Introducing Home Care Preferred - HCP

A terminal diagnosis brings a whirlwind of emotions and uncertainties, but it also presents an opportunity to take control of the future. Thoughtful estate planning can ease the burden on loved ones, ensure wishes are honored, and provide peace of mind during a difficult time.If an estate plan is already in place, now is the time to review and update key documents. A will or trust should reflect current intentions, ensuring assets pass according to ones wishes. Beneficiary designations are just as important as the documents themselves. Beneficiaries named on retirement accounts and life insurance policies should be checked to avoid unintended distributions. And remember, if you have a trust, ensure it is funded - meaning, the assets you intend are transferred or retitled to the trusts name. Ensuring that powers of attorney for both financial and healthcare matters are in place is critical. A trusted individual should be named to handle financial affairs if incapacity occurs. Similarly, a healthcare power of attorney and living will should clearly outline medical preferences including the types of heroic measures you want taken as your health fails. This reduces uncertainty for family members and medical providers. Depending on the circumstances, certain trusts may be beneficial. A revocable living trust can provide continuity in managing assets without the delays of probate. For those with minor children or dependents with special needs, a trust ensures funds are managed responsibly for their care. Irrevocable trusts may also be beneficial, depending on your familys goals and whether you anticipate needing long-term care. If nursing home care becomes necessary, proper Medicaid planning can help preserve assets for a spouse or family. While Medicaid rules are complex, strategic planning may allow individuals to qualify for benefits while protecting certain assets from being spent down on care costs. A terminal diagnosis also presents an opportunity to shape a personal legacy. Whether through charitable giving, a letter of wishes, or recorded messages for loved ones, taking time to plan for these personal aspects can provide lasting comfort and meaning.While its understandable to feel overwhelmed, delaying these important steps can create unnecessary stress later. Consulting an experienced estate planning attorney ensures that legal and financial affairs are in order, providing clarity and confidence in navigating the road ahead. Taking these proactive steps allows individuals to focus on what matters mostcherishing time with loved ones and finding peace in knowing that their affairs are settled.

The current administration has introduced policies that may significantly affect seniors, particularly concerning Medicare and Medicaid. Understanding these changes is crucial for seniors and their advocates to navigate potential challenges in healthcare access and affordability. Medicare: Shifts Towards Privatization The current administration has expressed intentions to shift Medicare towards a more privatized model, emphasizing Medicare Advantage plans. This approach aims to foster competition among private insurers, potentially driving innovation and reducing costs. However, critics argue that increased privatization could lead to disparities in coverage and access to care, as private plans may not uniformly cover all services essential to seniors. Medicaid: Proposed Budget Cuts and Their Implications Recent budget proposals from the administration include significant cuts to Medicaid, totaling approximately $880 billion over the next decade. These reductions could directly impact services vital to seniors, such as long-term care, personal assistance at home, and nursing home care. Given that Medicaid is the primary payer for long-term services and supports, these cuts may result in reduced access to necessary care for low-income seniors and increased financial strain on families.Regulatory Changes and Potential Consequences The establishment of the Department of Government Efficiency (DOGE), led by Elon Musk, has led to swift actions targeting various federal agencies, including those overseeing healthcare programs. Notably, the Centers for Medicare and Medicaid Services (CMS) have experienced administrative funding cuts and workforce reductions. These measures could hinder the agency's ability to effectively manage and oversee Medicare and Medicaid programs, potentially affecting service delivery and program integrity. Predictions and Considerations for Seniors While some of these policy changes are proposals and have yet to be enacted, seniors should remain vigilant and proactive:Stay Informed: Regularly monitor updates on Medicare and Medicaid policies to understand how changes may affect your healthcare coverage and access.Advocate for Needs: Engage with local and national organizations that represent seniors' interests to voice concerns and advocate for policies that protect essential healthcare services.Consult Professionals: Seek guidance from healthcare advisors or legal experts specializing in elder law to navigate potential changes and make informed decisions about your healthcare options.

By Faith Protsman, MD, Regional Medical Director, VITAS HealthcareTwo recent studies highlight how sepsis impact often extends well beyond the acute event that led to a patients hospitalization. The studies emphasize two particular points that should inform physicians and clinicians as they consider referring these patients to specialized care: Medicare patient data gathered between 2012-2017 shows that sepsis patients face considerably poorer health outcomes following hospital discharge when compared to non-sepsis patients, including elevated risk for death and increased use of advanced healthcare services. Sepsis survivors exhibit strong indicators of persistent inflammation and immunosuppression for up to a year after hospital discharge, increasing their risk of readmission or death. Both studies indicate a significantly elevated risk of death among sepsis patients after they have been discharged and ostensibly cured. Of course, sepsis patientsparticularly those of the Medicare cohort, who are largely of advanced agerarely leave the hospital in better condition than they entered.The Yende study, in particular, shows that neuroendocrine and inflammatory responses to sepsis can continue long after the patient survives a septic episode. For patients with advanced or chronic diseasesas was the case with nearly 78% of participants in the studythese biomarkers are associated with decline.Post-sepsis Discharge: A Critical JunctureIn many cases, these individuals life expectancies upon discharge will be less than six months. This is a critical juncture: While comfort-focused hospice care could provide an ideal source of support for the eligible patient, their family, and their caregiver(s), most sepsis patients are simply sent home without even a discussion about palliative end-of-life care and its benefits.Frankly, such an oversight is a disservice to everyone involved. The sepsis patient is left with physical and/or cognitive dysfunction, often without significant options for symptom management. Their partner or family will either need to assume caregiving duties or turn to costly private services. And the physician and hospital staff will likely see the patient again following another acute event, a readmission that impacts performance scores, strains resources, and unnecessarily fills beds.By no means do I intend to lay the blame for these unfortunate circumstances on physicians. Timely hospice referrals require ongoing education about end-of-life care, and open, ongoing communication between hospice providers and referral sources.More Help: How to Talk About Hospice Care >Those of us in hospice are working hard to bridge the gap, but even as our healthcare system transitions to a value-based model, the mentality of fee-for-service still permeates our nations acute-care facilities, and many hospitalists see a discharge home as a success.Hospice: A New Way Of Judging SuccessIn hospice, we judge our successes on the patients quality of life and the fulfillment of their goals and wishes near lifes end. Usually, that means going home with 24/7 support from an interdisciplinary hospice team. Whether home is a traditional residence, an assisted living facility, or nursing home, the hospice team will assist caregivers (and/or facility staff) with direct clinical care and education, integrative services, bereavement support, and delivery of medication, equipment, and supplies.In other cases, improving quality of life means remaining in a general inpatient setting with hospice support, taking the burden off hospital staff until the patient is able to transition home or until the patient dies. Hospice offers complex modalities in any setting, so patients who would otherwise be confined to an ICU can usually return home to be among loved ones.With support from hospice, a sepsis patient and their family are more likely to report higher satisfaction of care and greater quality of life. The patients emotional and spiritual needs can be met alongside their physical needs, thanks to care from chaplains, social workers, music and massage therapists, and other integrative specialists. Finally, the patient is more likely to die at home, surrounded by loved ones, rather than in the hospital.Because sepsis is most common in patients with advanced or chronic diseases that indicate hospice eligibility, acute incidences of sepsis should always trigger a hospice eligibility assessment. We owe it to our patients, their loved ones, and our colleagues in healthcare, all of whom can benefit from the support that timely end-of-life care offers.