Consequences of CBJ budget cuts to viability of hospice in Juneau

(Bartlett Regional Hospital photo)

By the Foundation for End of Life Care board of directors

Ben Franklin said nothing is certain but death and taxes. Most of us would rather dwell on taxes. 

But as the inevitable draws near, roughly 80% of us prefer to pass away in our homes, without pain and discomfort, surrounded by family and friends. Yet nationally, only about a third of us actually do, and less than a quarter in Juneau. Prominent among the reasons so few of us spend our final days at home are a lack of understanding of the availability and benefits of home health and hospice services.

Hospice aims to ensure we are as comfortable as possible, and to empower our control and dignity, during our final days. Hospice services include pain management authorized and supervised by medical staff, providing medical supplies and equipment, assistance with bathing and daily tasks, and counseling, spiritual, and grief support. Hospice doctors and nurses are on-call 24/7. Medicare and Medicaid cover all these services for the patient, so affordability is thankfully not usually a major concern for those who take advantage of hospice.

Unfortunately, the continued availability of hospice services in Juneau is in jeopardy. Bartlett Regional Hospital is the sole provider of home health and hospice.  Continuing to provide hospice services adds to the financial challenges Bartlett already faces. Hospice services cannot break even, because Medicare and Medicaid reimbursement is based primarily on the number of days these services are provided to a patient, but the 24/7 on-call requirement means that Bartlett must maintain at least six medical staff dedicated to hospice and home health. Approximately 50 of the 200 people who pass away annually in Juneau use hospice, and most don't start until a week or so before they pass. These are about half the national hospice utilization rates. Consequently, revenue from Medicare and Medicaid reimbursement doesn't cover unavoidable costs.

It has been shown that beginning hospice care early means a better quality of life, and often a longer life than predicted. This is why the Foundation for End of Life Care’s primary mission is to advocate for hospice services and educate patients, physicians, and the public about hospice and end-of-life services. The foundation is engaged in multiple efforts to increase public awareness of the value and availability of home health and hospice in Juneau. 

Like the rest of the country, Juneau's over-60 population is the only demographic that has increased every year since 2014. It now accounts for a fourth of our population. This trend results from the aging baby-boomer generation, and is unlikely to reverse anytime soon. Demand for hospice services will only increase. Our immediate objectives focus on efforts to increase both the number of people who qualify for hospice, and the average number of days patients use hospice services by 50%. Doing these things takes time and education.  However, if achieved, would go a long way towards making hospice fiscally sustainable.

We applaud the Juneau Assembly's continuing commitment to annually appropriate at least $200,000 to show community support for the hospice shortfall. We are concerned the Assembly's action this summer transferred $250,000 from the BRH budget to pay for rehabilitation programs. Bartlett board member Max Mertz and former CBJ Finance Director Bob Bartholomew recently articulated the negative consequences of that decision. That re-appropriation should not be at the expense of hospice, which is part of the spectrum of health care from birth to end of life.

We must also be concerned of potential consequences of decisions made as we work towards a Juneau that is affordable and a better place to live for all. We must ensure that Bartlett’s Hospice Program is not unaffordable for our aging population or absent from our community again. Placing individuals in situations where they may be faced with the difficult decision of leaving Juneau and their loved ones at the end of life to obtain hospice elsewhere is unthinkable.

We must maintain Juneau's only home health and hospice program that is vital to Juneau's residents, and the initiatives and decisions that will make that possible.

• The Foundation for End of Life Care board of directors are Bruce Weyhrauch, Roman Moytka, Julie Staley, Carrie Pusich, Murray Buttner, Jeffrey Short, Bob Urata, Angela Davis, Laura Kelly, Jennifer Hayes and Kristin Jones.