Hospice of Martha's Vineyard faces tough choices
Two Vineyard nonprofit service agencies are at odds this winter. Each has served the Martha's Vineyard community for a quarter of a century. Each has strong followings of loyal supporters grateful for the vital help provided in times of great stress.
The Vineyard Nursing Association (VNA) announced this winter that it has made a choice to offer a Medicare-certified hospice benefit to its clients, beginning in 2010. Hospice of Martha's Vineyard (HMV), which has always proudly rejected Medicare certification in order to offer end-of-life care independent of Medicare's rules, must decide whether to join VNA as a Medicare-certified agency or continue independently, as it has for the past 28 years. At the moment, it appears that HMV will not join VNA, and that VNA's course is set.
Defining the terms
"Hospice care" and "end-of-life care" are not exactly synonymous terms, but both mean help for a person who is dying, and by extension the dying person's loved ones.
"End-of-life care" is a broader term. Some patients or their families do not accept the diagnosis that the disease is terminal. Doctors can be wrong. Miracles do happen. However, patients who refuse to enter a hospice program still need the same kinds of help for the ends of their lives.
The help often includes nursing care, home health services, control of pain in a variety of ways, counseling and spiritual comfort, and practical support for the patient and the family.
The term "hospice" is more narrowly applied as care to a person who has received and provisionally accepted a diagnosis that the disease cannot be cured and that the end of life, while not exactly predictable, is near. Although a person who is in hospice care may continue to fight the disease, try to live as long as possible, and even hope for a miracle cure, "hospice" implies that the focus of care should be on helping the patient and the family through the final stages of a terminal illness. The goal is to make the patient's final weeks and days as happy and productive as possible.
A "hospice benefit" is a kind of coverage included in Medicare. If a patient has a doctor's diagnosis that he or she has less than six months to live, a Medicare-certified hospice program will provide all medications, palliative radiation, equipment (such as a hospital bed), occupational and physical therapies, home health aides (for example, for bathing), and social counseling. If the patient lives longer than six months, the hospice benefit may be renewed, but, as HMV points out, it may not begin before the six-months-to-live point.
Hospice of Martha's Vineyard
HMV is certified as a hospice by the Massachusetts Department of Public Health (DPH). For 28 years, almost since the start of the hospice movement in the United States, HMV has provided care and support for dying patients and their families. Financed entirely through local fundraising, HMV provides professional nursing care and the services of a professional social worker. Non-professional volunteers are a large part of HMV and assist the patient and his family by running errands, doing housework, spending time with the patient or the family, or in any other way they are requested. According to HMV executive director Terre Young, during the early stages of support, an HMV nurse will visit once or twice a week, offering care and information about the progression of the disease. The HMV medical director and the social worker will make at least one visit, and trained volunteers will contribute about two hours a week. If requested, the HMV chaplain will call or arrange for other clergy. When the patient is actively dying, the nurse (and volunteers as requested) will be there much more frequently. HMV is on call 24 hours a day. HMV also offers bereavement counseling. Through it all, Ms. Young stressed, the family, not HMV, is in charge.
While all of HMV's services are free, other medical needs must be paid for by the patient's insurance. These include drugs, therapists, home health aides, and medical equipment. Of 61 HMV patients in 2008, 21 received home health aides' care from VNA, and the rest received care from other providers or their families. There is a small fund, called the Christopher Fund, which can help HMV clients who don't have insurance.