How Home Care and Hospice Can Make a Difference

News headlines have been splashed recently with terms, such as “fiscal cliff” and “debt ceiling.” Congress has been negotiating for months on ways to reduce spending while also still providing the best services to their constituents. In many instances, finding those solutions can be incredibly challenging. However, there is one obvious step to help alleviate the some of the rising costs of healthcare, while still providing top-notch service - home care and hospice.

Positive Impact of Home Care and Hospice

Home care and hospice are both proven ways to help reduce costs. A recent study showed that when used as the first post-acute setting after a hip fracture, home care saved Medicare an average of more than $5,000 per patient. Home care can also help reduce costs through lowering rehospitalization rates and improved chronic care management, as the Alliance for Home Health Quality and Innovation demonstrated in this video in November.

Hospice care can also reduce costs. A recent Duke study stated that hospice care reduced spending by more than $2,300 per patient compared to normal care, which typically included costly hospitalizations near death.

Improve Your Loved One's Quality of Life

Most importantly, both home care and hospice care improve quality of life while providing cost benefits. The overwhelming majority of patients prefer to receive treatment in their own homes, and both home care and hospice care allow that for patients. Studies have shown that hospice patients live longer than other patients in similar conditions. Furthermore, home care patients recover faster than similar patients.

These two vital care choices should be more receptive to new patients and not more restrictive. Ending costly rehospitalizations through home care and expensive hospital stays at the end-of-life should be a primary focus of how to reduce costs in healthcare.  By utilizing home care and hospice services to a wider group of patients, we can look past “cliffs” and “ceilings” and optimistically consider a large potential of savings, all at great benefits to patients.

Exploring a Challenging Conversation

Educating patients and their loved ones about hospice care, and how it can boost quality of life, is one of our goals at Liberty HomeCare & Hospice Services. Hospice care is not an easy topic to address. After all, many patients feel like they are giving up, or fear that end-of-life conversations may create anxiety or added stress for loved ones.

Tips for Starting the Conversation about Hospice

End of life conversations can be difficult to address, but understanding the rewards from the quality of life that follow can help make starting those conversations a little easier. Most people prefer to have their end-of-life care at home, and those at the end of life typically live longer under hospice care than without it. Determining that care, and what tactics will be used in a patient’s final days, can create peace of mind and alleviate some of the stress that inevitably comes when a family member’s condition worsens.

Start the Conversation Early

It’s also important to start talking about end of life as early as possible. Indeed, this gives loved ones the best opportunity to express their wishes before there may be a time when they are no longer able to speak on their own behalf.

How do you start the conversation?

Consider these tips below to start the dialogue with a patient’s doctor, which may be easier than starting that conversation with a loved one. These tips includes questions to address and valuable links to make the conversation a little easier.  It discusses questions about advance directives, medical treatments, and other preferences that a patient may have.

The following questions can help you determine what’s right for you as you begin end-of-life care conversations with your doctor:

  1. When it is your time to die, where you like to be, and with whom?
  2. If your preference is to die at home, what would you need to make that happen? Who would be your caregiver?
  3. How do you feel about depending on others at the end of life?
  4. Do you want to know if you have a terminal illness? Do you want others to know? Why or why not?
  5. What do you think a physician’s role should be in discussing end-of-life issues?
  6. What are your greatest fears about end of life? What would help reduce those fears?
  7. If faced with a terminal illness, what would be most important to you? What would it mean to live well for however much time you have left?
  8. Do you have an advance directive (i.e., a living will or power of attorney for healthcare)? Do you know how to get one? Do you know how, and when to update your advance directives?
  9. How do you think you would react if your doctor tried to discuss end-of-life care options with you? Would you feel your doctor wasn’t doing everything possible to cure your illness and save your life?
  10. If it was determined that you were terminally ill and could no longer eat and drink on your own, would you want artificial nutrition and hydration (e.g., a feeding tube and intravenous fluids)?
  11. If you could no longer breathe on your own, would you want to be hooked up to an artificial breathing device (a medical ventilator)?
  12. Do you feel comfortable talking to your physician about end-of-life issues?
  13. Have you had the conversation about your end-of-life wishes with your family members and healthcare providers? If not, are you going to discuss these matters with them, and if so, when?
  14. What do you know about hospice? How did you learn about it? What experience have you had with hospice?
  15. Do you know what hospice services are available to you?

For more information about initiating end-of-life conversations, visit

Creating a clear plan of action will help families make the most of the remaining time they have with a loved one.

