April 8, 2011

USA: None of us can avoid paying taxes, and none of us can avoid dying.

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EUREKA, California / Times-Standard / April 8, 2011

My Word: Death and taxes

By Marylee Bytheriver / For The Times-Standard

”Nothing is certain but death and taxes.” That phrase comes to mind in April when we are all thinking of taxes.

As unpleasant as it is to think about taxes, at no time of the year do any of us want to think about death -- either our own or the death of a loved one.

Still for when the inevitable occurs, it is comforting to know that end of life hospice care doesn't cost anything. It is a little known fact that for most of us, hospice care is a Medicare benefit we have already paid for through those pesky taxes.

Last year, the father of a friend of mine was nearing the end of his life. Paid caregivers helped her exhausted step-mother care for him at home. When my friend suggested enrolling her father in hospice, her step-mother said they couldn't afford any more help. She just did not believe that hospice would not cost anything, and in fact would save them money by paying for medications for which the family was paying significant co-pays. Only when my friend guaranteed to pay all of the cost of hospice did her step-mother agree. My friend knew, of course, what her step-mother subsequently found out -- hospice care is completely paid for by Medicare, including home visits by a doctor and nurses, social workers, chaplains, and home health aides. By enrolling in hospice, her father got the care he needed to stay comfortable and free of pain, her step-mother received support and respite, and the family did not have to pay for any of the costs associated with the terminal diagnosis including medications and medical equipment such as oxygen and an electric bed.

Illustation by courtesy of Hospice of Humboldt

My friend's father, like most people who are dying, was elderly, and therefore was receiving Medicare -- the tax-supported health insurance for Americans 65 years or older. At Hospice of Humboldt, about 85 percent of our patients have Medicare.

Unfortunately, sometimes younger people also have life-limiting conditions. Medi-Cal pays for hospice care for low-income patients who are not old enough for Medicare. So does Blue Cross, Blue Shield and other private insurance programs. Even the VA pays for hospice care for qualified veterans.

At Hospice of Humboldt, about 1 percent of our patients are not covered by any of these insurance programs -- people who earn too much to qualify for Medi-Cal, are too young for Medicare, and do not have job that provides health insurance. For private pay patients such as these, we have a sliding fee scale based on income.

All our patients and families receive the same full range of heartfelt services -- medical care and personal care for the patient, support and comfort for the family during the patient's final illness, and grief support services both before and after the patient's death.

None of us can avoid paying taxes, and none of us can avoid dying. But at least we don't have to pay for receiving expert, compassionate hospice care at the end of life. For most of us, our taxes will pay for hospice care.

Marylee Bytheriver is the executive director of Hospice of Humboldt.

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