Overview
Over the past three weeks, we have examined the differences in healthcare, access to healthcare and resources, and factors that affect access to healthcare in the populations of Niskayuna and Schenectady. These differences seem to be highlighted in Schenectady because we see a more diverse patient population with different socioeconomic statuses that affect their access and quality of care. Demographic shifts, racial disparities, and lack of investment are examples of factors that have affected access to care in Schenectady. We have seen many organizations and programs that have important initiatives to improve access and quality care for diverse populations. This raises an important question: is socioeconomic status and financial resources the most important factor that influences access and quality of care for all populations?
This week, we are looking at this question through the lens of one population: the terminally ill patient population. We will explore what resources are available for the terminally ill population, and will examine who can access these resources.
Brief Analysis: Hospice Care
Merriam Webster defines being terminally ill as “having a disease that cannot be cured and will cause death” (1). Patients with terminal conditions have considered all medical treatment options/cures and need emotional and physical support to live the rest of their life (2). The goal of care for these patients is to help them remain comfortable and provide resources for them to have a high quality of life towards the end. Hospice care is one option that many choose to provide care for terminally ill patients. For those who want a brief overview, hospice care is a 24/7 service that provides medical care for terminally ill patients, consisting of teams of a primary care doctor, nurses, home health aides, spiritual counselors, chaplains, and other providers (2). The goal of hospice care is to provide medical care that allows the patient to remain comfortable in their home or facility; this medical care excludes treatments that aim to cure their terminal disease (3). Who pays for hospice care? Private insurances, Medicaid and Medicare do cover hospice care. Even though hospice care seems accessible to everyone, there are many caveats for various populations that inhibit access to hospice care.
When we examine Niskayuna and Schenectady, we see that the Niskayuna population has a higher median income, higher education levels, and a lower poverty rate than Schenectady (4,5); this tells us that the population likely has better access to resources that will allow them to seek and acquire hospice care . Financial resources are a big factor when it comes to healthcare. When we looked at Schenectady last week, we saw diverse patient populations that were categorized as ‘low-income’, ‘at-risk’, mainly due to their socioeconomic status and financial resources. The historical demographic shifts in Schenectady have increased the population of low-income individuals that may have inadequate access to resources. Terminally ill patients living in these areas are going to have difficulties accessing hospice care that will help them live comfortably for the rest of their lives.
Looking at diverse Schenectady populations, we find organizations such as the City Mission, Catholic Charities, YWCA Schenectady that provide resources to the homeless, underserved, uninsured, and inner-city population. Terminally ill individuals in these populations are going to have difficulty accessing hospice care. Those who are uninsured, which encompass the homeless population and many others, will not qualify for hospice services because they do not have an insurance plan that will cover the cost of hospice care. Even if some people have insurance, those who do not have a primary care doctor/provider may not receive the approval needed to facilitate hospice care. Medicaid requires a “physician certification that an individual is terminally ill and hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions” (6). Many of these individuals may not have caregivers or a support system to organize their care and reach out to hospice. In addition, there are populations that live in the inner-city and at-risk areas may not have access to internet/broadband services, so they do not have any way of reaching out for services and care. Therefore, there are a lot of barriers to accessing end of life care in the community, and to me, it is imperative that we change that.
What are people doing to help?
The Community Hospice is a hospice service that provides care for terminally ill individuals. Medical treatments provided by Hospice involved managing pain and addressing
symptoms, not treatments to cure the disease. The team of providers includes a nurse, social worker, chaplain, and home health aide that act on a “plan of care”, a customized plan that prioritizes the well-being of the patient (7). Hospice works alongside caregivers to provide the best experience possible for the patient. Many people can choose to receive hospice care at home. Community Hospice is making an extra effort during the COVID-19 pandemic to provide care and reach the terminally ill, despite the personal risk to their health.
I had a personal experience with the Community Hospice in 2010, when my grandfather was living his last days in my family’s home. He was discharged from Ellis Hospital and chose hospice care, where he received medical help for pain management towards the end of his life. For my family and I, this was a painful experience seeing my grandfather suffer from various ailments as we knew he only had weeks to live, so we were so grateful that the Hospice team was able to provide him with anything that was necessary for him to be at peace throughout those days.
The Joan Nicole Prince Home is a home in Scotia that provides end of life services for terminally ill patients free of charge (8). They are a unique organization because they are not a medical facility, but aim to provide the same goal of hospice: helping terminally ill patients be at peace towards the end. Their mission is to provide a homelike environment for patients to live comfortably for the rest of their life. The patients have hospice services, and the home has volunteers that provide everyday care and support for the residents.
Conclusion
The terminally ill population needs support and care to be comfortable and at peace towards the end of their life. Barriers such as financial resources hinder many from receiving adequate care that will help them function such as hospice care. Organizations like the Joan Nicole Prince Home step in to provide care regardless of their socioeconomic status. What resources are available for the terminally ill in your area? It is up to us to ensure that the terminally ill have a comfortable and peaceful environment to live the last days of their lives. I have seen firsthand that support and even physical presence help people more than you will ever know. Please consider volunteering (safely!) and helping the terminally ill population.
References
- “Terminally Ill.” Merriam-Webster, Merriam-Webster, www.merriam-webster.com/dictionary/terminally ill.
- “What Are Palliative Care and Hospice Care?” National Institute on Aging, U.S. Department of Health and Human Services, www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care.
- Terminal Illness: Supporting a Terminally Ill Loved One. Mayo Clinic, 16 Nov. 2018, www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/grief/art-20047491.
- “QuickFacts: Niskayuna Town, Schenectady County, New York.” United States Census Bureau, United States Census Bureau, www.census.gov/quickfacts/niskayunatownschenectadycountynewyork.
- “ QuickFacts: Schenectady City, New York.” United States Census Bureau, United States Census Bureau, www.census.gov/quickfacts/fact/table/schenectadycitynewyork/PST04521
- Hospice Benefits. Medicaid, www.medicaid.gov/medicaid/benefits/hospice-benefits/index.html.
- “Hospice Serves You Wherever You Are –and Whoever You Are.” The Community Hospice, www.communityhospice.org/services.
- End-of-Life Care: Scotia, NY. Joan Nicole Prince Home, www.joannicoleprincehome.org/.
Comments by nathk