That’s what end of life care is about: increasing the quality of life for all involved.

New Hospital Readmission Penalties Reflect Why Patients Need Home Care

The debate over the merits of the Affordable Care Act won’t end soon, but its impact has already started. More than 2,000 hospitals nationwide will have their Medicare reimbursements reduced due to high readmission rates, as detailed in this Kaiser Healthcare Report.

Readmission Problem

Those numbers illustrate how prevalent the readmission problem has become, and it also spells out how many readmissions hospitals are doing and where improvements could be made. Some hospitals in Liberty’s coverage area will not face any reduction in their Medicare reimbursements. However, many hospitals will face substantial penalties, up to 1 percent of their reimbursement totals.

Home Care Makes a Difference

Those penalties will cost hospitals millions of dollars, and reflect the changes that need to be made. Home care can make a difference for hospitals, by keeping patients at home and helping them get treatment they need for chronic conditions without having to face a return trip to the hospital within the first 30 days of discharge.

Those first 30 days after discharge are often critical. Patients can return home, and not realize the importance of follow-up care and treatment at home. Some hospitals, including those in Charlotte and Wilmington, have been successful in getting those patients set up for home care and follow up visits. However, many hospitals, particularly those in rural areas in the Carolinas and Virginia, have a much more difficult challenge.

Home care can help alleviate this burden. I’ve discussed how home care can help in a previous blog. Indeed, the latest news just echoes the importance of getting home care involved. Hospitals must work in coordination with home care companies, such as Liberty HomeCare to ensure the best outcomes for their parents. No one wants patients back in the hospital only a few weeks after discharge – that can be a drain for everyone, including the patient and their caregivers. Getting home care involved quickly after discharge is the best approach for all involved.

Hospice Care Creates Better Quality of Life

Hospice Care Makes a Difference

A new study published in the June issue of Health Affairs re-affirms something we in the hospice industry already know.

In the study, half of adults age 65 or older had visited a hospital emergency department in the last month of their life. But those who were in hospice care had dramatically fewer visits than those who were not, illustrating that they had a better quality of life.

The leader of the study, Alexander K. Smith, and other authors recommended that government, health care systems, and insurers develop policies that encourage physicians to talk to patients and their families about end-of-life issues.

Another study bolsters that argument. Earlier this year, the American College of Chest Physicians found that patients who have had end-of-life discussions were twice as likely to rate their care as “best imaginable” than those who did not. Yet, less than 15 percent of those surveyed had discussed end of life issues with their physician.

The studies reflect that many people still don’t understand how beneficial hospice care can be for all involved. That’s disappointing, considering the number of recent studies that have validated that conclusion. The Journal of Clinical Oncology reported that back in 2010, and so did the Commonwealth Fund all the way back in 2004.

Promote Education about the Benefits of Hospice Care

All of those studies reflect the need to further educate the public on the benefits of hospice care. Patients and their families often don’t realize how impactful hospice care can be, even as other families describe its positive impact. Educating the public will help reduce the number of emergency department visits, while providing a better outcome for all involved. That’s something we should all strive to see.

We Appreciate, and Need, Nurses More than Ever

National Nurses Week

National Nurses Week celebrated nurses nationwide earlier in May, and nurses at Liberty HomeCare & Hospice Services make a major difference in their patients’ lives, in the care and compassion that they provide.

Patients and their families have complimented our nurses for their care, and we always want to continue to provide that kind of exceptional care for our patients. But an increasing shortage of nurses in the coming years may make maintaining that kind of care for our home care and hospice patients more challenging.

Nurse Shortage

The shortage of nurses in the three states Liberty serves – North Carolina, South Carolina, and Virginia – continues to grow. Between the three states, there is a shortage approaching 25,000 nurses. As sobering as that statistic is, the shortage is expected to grow in the next 10 years. In fact, one of every five jobs created in 2012 has been from the health care field, including nurses.

We need to encourage more people to consider the nursing industry, as our population continues to age. But how can it be done? Liberty offers an Educational Assistance Program that has aided some employees.

Capital grants can also aid nursing schools, as can the Nurse Education, Expansion, and Development Act. This federal act would give grants to nursing schools to increase the number of nursing faculty and students.  State legislation can also help improve opportunities for future nurses, and relieve some of the expected shortage.

Liberty HomeCare & Hospice Services aggressively recruits the top nurses in our coverage area. We know how vital they are to our patients’ care. We hope that these suggested measures and others can help make a difference, so all patients get the kind of care they deserve.

