Great Article on NEJM - New Era of For-Profit Hospital Care (Medicare Benefit)

[Danni R.]

Between 1993  and 1998 I worked as a Certified Hospice Home Health aide, visiting several hospice clients for about 2-3 hours each (a 6-8 hours work day), including every other weekend. Some of my clients had Alzheimers, some had cancer, some had other terminal diagnoses. The clients with Alzheimers lasted the longest.

I was paid between $8.50 - $9.00 per hour. Sometimes I had to do "on call" shifts, carrying a pager, for which I received $1.50 per hour during "off time", and my regular pay, should I be called. I also was reimbursed for mileage (I believe it was somewhere between 20 -24 cents per mile).

Our supervisors were RN's which dropped in a few times for an hour, or so, during the week, or as needed. We had specific care plans that had to be followed, documented, and submitted to the home health care/hospice agency. 

Some hospice clients were cared for in their own home, other times I had to go into nursing homes, or long-term care facilities (and this is where I wondered how come the agency brought in Home Health Aides to change the sheets, wash them, change the urinary bag, and apply lotion for a couple hours, when they already had permanent nursing staff getting paid for the client's care.).

While I got my small share of the above mentioned Medicare Benefits in form of wages, the big money went to the for-profit Home Health Care agencies; sometimes also referred to by the generic name of "Visiting Nurses".

[Danni R.]

PERSPECTIVE:
To ensure that a reluctant medical community would embrace Medicare at its inception in 1965, Congress declared that any willing provider could participate. Since that time, the vast majority of physicians and hospitals have come to rely on Medicare as a major source of revenue. But as additional Medicare benefits have been created, they have increasingly been provided by for-profit companies that find doing business with government, though sometimes frustrating, a worthwhile commercial venture. Perhaps the most untraditional Medicare service offered by such organizations is hospice care.

The rest of the article here:
http://content.nejm.org/cgi/content/full/360/26/2701

Please feel free to comment, and share your perspective on this topic.