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Louisiana Hospice

Bobby Jindal, Governor of Louisiana.

Bobby Jindal, Governor of Louisiana.

“You can judge the character of a man by how he treats those who can do nothing for him”.   Malcolm Forbes

The source of the above referenced quote is debatable and has been credited to Ann Landers, Goethe, and numerous others.  It really doesn’t matter.   I cannot think of a single decent person who has not treated those who can nothing for him with respect and dignity.

Louisiana, known for food, fun, Mardi Gras and large close knit families has been let down by our Governor and the Department of Health and Hospitals.  I am deeply saddened and ashamed by our elected governor and his appointed head of DHH, Bruce Greenstein.

Effective February 1, 2013, Louisiana Medicaid will no longer pay for hospice.  Patients with Medicare will continue to receive benefits but those who depend upon Medicaid alone will no longer receive care in their homes or hospice care delivered as an adjunct in a nursing home at the end of their life.

Those individuals that rely on Medicaid for hospice care as the sole payor source for their healthcare will be forced to choose between dying at home with loved ones ill equipped to manage their care or go to a sterile institution and be cared for by strangers.

Consider who these people are.  Gay men dying of HIV, IV drug users with failing livers and those people who haven’t been able to find or hold onto a job with benefits will suffer disproportionately.  Most addicts who have terminal illness have an underlying psychiatric disorder either diagnosed or undiscovered.  Society’s undesirables, the forgotten, and those who are financially burdensome because they don’t pay taxes will be overlooked by the state of Louisiana.

Lucky for the Governor, they will not be able to vote once they are dead.  They will not speak out because they can’t.  If they have families, they will be too exhausted from caring for a dying loved one to worry about politics.  In some ways, this was a politically savvy move for the governor.

What Jindal overlooked is that these financial burdens to society have value other than financial.  Of course, Jindal doesn’t recognize their contributions to society because they can do nothing for him.  The gay man with end stage HIV may have a family who loves him.  The IV drug abuser may be all that their spouse has.  The unemployed may have children who are losing a parent.  The disproportionate number of patients with mental  illness will hardly notice the absence of benefits.  They have long since been overlooked by the Jindal administration.

He drove home the cruelty of his decision by insisting that that the home health care benefit remained in effect for Medicaid patients.  Essentially this translates into home health care agencies taking on even more underpaid and unpaid care.  The 50 visits a year Medicaid paid at a rate of half of what Medicare pays allows for home health is often insufficient for non terminal patients.  The quota for a terminal patient can be exhausted in a month or less if the patient receives quality care.

Many agencies will provide the care at a sharp loss while Medicaid RACs scrutinize every visit note for an opportunity to take back the scant amount of money paid.

But these guys – the gays, the junkies and the bums who don’t work obviously do not merit good care in Jindal’s opinion. They can do nothing for him.

If you agree with Jindal, I respect your right to your opinion but I do not care to hear it.  If you think that the state of Louisiana has implemented a reduction in Medicaid Benefits that is the equivalent of spitting in the faces of the needy and poor, please take the time out of your day to let The Secretary of DHH our governor know.

Bruce Greenstein, Secretary of Louisiana Department of Health and Hospitals is at:

Department of Health and Hospitals
P.O. Box 629
Baton Rouge, LA 70821-0629

The ‘contact us’ page on the Governor’s website has a variety of ways to contact him.  See below.  If you are a hospice or hospice association and are holding a public event soon, please consider asking B0bby to attend.

Choose one of the links below to interact with Governor Bobby Jindal:

    1. Email the Governor
    2. Request the Governor Attend an Event
    3. Request a Meeting with the Governor
    4. Request the Governor for a Photo
    5. Request a Proclamation from the Governor
    6. Request an Official Statement or Certificate from the Governor
    7. Apply to serve on a Board or Commission
    8. Nominate someone for the Governor’s Spirit of Louisiana Award
11 Comments Post a comment
  1. Sue Hull #

    Well, I sent him an email. I told him I am a Republican, and I am ashamed of him. Since I live far far from LA, he probably won’t care a bit about my opinion, but I gave it to him anyway. I told him it was a cowardly act. I am disgusted.

    That’s all.
    Good night.

    December 30, 2012

    • That’s quite enough, Sue. I don’t care where you live. If we don’t speak up for those who cannot, who will?

      December 30, 2012
  2. Danny Crudo. Pharm.D. M.S. #

    I am surprized that there is not some level of coverage required in order to receive matching federal funds. I suspect that this population is small and the savings will not be realized . The cost will be shifted and most assuredly be higher because services will be provided by professionals not specifically trained on end of life issues. I can’t imagine many State Medicaid Programs that have no hospice benefit at all. I would love to know what those involved in cutting the benefit were thinking!

    December 30, 2012

    • We sort of opted of the ACA Medicaid requirements. There will be no matching funds.

      December 30, 2012
  3. A. #

    Emailed this morning – please help Julianne – maybe us folks from other states can have a tiny impact on the decision making process~

    Dear Mr. Jindal,

    I learned this morning of your decision to eliminate hospice benefits for the Medicaid patients within your state. I ask that you please reconsider this decision as I believe it to be short-sighted for several reasons.

    First, the cost to your state for patients re-hospitalized due to a lack of adequate care opportunities will more than exhaust any funds you might have spent on hospice care. I’m sure you’re well aware that the uninsured turn to emergency rooms and hospitals for care when other options don’t exist.

    Second, I have interacted with some of the home health agencies within your state and have reviewed the care provided to your constituents. You have some fine agencies serving the people within your state, and perhaps even folks in your family. Home Health agencies tend to be run by caring people with compassion towards those in need. They will not be able to ethically turn down referrals to provide care for patients who belong in hospice but don’t have any other option for care. The financial drain of these patients will cause agencies to chose between providing care at a loss or to ‘cherry pick’ which patients will be served – they’ll have no choice or they will risk financial insolvency.

    Finally, although I do not know you personally, I believe you are a person able to understand the dignity of each and every person. It’s a very rare thing for a person to be so successful in life without having an ability to be caring – even undereducated voters can see through that sort of ruse. I appeal to your sense of humanity and ask you to find a way to shift resources and fund this important cause.

    Thank you for your time in reading my thoughts – even though I’m an Ohioan with no possiblity of ever remotely impacting your life directly.

    December 30, 2012

    • Thank you for articulating your objections so articulately. Sadly, my anger and dismay shows through. In fact, I didn’t make a big deal over it because I just knew it would be a short lived idea when it was announced a couple of weeks ago. Then I came to work and the hospice that shares the building with me assured me that I was incorrect. They contended that the hospice benefit was no longer available at home but could still be provided in nursing homes. I went back to the source and found differently. This is significant because the owners of the hospice are very political – much more so than I ever hope to be. So, if it was a surprise to them, I am quite certain that many people were not expecting it.

      I heard from a Twitter friend this morning that AZ did the same thing in 2009 and total Medicaid costs increased by 4.4 percent. Again, please allow me to point out that this was a twitter friend who conveyed the information to me in 144 characters or less. I should really do my own research first before sharing it with y’all. However, I am at the office on Sunday afternoon trying to meet a deadline for appeals. It’s like agencies can’t win for losing. First they don’t want to pay and then agencies have to spend precious time and resources to hold on to the revenue resulting from providing care to the elderly in their homes.

      In the back of my mind I have been trying to figure out what twists and turns our industry will take in 2013. I still haven’t come to any conclusions but I know this – it can’t be worse than 2012 and we survived that!

      December 30, 2012
    • M.R. #

      Very well said. While I feel there need to be difficult & sometimes unpopular decisions made during these challenging economic times; these decisions must be made with foresight of the overall impact.

      December 31, 2012
  4. Teddy Mack #

    Try to get this. I know it’s hard, but try. THERE. IS. NO. MORE . MONEY. FOR ANOTHER. ENTITLEMENT. If Bobby signs up for the Federal Poison Pill when the money runs out, Louisiana will be saddled with yet another unfunded mandate. What happens then? How about having to bankrupt the state, literally, and shutting down ALL Medicade services.We are damn lucky having him where he is. This is a simplistic comment, but it is substantially correct.

    I have been in healthcare for over 40 years and he is hands down the smartest man I have ever known in government. Sorry Moon. That’s just how it is.

    December 31, 2012

    • Teddy, thank you for your comment. Please do not feel as though you must type slowly in all caps with excessive punctuation to get me to understand your point. I find it a little condescending that you believe your simplistic response that there are no funds for ‘another’ entitlement may be difficult for me to understand.

      Obviously, I have not been in healthcare as long as you have. You must be quite the senior citizen by now after having worked in healthcare for over 40 years. If your memory still serves you at your age, will you might remember that when they when AZ cut hospice benefits in 2010, the net result was an overall 4.4 percent increase in Medicaid spending. Increasing money spend by Medicaid will not prevent bankrupting the state. In fact, the only way I know to avoid bankruptcy is to spend less money.