Maintaining Patient Trust Remains Home Care’s Goal

A disturbing news story out of Texas has made myself and everyone else associated with Liberty HomeCare & Hospice Services feel overwhelming shock and disappointment.

A doctor in Texas is allegedly the leader of the biggest Medicare fraud in U.S. history, involving more than $375 million from the Dallas, Texas area.

This incident is unacceptable, plain and simple, and doesn’t reflect the important work done by the home care industry. There are hundreds of thousands of home care workers in the Carolinas, Virginia, and the rest of the U.S. who do passionate and caring work. Indeed, these workers represent the highest moral and ethical standards in serving some of our communities’ most dependent and vulnerable seniors.

Liberty HomeCare & Hospice Services, as well as hundreds of other home care agencies, supports any effort to confront doctors or agencies that are abusing the Medicare and Medicaid systems and the patients we serve. If you are aware of any kind of abuse, or want more information, I urge you to take action by calling me directly at 1-910-815-3122 if it is related to Liberty or by visiting

Expert Home Care is Vital for Seniors

The report from Texas is unsettling, but the staff of Liberty HomeCare & Hospice Services remains committed to enhancing the quality of life of our patients. We know that home care is a vital part of the health care industry, and won’t let the regrettable actions of a few taint the positive impact of so many others.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

HELP Hospice Act Vital Legislation Congress Should Approve

At Liberty HomeCare & Hospice Services, we hear all the time from the families of hospice patients, who tell us how our hospice care significantly helped them through the final stages of a loved one’s life. Studies have shown that hospice care can improve quality of life and reduce health costs. Indeed, it's not surprising that the utilization of hospice care continues to grow.

Affordable Care Act's Impact on Hospice Care

The Center for Medicare and Medicaid Services (CMS) has promoted Hospice Services for the last two decades.  That growth could face challenges in the coming years as a result of the Affordable Care Act, which recommends changes to hospice payment authority and a new face-to-face requirement for Medicare hospice patients.

HELP Hospice Act

But the proposed HELP Hospice Act can help patients adjust to those changes, while making the transition easier. The HELP Hospice Act, which has already received bipartisan support in the U.S. House of Representatives, features three core segments.

  • Any new payment methodology must first go through a two-year, 15-site demonstration program. This pilot program can help develop the reliable, evidence based, comprehensive data needed to determine which payment reform approach is best.
  • The HELP Hospice Act would increase hospice survey frequency, on average, to once every three years. This increase from the current average of 6 to 8 years would provide a better certification process, and allow for improved and appropriate regulatory oversight.
  • The HELP Hospice Act would modify the face-to-face encounter requirement by allowing clinical nurse specialists and physician assistants to also conduct the encounter, and allow hospice agencies seven days after the initial election of services to complete the requirement. These changes would help all agencies and particularly help small and rural hospices, which face operational constraints and may have to turn down patients who are most in need.

Many of the HELP Hospice Act’s principles do not cost any additional money, while still making a big difference for hospice organizations and their patients. All hospice patients and their families deserve the opportunity for the best care possible, and the HELP Hospice Act is a major step in that direction.


Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Medicare Change Resolution Needed Before New Year

Physicians who accept patients with Medicare could face a dark choice in 2012. On January 1, the Centers for Medicare & Medicare Services are scheduled to start paying Medicare claims at a 27 percent reduction from 2011 rates.

Issues for Physicians

Congress’s “super committee” has been meeting for weeks to determine ways to address the federal deficit. Health care leaders, including the American Medical Association, had hoped that Medicare reduction would be taken out of budget revisions. However, nothing has been accomplished yet.

That could mean that doctors will refuse to see new Medicare patients after the New Year. A recent article stated that more than half of the physicians in Texas would likely stop seeing patients if the cuts take place.

Unfortunately, those kinds of tough choices were already happening locally, even before the latest round of cuts. WRAL-TV in Raleigh, NC reported that in 2010 more than 80 physicians in N.C. stopped seeing Medicare patients, and more than 100 stopped in 2009.

Seniors Need Proper Care

The cost for physicians is often more than the payment that they receive from Medicare, which is even before this latest cut was proposed. So, it is understandable why a doctor might want to stop seeing those patients.

