Hospice Care

When the state legislature passed a measure last year to include hospice care in Medicaid benefits starting Jan. 1, it in effect created a new benefit for AIDS patients. Typically, patients with acquired immune deficiency syndrome are too young for hospice benefits provided under Medicare, are unemployed and do not have private health insurance. But most do qualify for Medicaid, which is available to people who cannot afford medical care. Prior to Jan. 1, Medicaid did not cover hospice care, which is provided for people who are terminally ill. Hospice program administrators say they are hurrying to incorporate the new state provisions into the package of services they already provide for AIDS patients.

Ever wonder where the elderly go to die? Hospitals and nursing homes are good answers, but most terminally ill patients die where they live - at home. For those who can't remain at home because their illness requires specialized care or critical support systems, there are 3,200 end-of-life facilities throughout the nation known as hospices. The National Hospice and Palliative Care Organization defines hospice as a philosophy of care that accepts dying as a natural part of life.

George Boehmler is dying. The 82-year-old retired machine mechanic is almost blind and completely bedridden. Colon cancer is slowly and painfully eating away his body. His prognosis is one month. But Boehmler is not sick enough. Hospitals - unable to make him better - will not admit him merely to die. His family has tried a nursing home, but it drained most of his money. Besides, his wife, Elsie, wants him to die at home. Boehmler wants to die there, too. So, about a year ago, he returned to his rowhouse in Mayfair from a nursing home.

DEAR ABBY: When my husband, "Jeff," and I married, we drew up a medical proxy and health-care directives should future incapacitation arise. Jeff is now terminally ill with brain cancer and has about five months to live. I had to quit working because Jeff is now my full-time job. As his illness progresses, we have discussed placing him in a hospice. But the closer he gets to death, the more he changes his mind. He demands that I lift, jerk and pull him in and out of bed. He needs assistance eating, dressing, bathing and using the toilet and is in a wheelchair.

After a few years of working in hectic emergency rooms and intensive-care units, Christopher Frazer decided to go into hospice care. It fit his personality more as he was sensitive and family-oriented but also had a great sense of humor, said those who knew him. Over the last 10 years, Mr. Frazer developed his own style of taking care of the dying. He used complementary therapies such as massage and aroma therapy on his patients, and also trained a lot of coworkers at the Moorestown Visiting Nurses Association.

The first program in the country to care for terminally ill people who live alone is being offered by Wissahickon Hospice. The two-year pilot program, financed by a $144,000 grant from the Pew Charitable Trust, will provide free care to 34 patients in the Montgomery County and northwest Philadelphia area. Although officially scheduled to begin Tuesday, the first patient has already been enrolled. Formerly, patients lacking a primary caregiver, such as a family member or live-in companion, were not eligible for hospice care at home because of safety.

In earlier centuries, most terminally ill people died at home. By the mid-1970s, that trend had reversed, with more than 70 percent of deaths occurring in hospitals and other institutions. In the last three decades, however, hospice providers have quietly revolutionized the way people die in America. Now there is a gradual shift back to the earlier times, as more people are choosing to spend their last months at home with hospice care. Samaritan Hospice has been part of this revolution from the beginning.

JoAnn Splon Downes, 81, of Center City, a social worker who was one of the pioneers of hospital-affiliated hospice care in Philadelphia, died of Parkinson's disease on Easter, April 8, at home. "She was comforted by the presence and spirit of family gathered for the holiday," her children wrote in a tribute to their mother. In 1978, Mrs. Downes had been a social worker in Philadelphia for two decades when she was asked by a friend, Dr. Jeffrey Hartzell, to be administrator for a new program he was establishing at Pennsylvania Hospital - the first hospital-based hospice service in Philadelphia.

ATLANTA - The first time Charlie Manuel went to spring training as a big-leaguer in 1969, he found his locker placed between all-stars Harmon Killebrew and Bob Allison. Manuel was 25 and, after six seasons in the minors with Minnesota, he could not believe his eyes. "I thought that was the greatest thing in the world," Manuel said Friday. That's why the Phillies manager was deeply saddened to hear the news of Killebrew entering hospice care for the last days of his bout with esophageal cancer.

On a recent Sunday afternoon, my friend and neighbor Ann Sara Weiss held my hand, looked into my eyes and said goodbye. Six days later, she was gone. She died at home on the Saturday morning after Thanksgiving, holding breast cancer at bay for one last holiday, surrounded by a loving crowd of relatives and friends. When Ann's husband, Len Freedman, called me at my parents' home in Ohio with the news, I recall that Peggy Salvatore had said it would be like this. Salvatore is a nurse with the Albert Einstein Medical Center hospice program.

