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Hospice is a service to support a terminally ill patient’s physical, emotional, social and spiritual needs. Hospice concentrates on managing a patient’s pain and other symptoms so that the patient may live as comfortably as possible and make the most of their remaining time. Hospice also supports the patient’s family and caregivers, including grief and loss counseling.

Another advantage of hospice is that a hospice nurse can declare death and facilitate transportation to a mortuary. If someone dies at home and you call 911 and there is no DNR, paramedics may attempt emergency procedures.

Typically hospice care is provided in the patient’s home, with the majority of the day-to-day care falling on family members and caregivers. As this article on the “Cost of Dying..” points out, ” hospice has ballooned into a nearly $19 billion industry. It’s now the most profitable service sector in health care, as the industry’s business model relies heavily on unpaid family caregivers.”

As we increasingly see that we want to provide home-based care, we’re relying even more on caregivers. And it does take a toll.
-professor Katherine Ornstein, who studies the last year of life at Mount Sinai Hospital

Medicare will pay a set fee to qualified hospices for care of those with a terminal illness with a prognosis of six months or less to live. To stay on hospice, Medicare requires documented continued decline. Medicare will cover medications related to the terminal diagnosis and medical equipment, but will not pay for treatments intended to cure a terminal illness or treatments unrelated to the terminal diagnosis. The Medicare hospice benefit does not cover room and board in a nursing home or hospice residential facility. Some hospices provide extra services such as aroma, music therapy, etc. Some hospices have volunteers for extra support.

If you have a Medicare Advantage Plan you may be limited to hospices approved by the Medicare Advantage Plan.

You have the right to change your hospice provider once during each benefit period.

Pearls of MAID by Dr. Flora Danque:

  1. Taking MAID meds doesn’t go on your death certificate. Your hospice diagnosis is what will go your on death certificate as your cause of death.
  2. If you pass away in your home, you own your home & it is sold within 3 years of your death, your death must be reported to the new buyers.
  3. One of my patients sold her home and asked the new owners if she could rent back for 6 months. My patient was a former real estate agent.
  4. If you receive social security, retirement benefits and/or annuities, think about when it is deposited into your account. A lot of my patients choose a date past their deposit date or after the first week of the month, if you have the luxury of time to do so.
  5. Taking MAID meds is not a spectator sport. I love Apreva Hospice because our nurses don’t demand that they be present while you take the MAID meds. Think about who you want present when you take your MAID meds. This is a very private and intimate procedure.
  6. You want to be working with a hospice that supports MAID. I recently was asked to assist a patient that requested MAID. The patient requested he take MAID rectally. I called his hospice agency to request an enema be given and the nurse manager promptly refused my request for an enema. The nurse told me her hospice doesn’t support MAID & she refused to take my order for an enema. I left my home at 10:30 pm so I could give this patient an enema. In the morning, patient had a bowel movement and was able to participate in MAID with a rectal foley catheter.
  7. Apreva Hospice has a MAID talk link to their website. This video was filmed 2 years ago and the timing between taking the anti-nausea meds & drinking the MAID meds has decreased from 1 hour to 30 minutes. Here is the link: Physician Services | Services | Apreva Hospice
  8. Who is present when you take Maid Meds? Some patients only want me to be present. Another patient ordered 20 pizzas & a keg, then invited his 35 family members to celebrate his life and not mourn his death.
  9. My oldest patient to take MAID meds was 102 years old and the youngest was 20 years old.
  10. One size does not fit all people. I have a former NBA Player who is 6’8” and 290 lbs. What works on a woman who is 5’1” and 100 lbs won’t work on someone who is 6’8” and 290 lbs. We are able to increase certain MAID meds to make it more potent.
  11. Just because you ask for the MAID meds doesn’t mean you have to take it.
  12. The MAID meds drink is about 2 oz of fluid. I use apple juice to sweeten the very bitter drink and I give your raspberry sorbet.
  13. MAID meds: Valium – causes sleepiness. Morphine – causes respiratory depression. Amitriptyline, Phenobarbital & Digoxin – are cardiac toxic at high doses.
  14. Once you drink the MAID cocktail, you will fall asleep between minute 0 to 8 minutes. Then, most people lapse into a coma between 8 minutes to 20 minutes. On average, it can take 1-2 hours to pass away. Majority of my family members reported that this is a very peaceful experience.
  15. The fastest patient to pass away after drinking MAID meds was 10 minutes. The longest time to pass away after taking MAID rectally was 13 hours. On the national level, the longest time it took for a patient to pass away with MAID was 26 hours.
  16. Once you and your witnesses sign the MAID request form, it is good for your lifetime. The form does not expire. Remember, to qualify, you must have a terminal illness.
  17. The MAID meds do expire in 6 month after it was dispensed to you.
  18. Apreva Hospice supports VSED & palliative sedation in appropriate case by case basis. We also assist with extubations. Now, to qualify for hospice with VSED, you have to have proof that you’ve lost weight, usually via your physician’s medical records on you. Medicare has been cracking down on dishonest hospices.
  19. To participate in MAID, you must be enrolled in hospice services. For me, no exceptions. Hospice is able to vet out appropriate patients that qualify for MAID. You must have a terminal illness to participate in Hospice & MAID.
  20. If you die at home without hospice, you become a Medical Examiner’s case. That’s why it is best to be on Hospice service if you have a terminal diagnosis.
  21. If you have problems swallowing or you have severe nausea/vomiting, a Foley catheter can be placed in your rectum to deliver the MAID meds. You must have the strength to push down the plunder to give yourself the MAID meds.
  22. Once you pass away, I will call the mortuary, give the causes of your death and sign your death attestation. I will communicate with your loved ones when your death attestation was completed. Once this step is completed, your loved ones will hopefully have access to purchased your death certificates from the mortuary in 10-14 business days.
  23. Factors that prolong your death are GI cancers, history of very high narcotic or Xanax use, severe constipation, history of IV drug use, age < 55 years old, history of alcohol abuse and your otherwise healthy other than primary cause of death.
  24. To reach me, call Apreva Hospice at 619-450-4414 and leave me a message or the staff will put you through to my cell phone.

With Much Gratitude!
Flora I. Danque, M.D.


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