These latest cuts could trigger an even bigger decline in available physicians for local seniors. All patients need proper care, and these cuts will affect millions of seniors both locally and nationwide. AMA President Peter W. Carmel, MD, said this in regards to the budget stalemate:

“The deficit committee had a unique opportunity to stabilize the Medicare program for America’s seniors now and for generations to come,” he said. “Once again, Congress failed to stop the annual charade of scheduled Medicare physician payment cuts and short-term patches, which spends more taxpayer money to perpetuate a policy everyone agrees is fatally flawed.”

As Dr. Carmel mentioned, these cuts have been pushed off before. Delaying cuts isn’t the answer, finding a better solution is. Congressional leaders still have time, although the window is closing, to do just that. Let’s hope they can come up with a plan that serves everyone.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Home Care: The Best Way to End Hospital Readmission Trend

Recent media coverage of the Occupy movement from Wall Street to Wilmington illustrates the growing disenchantment with the status quo in America.

That kind of discord is also evident in the health care system, as skyrocketing costs continue to sap consumers and have detrimental effects on the economy. The new Affordable Care Act was signed as a way to curtail that, but no one can guarantee that it will stop the surge of health care expenses.

Hospital Readmission Issue

One thing we must curtail now is the rehospitalization of patients. Readmissions are a major drain on our economic system. The Wall Street Journal reports that 4.4 million hospital stays are from potentially preventable readmissions. Those readmissions are costing $30 billion a year, or roughly 10 percent of all money spent on hospital care.

One in five Medicare patients will be readmitted within 30 days after an initial visit, and in many instances, those repeat visits can be avoided.

In half of those cases, patients did not see a doctor before being readmitted. Many patients do not follow up with a doctor once they leave a hospital because they are fearful of ending up readmitted again or don’t understand the risks of missing a follow-up appointment. Patricia Rutherford, vice president of the Institute for Healthcare Improvement, acknowledged the problem to the Washington Post earlier this year.

“We don’t do a good job of coordinating care,” Rutherford said. “For very sick patients being discharged, 30 days is way too late to see a doctor.”

A Better Approach

Home care agencies such as Liberty HomeCare & Hospice Services can help better coordinate care for discharged patients and ease their concerns. Home care offers patients the option to be treated in the comfort of their own home. Home care saves millions of dollars each year, and can create faster recovery times for patients.

Recovery time at home increases even more with proper planning of care. Follow-up with patients is vital, including self-management programs, counseling, and developing exercise programs for recovery.

November is National Home Care Month

November is National Home Care Month, giving us all an opportunity to appreciate the valuable services that home care provides. But the benefits of home care aren’t just reserved for one month – home care can make a big difference year round.

That’s the message that patients and everyone else needs to understand. No one wants them to return to hospital rooms. Instead, those patients can get the care they need in the place they want – their home. Let’s get that movement started now.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services

Reducing Specialized Therapy Opportunities is the Wrong Idea for N.C.

October is National Physical Therapy Month

October is National Physical Therapy Month, and there’s a lot to celebrate. Physical therapy provides numerous benefits for patients. Physical therapy boosts patient recovery times, limits the risk of falls in the home, gives patients needed exercise, and improves independence.

At Liberty HomeCare and Hospice Services, we know these benefits have a direct, positive effect on our healthcare system. However, new guidelines being discussed in North Carolina would dramatically limit the amount of physical therapy that would be available to Medicaid recipients.

Latest Proposal by the NC Department of Health and Human Services

According to the latest proposal by the North Carolina Department of Health and Human Services, Medicaid recipients would only be eligible for a total of three home health therapy visits per year. This includes physical therapy, speech therapy, and occupational therapy combined.

That is a dramatic decrease from current standards. Currently, patients receive physician ordered therapy according to the patient’s individual needs.  Giving them the opportunity to achieve optimal outcomes and avoid the costly complication of re-hospitalization.

There are also several serious issues that need to be addressed about the proposal. How will a doctor know whether a patient has used up their three visits for the year (no such database currently exists for them), and how will the new limitations affect physicians’ recommendations? Limiting the patient to only three visits would dramatically reduce any benefit they can receive from such services. In fact, allowing only three visits is not much better than eliminating their availability entirely.

All of that is potentially bad news for Medicaid patients in North Carolina.  This was the result when the legislature passed the new state budget.  This reduction doesn’t benefit anyone.  This new policy doesn’t help the patient, and it doesn’t help the Medicaid system, because less therapy will create more re-hospitalizations. That will further strain the system and cause costs to continue to rise.

Why push for a plan where nobody wins? There has to be a better way.

Tony Zizzamia

President, Liberty HomeCare & Hospice Services