Dignity: A Story for Home Care & Hospice Month

By NAHC Director of Membership Lisa Rackstraw

My father was diagnosed with kidney cancer when he was 42 years old.

One day Dad seemed fine, the next day surgeons were rushing him into surgery in Denver, Colorado to remove a kidney that contained a grapefruit-sized tumor. As I rushed to get a flight to Denver, I knew my father would not like all the fuss.

Dad was born and raised in Halifax, England. He left school when he was 16 and had no formal education, but what he did have was determination and lived by a “pull yourself up by your bootstraps and get on with it” mentality. Facing cancer only cemented his determination to get through the illness and no complaints ever left his mouth.

My father started his career as a coal miner in the mines in Cornwall, England.  That’s where I was born; a beautiful part of England lined with breathtaking coastal cliffs, beaches and tiny fishing villages.  He was an avid reader all his life.  He basically read himself up from coal miner to a senior engineer.  He worked for an international corporation out of Germany.  This career led us to move often, both internationally and domestically.

He approached his battle with cancer the same way as he approached any subject matter that he was not well-versed in.  He read every book and study on kidney cancer.  He participated in numerous experimental treatments at the National Institutes of Health.  He battled faithfully for two years.  All along with determination and no complaints – and with dignity.

Dignity was a big presence in my father’s life.  He was a proud man.  Proud of his career and proud of his family.  I can remember the car service coming to the family house for him to take him into the city to give a deposition in a lawsuit his employer had brought against one of their clients.  My Dad was very ill, the doctors had given him six to eight weeks, but his determination and dignity carried him that day to fulfill his obligation to his career.  The lawyers deposed him for hours and he held strong.

We knew my father had planned with his doctors and his lawyer to pass on at home.  He’d had his fill of hospitals over the past two years.  His dignity was served best at home.  His master bedroom became care central.  His Hospice Caregiver Michael entered our lives, touched our souls and left an endless impression.  In fact, I don’t think any of us talk about my father’s death without mentioning Michael.

I was 22 years old.  I had been volunteering for some years by now at a local nursing home back in Washington, DC.  I recognized the empathy, understanding and endless gift of caring within him as he went about the business of caring for my father.  But it didn’t feel like a job to him, it was an extension of who he was.  I’ve always believed caregivers either have it or they don’t.  Like teachers, one cannot fake it.  It takes a very special person.

Michael was in the family home everyday for the next two months.  He allowed my father to spend the remainder of his life as comfortable as possible, in as little pain as possible, in the sanctuary of his home, surrounded by his family, surrounded by familiarity — with dignity.

Michael allowed us, the family, to come to terms with my father’s inevitable passing on without the added stress of trying to care for his daily needs.  He allowed his children to not have to face what could have been embarrassing and heartbreaking moments between father and child had he not been there to bathe my father, dress him, feed him and assist him to the bathroom.  Alleviating that stress and giving us the peace of mind that our father’s daily needs and comforts were being taken care of brought us comfort during one of the most heartbreaking times in our lives.

My father moved on with no complaints and with dignity.  Thank you, Michael.

Home Health Industry Unscathed In Latest CMS Improper Payments Report

Home Health Care News | By Andrew Donlan
 
The Centers for Medicare & Medicaid Services (CMS) released its improper payment report last week. It was another win for the home health industry, which has become less of a culprit in the reports over the years.
 
Overall, the Medicare fee-for-service (FFS) estimated improper payment was 7.38%, or $31.2 million. That was the seventh consecutive year it has been below the 10% threshold established by improper payment statutory requirements, according to the agency.
 
In 2022, the improper payment rate was 7.46%.
 
“While CMS’ improper payments reporting programs are designed to protect the integrity of CMS programs, not all improper payments are fraud or abuse. It is important to understand that improper payments are payments that do not meet CMS program requirements,” CMS wrote in a corresponding fact sheet on improper payments. “They can be overpayments or, underpayments, or payments where insufficient information was provided to determine whether a payment was proper.
 
From 2016 to 2020, home health improper payments decreased by $5.9 billion. Then, in 2020, the industry had a 9.3% improper payment rate. In 2021, it had a 10.24% estimated improper payment rate.
 
In the latest report, home health was not included as one of the sectors contributing most to overall improper payments.
 
Those sectors were skilled nursing facilities, outpatient hospitals, inpatient rehabilitation facilities and hospice.
 
Review Choice Demonstration (RCD) could be helping the home health industry improve on payments, at least in Illinois, Ohio, North Carolina, Florida and Texas.
 
CMS did mention RCD’s expansion within the report.
 
“HHS announced expansion to the Review Choice Demonstration for Home Health Services to Oklahoma, starting December 1, 2023,” the agency wrote. “This demonstration is also ongoing in Illinois, Ohio, North Carolina, Florida, and Texas. It offers Jurisdiction M providers three initial options: pre-claim review, post-payment review, or minimal post-payment review with a 25% payment reduction for all home health services. A provider’s compliance with Medicare billing, coding, and coverage requirements determines their subsequent steps in the demonstration.”