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Hospices dispute fee for patients who live longer than expected

Dec 07 2011

The association that represents hospices in B.C. is taking issue with a provincial policy that bills patients a $30 per day fee for living longer than expected.

The B.C. Hospice and Palliative Care Association started surveying hospice societies to find out which issues around end-of-life care need to be addressed in the province.

The province has a long-standing policy in place to reassess palliative-care patients when they improve under care. Those reassessed from palliative to an alternative level of care are charged about $30 a day.

"The idea of charging a fee to people who are designated as hospice/palliative care [is something] I've really struggled with over the years," said Fraser Black, medical director at Victoria Hospice.

"The last thing these patients and families need to be worried about is finances."

The fee is applicable to people who are in hospice residential beds, not in acute beds or tertiary palliative-care beds.

"We have voiced our concern about this for a number of years," said Black.

The policy has been in place for more than a decade, but it

has not been consistently enforced.

Black said he's glad to see that the association is surveying its members to find out what needs to be addressed.

In its response to the survey, Nanaimo Community Hospice Society will join its Island counterparts in saying the policy should be changed.

A growing number of hospice societies oppose the policy as an unfair charge on families when a dying person needs the kind of care they can only get under palliative care.

"It's not their fault they don't have anywhere else to go, but that's what happens," said

Wendy Pratt, society executive director.

If a patient has a terminal illness diagnosed and needs palliative care to manage pain and symptoms, he or she will undergo treatment at the

palliative-care ward at

Nanaimo Regional General Hospital.

"The issue is that when you are palliative that means you are imminently about to die. That can take anywhere from a couple months to a year and, in a few cases, longer," Pratt said.

"Sometimes when they end up there, because of the excellent care they get, they may live a little longer than they might otherwise."

If patients improve, Vancouver Island Health Authority can have them reassessed. The per diem applies for alternative level of care patients.

"VIHA says you shouldn't be here, but because there isn't anywhere else, we're going to charge you as if you had somewhere to go."

The policy is set by the provincial health ministry and pre-dates the formation of health authorities in B.C., said VIHA spokeswoman Shannon Marshall.

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