By Craig Dresang, CEO, Yolo Hospice
Originally published in The Davis Enterprise
Picture yourself homeless, living on the streets or under a bridge with your significant other, and trying to make sense of the care you need for a terminal diagnosis you just received in a nearby emergency room. You have no bed or place to live, no physician, no family support, and no one acting on your behalf as a champion for what’s important to you. Your feel void of hope or dignity. This describes a patient who was recently referred to Yolo Hospice. Sadly, and fortunately, the organization is frequently challenged by referrals like this one.
Two truths have become increasingly clear for me since I arrived at Yolo Hospice in 2014. First, decade after decade, the organization has created a platinum standard for end-of-life care in the Sacramento Valley. Second, it also serves as a critical safety net for those who historically have been unable to access care.
Every month, I see the strength of that safety net at work through the decisions and commitments made by our hospice team. When that net catches someone who is homeless, our team works hard to find safe and permanent housing for that patient. This is especially important so that hospice care can be provided in a responsible and dignified way.
Even with increased access to healthcare through the Affordable Care Act (ACA), there are still a significant number of people who have challenges finding care, especially in the final phase of their life. That reality is sometimes hard to understand, given the fact that California is home to more hospice organizations and companies than any other state in the country. The Golden State is bursting at the seams with more than 400 hospices, while other states such as Florida or New York have fewer than 50 end-of-life care providers. One reason other states have far fewer hospice providers is that they are Certificate of Need (CON) states. Those states rely on the CON process to regulate the expansion of health care facilities and programs in order to avoid the duplication of costly medical services. It requires healthcare providers to apply for state approval before establishing new or expanding existing services.
On the surface it appears that there should be enough care in California to go around. However, we routinely find that some people have challenges accessing care during the most vulnerable time of life. Too often, high-need patients who have no health coverage or who rely on revolving homeless shelters are shut out of other care programs.
The issue of access is mostly related to cost. Who will cover the cost of care for the uninsured or those who are not eligible for Medicare or Medi-Cal? A recent government study reported that most uninsured people are in low-income working families. More than eight in 10 were in a family with a worker, and over five in 10 have a family income 200 percent below the poverty level. People of color are at higher risk of being uninsured than non-Hispanic Whites.
The report also revealed that nearly half of uninsured adults said the main reason they were uninsured was because the cost was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults, are not eligible for Medicare. In addition, undocumented immigrants or visitors are not eligible for Medi-Cal, Medicare or Marketplace coverage.
For Yolo Hospice, the good news is that strong community support allows the organization to spend philanthropic dollars on care for the most vulnerable patients in our community, and on uncompensated care and programs for families. One of those unfunded programs is our long-standing and free-of-charge bereavement program for children and adults. In 2015, the organization committed nearly $250,000 to this valuable community resource. Nearly half of our bereavement clients are from the community at-large and not hospice family members. Other community impact programs include a Veterans program, family navigation, crisis intervention, an extensive end-of-life resource library, professional and community education, subsidized health services, financial assistance and support, and palliative care.
We believe no one with a terminal illness should have to worry about how to pay for their care. Yolo Hospice does not turn patients away because they do not have health coverage or another form of reimbursement. For those of you who support us, thank you for helping us keep that promise.
Special Note: YoloCares, the organization’s palliative care pilot program has been extended another six months by Partnership HealthPlan of California (PHC). We are pleased that this pilot has been effectively serving PHC’s Medi-Cal population and plan make YoloCares widely available to the community by mid-year 2016.