By Tedford J. Taylor No topic is a less likely conversation-starter than our eventual deaths. Still, there is a lot to talk about. When polled, about 90 percent of people presented with end-of-life scenarios prefer the prospect of dying at home with family and a plan for treatment for comfort, rather than unlimited care in an intensive care unit (ICU). Does that surprise anyone? Nearly 40 years ago, the parents of Karen Ann Quinlan, distraught as they watched machines keep their daughter alive, launched a court battle in New Jersey to discontinue care they believed only prolonged their family agony.

In the 1970s, when he was in his 40s, Jack Rosenberg decided to give up swimming and start running every day. The kind of man who "never did anything in a mediocre fashion," in the words of his daughter, Anne, the surgeon ran eight miles each morning along Route 130 from his Mount Laurel home to his office, at what was then Rancocas Valley Hospital in Willingboro. Each morning his wife, Sylvia, to whom he was married for 57 years, would be waiting at his office with his suit.

By Rebecca Nurick Perpetrators of Medicare and Medicaid fraud are clever and creative - and often quite successful: Every year, scams cost taxpayers about $65 billion. In recent years, the federal government has invested in programs to prevent Medicare fraud, and to make the criminals who commit it pay, both in fines and jail time. In particular, the Affordable Care Act will provide increased resources to fight these crimes. Beefed-up task forces have caught thieves around the country who have engaged in identity theft, billed for services not provided, or even performed unnecessary medical procedures.

Life Choice Hospice, of Dresher, has expanded from three to 12 states and more than doubled its size with the $85 million purchase this month of SolAmor Hospice Corp. from Genesis Healthcare Corp. Genesis, a national nursing home and rehabilitation company in Kennett Square, retained a one-third stake in Life Choice, which was founded in 2003 in Philadelphia and sold in 2009 to investors counting on increased demand for hospice services as the U.S. population ages. Despite the turmoil in the health-care sector and broad efforts to reduce spending, prospects for hospice care remain strong, Life Choice chief executive David Glick said Tuesday.

James W. Patterson, 71, a Philadelphia lawyer whose expertise was transportation law, died Wednesday, Nov. 28, of prostate cancer at Penn Hospice at Rittenhouse. For more than four decades, he represented freight and passenger carriers as well as the manufacturers and distributors who used those carriers. He liked to tell people: "If you bought it, a truck brought it," said Louis Rizzo, managing partner with Reger Rizzo & Darnall L.L.P., where Mr. Patterson worked for the last seven years.

Marcy Oleksiuk visits Judy Kincade once a week for a heartbreaking reason, but you'd never know it from the mood in the room. The Kincade household is relentlessly cheerful as children and grandchildren constantly come and go. Once a week, Oleksiuk is among them. She chats with Kincade, gives her an autographed picture of a favorite star, and recently exchanged Hurricane Sandy survival stories. But most of all, Oleksiuk listens to country music or watches T.J. Hooker reruns with Kincade's husband, Les. He is the heartbreaking reason.

A suburban Philadelphia doctor who provided hospice care for the terminally ill was charged with taking kickbacks for referring dying Medicare and Medicaid patients from his private practice to the health care company where he worked part-time, the U.S. Attorney's office announced Thursday. Yevgeniy "Eugene" Goldman, 54, of Huntingdon Valley, had a private practice in Philadelphia but also worked as a part-time medical director for Home Care Hospice, Inc. in Northeast Philadelphia.

Steven McGovern, 60, the son of former South Dakota Sen. George McGovern, died Friday in Sioux Falls after a lengthy illness. A family statement released Saturday by a local funeral home said that Mr. McGovern died on his birthday in hospice care. His sister, Ann McGovern, said in the statement: "Steve had a long struggle with alcoholism. We will all miss him deeply, but are grateful that he is now at peace. " - AP

After losing for the first time since mid-April, it was time for the San Antonio Spurs to face an entirely different set of questions Friday with their Western Conference finals lead over Oklahoma City cut to two games to one. No longer was the talk about whether the Spurs - riding a 20-game winning streak less than 24 hours earlier - were invincible. It was about how San Antonio could regroup - following a 102-82 blowout loss Thursday night in Oklahoma City - in time for Saturday's Game 4. "In the past, we've reacted really well to wins.