HJNO May/Jun 2021

Q&A volunteers to care for the dying and their families. Currently, 39 hospice agencies are licensed to service metro New Orleans parishes. Although the Medicare hospice benefit provides for at least six months of patient care, as well as a year of bereave- ment follow up with family and caregivers, the average length of stay in NewOrleans is only 73 days, with 50% of hospice patients dying within 32 days of enrollment and 30% within 7 days. This short length of stay is due to the incredible medical advances and life- sustaining therapies that have also devel- oped over the past four decades. In 2019, 8,280Medicare beneficiaries were enrolled into metro area hospices. Most hospice care is delivered as “Routine Home Care,” but “Continuous,” “Inpatient” and “Respite” levels of care are also available (64.5% of care in NewOrleans is delivered in the indi- vidual’s home, 21.9% in a nursing homes, 12.5% in assisted living facilities and 0.7% inpatient hospice facilities). Medicare paid for 91.1% of hospice care, Medicaid for 3.1% and private insurance 5.6% of care delivered in the metro area. Although the pandemic originally dis- rupted some patient visits, especially those patients living in nursing homes and assisted living facilities, with the approval of CMS, telehealth was introduced early on into the hospice plan of care for those patients, as well as for patients living at home but fearful of “outsiders”coming into their “safe pods.” As the metropolitan area and hospice professionals have adjusted to pandemic life over the past year, hos- pice home visits have returned to normal. Even inpatient hospice units have learned how to safely open their doors for family member visits as the availability of PPE has increased. Hospice workers are essential healthcare workers and are being inoculated as part of the 1b tier of healthcare workforce as the vaccine becomes available. Many New Orleans/Baton Rouge area hospices agencies are signed up to directly receive vaccine for their staff. Patients and families have choices and important decisions to make when choos- ing a hospice agency. Louisiana-Mississippi Hospice and Palliative Care Organization (LMHPCO) encourages consumers and caregivers to do their research and consult with their physician and healthcare plan to understand their options for hospice care. While all hospice agencies provide the same basic coverage and services, each IDT has its own “personality.”When choosing a hos- pice, it is important that the “personalities” of the family and the hospice IDTwork well together over those coming precious days in the family’s life. Although patients can trans- fer to a different agency if they are not satis- fied with their original choice of hospice, it is always disruptive and unsettling for both patient and family, as well as for members of the IDT. Medicare.gov now provides Perhaps what separated us from our Neanderthal cousins was our ability to care for another, especially when “another” was in the process of dying. Since the dawn of human existence, end-of-life care has devel- oped along with each society and become an emblem of that time in history. The modern hospice movement finds its origins in the example of the monks who accompanied the Crusades into battle. They would drag a mortally wounded knight off the battlefield to die under the shade of a tree while apply- ing whatever ancient remedy they had for pain and discomfort. The word “palliative” comes from the Latin “to cloak”or “conceal,” “to sooth and comfort.”The modernAmeri- can hospice is based on the British model developed by Dame Cicely Saunders in the 1960s, with one big exception: the British model is a place where care is delivered by a team of specialists; the American model delivers the care of an interdisciplinary team (IDT) into the individual’s home, where fam- ily members become the primary caregivers. This IDT model of care has recently begun to evolve into new and separate palliative care services, now being offered in the met- ropolitan area for patients who are not hos- pice-appropriate but who are dealing with a serious illness affecting their quality of life. Over the past 40 years, hospice pro- grams in this part of the country have been developing resources and training physi- cians, nurses, social workers, chaplains and JAMEY BOUDREAUX, MSW, MDiv , is the executive director of the Louisiana- Mississippi Hospice & Palliative Care Organization. Prior to 2001, he was the Executive Director of the Louisiana Hospice Organization, with 6 years of direct hospice social work experience. He was also an Adjunct Professor at Tulane School of Social Work, teaching “Death, Dying & Grieving” from 1998-2018. 26 MAY / JUN 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS