NewsNight Maryland; 292

From compassionate beginnings to big business is hospice care still providing comfort for the dying. Plus a new push to bring the Olympics to the Baltimore-Washington area. Good evening everyone I'm Camilla Carr. Bob all Fitch has the week off. Hospice care has grown from a volunteer movement to provide comfort for the dying in the 1970s to a billion dollar business in the 90s. In fact at least 20 percent of hospices are now for profit. Critics blame the increase in for profit operations on Medicare which has doubled its payments for hospice care. Excuse me. And tonight's Marilyn discoveries. We have three experts from the hospice industry and the medical profession to discuss this issue. Joining us now are Dr. Michael glow with Union Memorial Hospital of the the division of geriatrics Geraldine fire rose from Hospice of Charles County

and Dr. Meg hall with the University of Maryland School of Nursing and we want you to know in just a moment we're going to put a phone number at the bottom of your screens so that you can give us a call with a comment or a question. Miss fire rose I would like to be on with you. What is hospice care for the people out there who may not be familiar with it hospice is care for the terminally ill. It's any disease process. It includes any age and it's an interdisciplinary team approach. It's main focus is providing pain and symptom management so that people can have quality of life and a dignified death. But it's not curative. It is not curative. It's palliative. Dr. Glass could you walk us through the process of going into hospice care. Yes. What needs to take place is that there has to be the existence of the terminal illness. There has to be a referral from your physician and that referral usually will go to any number of hospice is around some areas have only a few in Maryland we're fortunate to have at least one hospice in every county. Once that referral is made

the hospice organization itself will pick up the ball and make sure that all host of services are made available. In some respects it depends in part too on the type of insurance an individual has. Medicare certainly is one of the larger providers given that the average age of a hospice patient is about 72. So that Medicare benefit is certainly an instrumental part of hospice care throughout the country. But suppose you don't have anything any insurance. Maybe most hospices actually will take patients even if they don't have any insurance at all. It's very rare especially in this state to have a hospice that will turn someone away. Miss Hall when you talk about hospice care you're talking about an incredibly emotional time for family members. I had and requires a great deal of sensitivity from the staff members. And yet you have companies now that are doing this for profit. What do you think about that. I think that there are some very basic characteristics that nurses especially possess that allows them to work with dying patients. And

regardless of where they are paid or what their background is they really seem to be able to develop that connection with the patients and their families very well. So they're very comfortable I think regardless of where they have because on their career and yet there are there are there is rather a list of abuses that a federal audit found in around hospices around the country sometimes that they were they were pain or they are paying sales commissions to people in order to recruit the dying. It is it's very disturbing and especially in a group of professions that really do focus on the individual in the family. I think part of it is that we are trying to fill a very rapid really growing need in the health care delivery systems so that perhaps the quality of our employees is not what it may have been 10 or

15 years ago. So we really do have to focus on the kind of care that we teach our students which we certainly try to incorporate in the University of Maryland School of Nursing and also our medical students to make them aware of the purpose of hospice misfires How has hospice care changed since these for profit operations have taken it over. I'm not sure in my opinion that it has changed that much. I think hospice continues to provide quality. Whether or not it's a profit or nonprofit organization I think even with the nonprofits that there's no margin there's no mission. Everyone has to have a positive positive bottom line to carry out the mission of providing terminal care. I I just I don't think that the nonprofit vs. for profit is is that much of a dividing line between the care that's being provided.

Dr. cloth What do you think. There's no question that profit or nonprofit really is an issue of tax structure. And in terms of providing quality of care there are no data to indicate that a for profit provides better or worse care than a not for profit. One of the concerns that we have that perhaps there have been changes in hospice probably really revolves around the issue that hospice is getting more recognition it is being used more frequently. Interestingly we're talking about a Medicare budget that is over 200 billion dollars yet hospice which we know saves on average in the last month of life over $2000 per patient yet provides by every measure better care and at less cost. Yet when we look at these audits that are taking place we're concerned about fraud. Well let's face it. You're going to see less than half a percent fraud when you're talking about this as is true in Medicare at large. Here we have a real crisis in people not getting access to

hospice to which they are entitled by the Medicare benefit. That's where we ought invest our dollars going after the fraud. While it does exist but it's in a very small relative percentage. Most companies would be excited to have such a low level of fraud except for a lot of tax payers or for family members the whole idea that there is a case in Chicago where a man has been indicted for allegedly the fraud in Medicare out of 10 million dollars. That's a lot of money and it's a lot of money for for anybody but when you think about that this is money that was allegedly taken from people who were dying. Well look what is happening if it's fraud in Medicare it's fraud in us and we're the taxpayers we're the ones who contribute. But look at our own state. We have problems identifying. Thirty million dollars worth of expenditures right here in Maryland associate with Medicaid. We overpaid one group 80 million dollars. I mean these things exist but it has to be put in perspective. And overall

hospice is doing a marvelously wonderful job in terms of providing care and doing it in extremely cost effective manner. Are there some bad apples and some terrible apples. Absolutely. But I think that the crisis that we have right now is if the referrals are coming much too late on average a hospice patient comes in with less than three weeks they're entitled to a six month benefit. How can you get in all the services that durable medical equipment. How can you get in the physicians the nurses the social workers the the therapist that are involved in just a three way or a one week period of time. That's the tragedy because we can provide respite for these families. We can allow them to have that comfort and dignity in the end of life. And we don't take advantage of it. Or Dr. Hall I think that swear we as professionals need to educate our own students our nursing students our physicians that hospice is an extremely viable option. And a lot of the research demonstrates that once patients are enrolled in the hospice.

The quality of their life is so much better. Probably because they are no longer receiving painful futile treatments at this point but also because the kind of caregiving that they are receiving is from their families. And when you talk about economic burdens it very often is an economic burden for family members who perhaps go back to a full time position or may not be able to work at all so lose some of the money from their own jobs. The burdens on families I think have diffused a great amount of the attention that nursing and medicine might have. Excuse me I don't want to interrupt but we have a phone call Peggy from Frederick. You're on the air. Yeah I'm calling from Frederick Maryland. My question really is for both. And not for profit organizations. How could you both better inform in advance your family and their client and the client

about what the cost the owner might cost to them would be isolated. Some of them go into this looking at the old volunteer concept that it wouldn't really cost them anything and then are terribly surprised by the deals that come through I'm not sure that this is always stay clear to them when they make the arrangements. Yes hi would you like to take that Medicare has no out of pocket expense except for perhaps a 5 percent co-pay for medications and a 5 percent co-pay for respite care. Otherwise there should be no cost to the Medicare patient Medicaid has no co-pay and the cost is completely covered by hospice. The only time there would be out-of-pocket expenses if as a third party in most of our third party insurers do cover hospice some completely and others marginally but most Hospices have a sliding scale so I'm not sure what you're referring to or or if there is a situation that you'd like to elaborate on but there should not be out of pocket expense for Medicare Medicaid

patients. Thank you we have another caller Peter from Baltimore County. Peter you're on the air. Yes hi. I'm very curious as to how you are you alter it appears so. I've been on the periphery as a caregiver for a grandparent that died at home and that's really where I began my interest many years ago in hospice because it was a very wonderful death. But it also was very demanding on my grandfather's family. Peter are you a caregiver or have you been a caregiver to him thinking about it for women. OK very good. People who are in your community and like you my question is I really would like to go into their wide range of approaches that people give them to subvert not to think of it but to give a very I think a very effective going to support yours.

You're right on target there are a lot of different approaches. In essence though the hospice is one of the areas of medicine that emphasizes spirituality much more than perhaps we do in other areas and there are a number of different religions enough number of different spiritual beliefs and hospice works very hard to work with the patient and hear to their particular beliefs. I would encourage you if you're interested in working with the dying to volunteer all the volunteers go through special courses to learn about how to provide care on a volunteer basis to hospice patients and I'm sure that you know your county certainly has a very good hospice and they would love to have someone like you helping out. OK. Thank you very much Peter. I took off I had. I've been wondering though what do you think about this practice of pain commissions to recruit people who are dying practice of pain commissions. Yes there is. There is at least those of us who recruit people that are dying. If I'm following one of the fields that you're discussing right now correctly one of the things that's happening is that there are groups that are recruiting patients that are

dying for other reasons one is for example there are reverse mortgages that are available to people. And what that does is allow them to have additional expenses for their final days of life. Many people actually consider that very positive but obviously they have to find people that are terminally ill. There are other organizations that are looking for patients that are dying and I think most hospices while they are not certainly not doing anything to make people die but they are anxious to be able to allow recipients to get their maximal benefit when they apply for hospice because they are entitled to the six month benefit. And you certainly don't want that to be overlooked by some provider somewhere. We have another caller Mary from Montgomery County Mary you're on the air. Hi. I have a question for you do not resuscitate orders. And then when I understood the hon. It is one of their premises that you're supposed to have honor the patients wishes in death with dignity. I was 100 Fortunately part

of a situation where a patient who wanted to be resuscitated and she was told by the honde that she could not be that do not resuscitate orders were not allowed in hospital and she also wanted At least amount as medication as possible. She basically was given so much morphine that she died because her respirations died and there were many times where she did not need the pain meds but she was given the pain meds because she was emotionally upset. When I'm good let me let me just interject. I'm a little bit concerned about hearing information third hand and we have to be very careful about that. You may be right on target and very accurate. But I will tell you that oftentimes I hear stories that a patient was given too much morphine and that the morphine killed the patient when in reality what happened especially when I've been asked to review some of these cases is that patients were handled very appropriately and it's the disease process. I mean after all these people are terminally ill and they are

going to die of their disease. But what happened was that the morphine allowed them to die through their natural process and just do a constable in a peaceful manner. I will tell you that no hospice. It is out there to accelerate death and it's especially true in the hospice network in Maryland and throughout the state. Our purpose is to allow people to die in comfort and dignity through a natural process we are neither to accelerate death nor are we to delay it. And that is a key concept that people have to understand. On the other hand let me address that issue about DNR. And that is that if a patient comes into hospice and they have had a Do Not Resuscitate order and they decide wait a minute I'm not longer ready to die I don't want to continue in hospice. They are very free to leave hospice and there are very strict criteria that we have to meet to keep people in hospice. And often times when they want to stay in hospice We unfortunately are unable to keep them in hospice. We have another caller. This is Bob from Worcester

County yob you're on the air. OK I just. To let you know that my family was involved with Baltimore My brother was terminally ill with the Gehrig's disease. He was under 40 years old and he had to go to hospital twice. He was very critical there for a while when they admitted him and everything was fine and he had a a Do Not Resuscitate order. And I just wanted to let the people know that we had a wonderful experience with here that it was very good for my brother and for the rest of family. He had gone back there he finally died at the hospital here. And it was done very professionally. And I just want to let people know that it's available to the younger terminally ill and that this is something that is very helpful. Thank you so much Bob for your comment. Dr. Hall I'm a little curious about how the patients have changed though. I mean before is it before it was the

majority or cancer pain and I think that's still still the case but. There are people in hospice care with other diseases. I think that's part of the reason that we have broadened hospice care to include palliative care. Any individual with any type of diagnosis and again any age if they have a limited prognosis and usually will say within six months to 12 months are fully eligible for hospice and it has changed and there still may be some people who do think hospice is strictly for cancer patients. But as you saw from Bob that is not the case. So we really have broadened our diagnoses. OK. And that will have to be our last word but I'd like to thank all three of you for joining us and also our viewers for their calls and your comments. We're going to switch gears now and talk about some business. It seems lots of Marylanders had their eyes on the stock or on the stock ticker as the Dow dropped more than two hundred

and fifty points during the day. Jeff Saul Cohen joins us with the Maryland is wow that's a big drop Jeff Mike really worries about a deepening recession in Japan and the impact on corporate profits here helped to lower stock prices around the world today. The Dow recovered from its lows ending the day down one hundred twelve points. The action kept the phones ringing for local brokers and financial planners. We are getting a lot of phone calls some people are nervous and apprehensive. On the other hand I've had some people looking for bargains. I have people have said which is a great time to buy what can we buy. So I do have some of that. I have some people that have expressed some concern but what I've done in the past is if you have a portfolio of some of the so much of stocks and so much bonds and so much in cash there's nothing to do. I would I hate to react to these kinds of events in the market. Market pro and yes my dad Jay Salk and the Bloomberg index of Maryland stocks was down about 2 percent today and is down 16 percent from its high in April.

In other local business news the strike against Bell Atlantic was settled with a new contract 73000 striking members of the Communication Workers Union put down their picket signs in return for a seven point eight percent raise over two years and other improved benefits. And Maryland's former secretary of business and economic development has a new place to hang his hat tonight Jim Brady is joining the boards of First Maryland Bancorp and First National Bank of Maryland Mr. Brady who briefly considered a run for governor has also joined the boards of a number of Maryland cultural and service organizations and Kabila that is the Maryland biz for tonight. Back to you. OK thanks a lot Jeff. And coming up next time. Is not Maryland going for the gold. What if it's going to take to bring the only fix to the Baltimore-Washington area. We'll find out from tonight's newsmaker So stay with us we'll be right back. We were three hours along the corridors of Russia's Hermitage Museum

one of the world's greatest museums. And one of the world's largest collections of our times masterpiece. It was. An impressive the same way that represent every major period from those of the Crimea to modernism. Tune in and to join it on. Sunday beginning of fun on NPT. Beginning August 7. NEWSNIGHT Maryland will host discussions with Green County Executive goodness on fourth consecutive Friday nights at 7:00. We give you a chance to get to know the time. And understand the issues that affect you and the counting live. Only on NEWSNIGHT. Now. Top Issue bottom line. Our NEWSNIGHT newsmaker tonight is John Moore the president of Nations Bank mid-Atlantic and the