      I did not question the Governor’s intelligence. He is indeed very well educated and in the past he has done a tremendous amount for Medicaid. He was once the head of DHH. When he was in charge of DHH, Jindal did what he should be doing now. He isolated the problem providers who were providing unnecessary services to adolescents and saved the state a bundle. Having been in healthcare for a little while myself, I can recall numerous instances of DHH revoking the licenses of a provider and yet the continued to operate for years. In the interim, patients received poor care, Medicaid paid bills and the cost to DHH for fighting the battles in court must have been enormous. Meanwhile, my clients compete with the sleaze buckets.

      PCA programs designed to keep the elderly out of nursing homes are shams. If you want to shut something down, close down the services who refuse to accept referrals from my clients. Most are in business soley to be paid for taking care of their relatives.

      If you want money to fund hospice, take a look at the Propublica Project on Nursing Homes. Go halfway down the page and look at the two boxes. The box on the left shows the highest fines paid by nursing homes. The box on the right shows the homes with the most deficiencies. Notice that many of the homes with the worst deficiencies did not make the list of the homes with the most fines. This project by Propublica is limited to nursing homes. I have no reason to believe that other providers would show much difference. If you want to have some real fun, you can view the actual survey reports of the homes with K or L level deficiencies. I bet if Medicaid cut off payment to the homes periodically to get across the point that the elderly deserve respect and care, we could cover hospice.

      Being substantially correct is insufficient. Where are your numbers to show that eliminating the hospice benefit will save the state money? Obviously it will come off of one column on the spread sheet but it costs a ton of money to go to an ER. Drugs are hard enough for a hospice nurse to get. How is an impoverished family member going to go get a signed hard copy of a script and carry it across town to a pharmacy that has the ability to fill it? Not everyone carries Morphine suspension.

      I have no taste for crime and I do not have any desire to be a victim but I think it is a little disturbing that Louisiana has the most adult prisoners per 100,000 capita than any other state. Our rate of 867 adults for every 100,000 is over 100 inmates higher than in the next closest state and almost twice as high as the national average. The percentage of prisoners with serious mental illness is at least 20 percent but health care providers who work in prisons estimate it to be much higher. If it were me, and of course it is not, I would take some of the corrections budget, dump it into the Medicaid budget and because it is less expensive to care for psych patients on an outpatient basis or in a group home, there would be money left over hospice care.

      But it is not me.

      Make no mistake. I remember Jindal well from long before he was governor. I remember when he worked alongside Senator Breaux in Washington on Healthcare. They did amazing things. But if we judged everyone on past performance or pure intellect, we might find that a lot of people who neglect and abuse the poorest among us have done good things in the past or have a superior intellect or education. It isn’t good enough treat vulnerable individuals right 95% of the time.

      December 31, 2012
    • Sue Hull #

      Teddy, I get what you are saying. I am a fiscal conservative. But, Bobby’s job is to MANAGE the state’s money, and he made a choice to completely do away with hospice for Medicaid recipients (“the least of these”). Did he have to completely do away with it? Could he have cut the benefit funding in half and let the agencies figure out how to work with the money they got? Could he have cut something else instead? Or half of something else? Why hit those who are least able to take care of themselves?

      December 31, 2012
  5. Gail #

    #1 I don’t think I could be as gracious as you, Julianne, in my response to the limited, condescending, and generally rude comment by Teddy Mack. I am sure he is very important whoever he is, and although I disapprove of how he said it, he does make a point. Where is the money? It has always been healthcare and education that suffer when the economy is tanking; the two things we need most. #2 When will the powers-that-be understand that services such as Hospice, Home Health, Rural Clinics, and the like are preventative services? The system would rather pay for multiple visits to ERs, lengthy hospital stays, and often pointless and unnecessary tests for the terminally ill who come in because their pain is unbearable, they are so nauseated they can’t see straight, or are short of breath, rather than a couple of bucks for the Hospice nurse to go out and handle the problem. When these patients know no one is coming, they often panic, (or the family does) and they go to the ER or worse, call 911 for an ambulance. It’s so typical of fiscal thinking. Like buying the cheap toilet paper (“we’re saving $1 a carton on those”), using twice as much as the “expensive” good stuff because they don’t clean diddly and end up spending more in long run.
    And that’s all I have to say about that.

    January 4, 2013

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