In fact, to receive funding through the hospice benefit program, at least 5% of staffing costs must be provided by volunteers. That’s a huge incentive to organizations to attract and retain volunteers.

Not all hospices in the U.S. operate on a for-profit basis. And I’m sure that some of the for-profit hospices provide excellent, caring services for people at the end of their lives. Nonetheless, I’m glad that in Canada, so far, we’ve maintained the non-profit basis for hospice services established by the founders of the hospice palliative care movement.

 

 

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I’m back in Virginia at the amazing writers and artists centre, the Virginia Center for the Creative Arts. I left snowy, windy, chilly Canada on Sunday and 13 plus hours (stretched over two driving days) I landed in Spring! No snow! Temperatures in the 60s and a million birds welcoming my arrival (or so I like to think).

When I was crossing into the US, the border patrol officer looked suspiciously at my car, packed to the rafters with boxes of writing, clothes, winter gear (shovel, scraper etc.) – more worldly goods than most people could imagine needing, even for a five-week sojourn. “What do you have in there?” he asked. “My writing,” I said. “I’m a writer.” When I told him where I was going, he asked if they were going to pay me to be there. (US border guards seem convinced that everyone wants to move here for good – hence the concern about my having so much “stuff” – and that we’re coming to the US to steal jobs from Americans.

“Are they going to pay you?”

“Oh no,” I said. “I pay them.”

He smiled, as he handed my passport back to me. “I was wondering,” he said, “I figured a famous writer like you was bound to get paid.”

We both laughed at his friendly ribbing, and I wore that grin from ear to ear all the way down to Virginia.

So, here I am, in my writing studio, preparing to write about death and dying once more.

This time there seems to be reliable internet, so I am hoping I’ll be able to blog regularly throughout my stay. I’d like to tell you about the people I meet at the bar where I go to edit my work at the end of a day of writing. I’d like to write about being a Canadian in Virginia (where virtually no one has ever heard of Ottawa – “it’s the capital of Canada,” I say, “near Montreal.”

I’d like to write about the American health care system and especially about the “for profit” hospice system that dominates end of life care here in Virginia (and in much of the United States). Stay tuned!

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