new chairman of our regions bid for the 2012 Olympics. Mr. Morton thanks for joining us. How would you rate our chances of getting the Olympics. It's really nice to be here. Well I would rate our chance again the Olympics is I think all of us involved in this. Are very cautiously optimistic I think that we have a tremendous amount of resources that we can promote here from venue to the fact that we are the nation's capital in Washington D.C.. And that's something you just can't duplicate if you're no other bid city. But at the same token I have to tell you we recognize that. It's a very daunting task to put together one of these bids a bid by itself is probably 600 pages long and covers about 17 different themes. And it's a very formidable challenge to win it with all the competition we're going to see both domestically and if we go into the international competition from international cities as well.

Tell us about the corporate commitment to this effort. Well I tell you what I think the real great things about this whole effort is that it's regional. And what we've seen as a group is how well we are putting the task in front of us of winning the bid ahead of all the regional issues that sometimes complicate a bid like this and the cooperation between the corporate leaders of both Baltimore and Washington D.C. in Northern Virginia I would tell you is outstanding. And I think will clearly add to the pattern in the history of working jointly together to solve big issues. You have two hurdles in this venture first beating the domestic competition and then the international competition. How does that work. Well our bid is due in March of the year 2000. And in that bid we'll compete against eight other cities San Francisco Los Angeles Dallas.

Tampa. Cincinnati. And New York City. And all those bids will be due in for two years the U.S. Olympic Committee will then evaluate our bids I'm sure they'll be a lot of on site visits they'll be some pre-Olympic events that will schedule to sort of show off and and evidence the experience we have in running something like this. And then at the conclusion of that two years they will to choose a city. That will be in the fall of the year 2002. And then in approximately three years thereafter 2005 the International Olympic Committee will then choose a city. But again I think we feel pretty good about it because being an East Coast location we happen to be in a time zone. That can be seen Dohrn normal daylight hours to the most of the population of the world and particularly here in North America. Does that mean you see the domestic hurdle as the bigger one. No I think the domestic hurdle is

probably easier to define the issues because we know the domestic cities better. But when we get into the international competition I think that we will be dealing with cities that we don't know as well and we will deal with a process that will be even more foreign to us. One of the benefits to a region of hosting the games you have the economic impact but you also have concerns about crowds and security. I would start out by saying this is probably the greatest economic development effort that this region Washington Baltimore will ever undertake. If you use the experiences in Atlanta the economic benefit to Atlanta was over five billion dollars. And that comprised the principal of. Two and a half billion dollars worth of investment in the infrastructure transportation housing etc. as well as the amount of money that the visitors and there were three and a half million visitors to

Atlanta spend in the city and the payrolls that were created with the 75000 plus workers in that city. So to me the economic impact is incredible but really. Also of equal importance and maybe even more importance in terms of the Olympics to a region. Is just the legacy that lives on with each generation having experienced it. And. The pride that develops from the people within is their cities or showcase to the world and almost 4 billion viewers will see the Olympics as they did in Atlanta and that kind of visibility and the participation of so many people and 50000 volunteers really just and builds a pride in the community that lasts for a lifetime. It's a two city bit unusual and it is somewhat unusual for Baltimore and Washington to be working together. I can't really say in the history whether it's unusual or not. I think in our case we're

very fortunate that we had bids being developed early on by both the Greater Washington exploratory committee in D.C. and Baltimore and beyond in Baltimore. And so it got it started. And from those beginnings the interest at the Q. corporate in the community leader level began to drift towards a regional bit where they saw the power of the region and all of the different venues and the infrastructures that were available in Northern Virginia Washington D.C. and all of Maryland up to Baltimore would be much stronger bid and plus we would be competing against each other I think that. In the process of having a two city. Each independently trying to go forward that we would have diluted the others bit. And so this way we feel we've really got a very. Strong bit in this process. One last question for you what what is your first order of business in this position. We've been going since probably December of last year and I would tell you that today we've

gone through what I'll call the organization phase where we put in place the board of the governing etc. of how we're going to do business in the next major step for our group. Is to. Bring on a full time CEO to really execute the production and the promotion of the fundraising that's going to require to successfully bid on this project. And that's it for tonight's edition of NEWSNIGHT Marilyn but be sure to join us tomorrow. Secondhand smoke is a dangerous carcinogen or is it. The answer depends on who you ask. Experts will offer their views on NEWSNIGHT Maryland tomorrow. For all of us here at NEWSNIGHT Marilyn thanks for joining us. Good night.