Say you are in a Hospice Program w Pacemaker to assist your heart

I understand the reasoning/logic if the definition of 'hospice' is 'terminal, not expected to live, death is but weeks away.' People in such circumstances are under a huge load of anxiety, often, not always, sometimes in pain, loaded up on drugs of one kind or another, and in most cases it would be unethical to perform major surgery or corrective surgery due to the risks of their dying on the operating table....even two/three/four weeks ahead of 'schedule'.

It sucks, but so does having to go to hospice in the first place.

Vijay, Medicare pays for replacement if the replacement is deemed to relieve pain or discomfort. If your doctors say that it is curative, then you have to stop hospice in order to have the replacement.
I see and disagree with the reasoning.
If you make certain your physician understands and WRITES that you need replacement because of pain, medicare will cover it. It spawns from the fact that you are getting stronger medication that a person with deep pain can't (though should) receive.
You have the right to revoke hospice at any time to receive life saving care. And you have the right to reenroll after the surgery.
You may experience uncomfortable or frightening symptoms , chest pain, fainting, shortness of breath, or irregular heartbeats if your pacemaker stops.

@vijay26: I have worked with people enrolled in hospice and the general criteria for admission is for those individuals with a life expectancy of 6 months or less. Therefore, people enrolled must have evidence of a terminal illness; frequently, they have co-morbidities meaning they also have other medical conditions. For instance, a person with cancer might have a pacemaker for a heart condition. In certain cases, such as if that pacemaker evidences failure to the degree that it would cause debillitating distress to the individual or that not replacing it would cause cardiac arrest and NOT death from the admitting diagnosis, these would be considered valid reasons for replacement.

However, if it is determined that the pacemaker is to prolong life (this is not an indefinite life-saving procedure, addressed below) for a separate diagnosis that the individual elects to have, then as @gently indicated, one would have to revoke hospice services to undergo the procedure. Once completed, there would be the option to request re-enrollment as soon as possible, even the day after surgery - as long as the criteria remains valid. For example, if the diagnosis was terminal cancer or kidney failure there would not be an issue. If the diagnosis was cardiac related and the pacemaker helped to resolve that, the criteria would likely no longer be met.

I'm uncertain if your question is asking if one agrees with the use of the word replacement implies that that Medicare thinks that a person with a pacemaker will live forever. I'm unclear what the basis is for that understanding, as a pacemaker can only adjust the rhythm of the heart; it cannot fix failing heart musculature or clear blocked arterties that frequently accompany the aging process.

I realize that was a long explanation but has it helped you understand the situation any better?

Thank you for your lengthy explanation above.

Why would Hospice even enroll a person, knowing he has a pacemaker to begin with?

Please reply again.
Thanks.
VJ

@vijay26: Having a pacemaker is not a contraindication for hospice enrollment if a person is deemed to have a life expectancy of 6 months or less. A pacemaker does not in itself prolong life, it works to fix the hearts electrical rhythm; it cannot prolong the beating of the heart if the heart muscle wears out or the vessels leading to or from the heart are occluded. A pacmaker cannot prevent death from other causes, such as cancer or major organ failure - for example, advanced kidney disease, advanced dementia or liver or heart failure like cardiomyopathy (disease of the heart muscle). A pacemaker does not provide shocks to the heart as you might hear about or see on TV that brings a person back to life - that is a defibrillator.

Sometimes there are illustrations or actual models that can help demonstrate exactly how a pacemaker works. May I ask if you or someone you know is in this particular position? If so, has a discussion been held with the hospice case manager to explain the rationale for this in greater detail?

A friend of our family died few years ago w/o support w pacemaker issue from Medicare and her insurance co.

People have many implanted devices to support their bodily functions. Sometimes, they breakdown and they need to be "replaced" from outside help.

Let me ask you this:
Suppose a person in Hospice program wears diapers daily. When it gets soiled, it has to be "replaced" with a
new one. If you leave it w/o changing, you know what will happen.

This diaper "replacement" can be done by anyone. It is
not a rocket science.But, "replacing" a broken Pacemaker requires hospitalization and an Interventional Cardiologist' work. Medicare must allow
this type of intervention, because it is not a new intervention to cure, but to manage symptoms in the best possible way to enhance comfort to the patient in need. It cannot be done at home by.a group of Hospice staffs in patient' home unfortunately.

Hospice, in the above scenario can be considered as Hospital Hospital and at home, it is Hospice at home.

Hospice is a great program to treat people w multiple chronic incurable conditions and reduce high costs of Healthcare.

That's all.
VJ

Hospice can be provided both in Hospital and at patient' home.

Please show me a law where it says that Hospice can be done only at home and not in hospital!

Name few instances in simple language that Hospice is effective only if it done at home by untrained none professionals today.

@vijay26: I'm afraid I'm not following what the question is here. Hospice provisions are not guided by where the services are provided. In fact, I am going to visit a client today who has transitioned from home to inpatient hospice where the goal remains the same: comfort as opposed to curative care. In both cases, hospice services are provided by all trained professionals, whether they are doctors, RNs, LPNs, CNAs, aides, pharmacists, occupational/physical therapists, social workers, chaplains/spiritual counselors, bereavement counselors. Untrained individuals are not considered part of the team, however, family, friends and other loved ones are encouraged to be involved to the extent they can and as per the individual's wishes who is receiving care.

Whether at home or at an in-patient setting, the goal remains keeping the indivual clean (that means changing soiled garments and linens), relieving physical discomforts such as pain, nausea, breathing difficulties, and fatigue. However, curative medical treatments are stopped because they are no longer considered compatible with a life expectancy of 6 months or less, a standard hospice requirement. Should a patient desire a curative intervention, they must discontinue hospice servies. This is in the contract.

Guidelines are detailed in https://www.medicare.gov/coverage/hospice-care. I would suggest for any additional clarification, further discussion take place with the specific hospice organization that may be involved with indivual care.

@grammato3

In addition, if you decide to leave hospice you can always enroll in palliative care. This is a support program for folks with chronic conditions. If and when you are eligible for hospice again you can let your local hospice know.

@vijay26, you're right hospice care can be delivered by medical professionals at the patient's home (home hospice) or in a hospital or hospice medical setting, often referred to a residential hospice.

Hospice care professionals on a team (home or residential settings) may include specially trained physicians, nurses, social workers, occupational therapists, chaplains and others depending on the services needed. Hospice services often also include specially trained hospice volunteers and/or end-of-life doulas, who are non-medical professionals providing holistic, emotional, and practical support to both the hospice patient and their families.

@vijay26, I can see that you have a lot of questions about palliative and hospice care. Are you or a family member preparing for hospice care?