First Interview with Jack Gordon
[Note: Mr. Gordon served as Chairman and CEO of HFA until his death in 2005.]
Jack D. Gordon is Chairman of the Board, Hospice Foundation of America. He served as a Florida State Senator from 1972-1992. He was the First Director of the Institute of Public Policy and Citizenship Studies at the Jack D. Gordon Institute of Public Policy, Florida International University.
Q: You served 20 years as a State Senator in Florida. Your district included Miami Beach and the City of Miami. Tell us about your history with hospice legislation.
A: Before the Medicare Hospice Benefit came into being in 1983, I was the Senate sponsor of a bill to license hospices in Florida. That bill was the first in the nation to set standards for hospice care through licensure. Two of the guiding principles of the bill were that when a person entered hospice, he or she could not be denied hospice care due to an inability to pay; and no more than 20% of the aggregate patient days could be spent in a hospital. When the Medicare Hospice Benefit was introduced in Congress, the sponsors used the Florida legislation as a model because it de-emphasized institutionalization.
One significant difference between the state law and the Federal law was that the Florida legislation defined "terminal" as being one year, not six months. Many people do not realize that the current six month limitation in the Medicare Benefit came about purely as a financial compromise to help get the bill passed; it is not based on medical or psychological criteria. That's an important point, and the Florida law still permits a one-year prognosis. It is paying for it that is the problem.
Q: In addition to Medicare, Medicaid covers hospice in 41 states. What specific expansion can you see for the Medicaid Hospice Benefit?
A: The poorest elderly are often in nursing homes under Medicaid. Many of them have had to relinquish their assets to qualify for Medicaid, and many do not have family members close by. Because nursing homes are underfunded, these facilities are often providing less than adequate care, especially at the end of life. Making hospice more available to this population makes sense both out of compassion and financially. Purely in dollars spent, the costs of providing hospice care on a daily basis are less. And the care is comprehensive-medical care, spiritual care, volunteers for companionship-all of which can bring added meaning to these individuals at the end of life. After all, who are the patients in nursing homes? They're our parents, grandparents, aunts and uncles. Why wouldn't we want the best care for them?
Q: Many of the elderly in nursing homes may not have a caregiver or family member to advocate for them; who can help them gain access to hospice care?
A: Well, physicians can help them gain access. Physicians must continue to understand the great benefits of hospice. In 2001, HFA developed the Hospice Medicaid Education Project, which was funded by the Florida legislature to educate doctors to make use of the benefit. We identified doctors who had a large number of Medicaid patients. In addition to educating them about the benefits to their patients, we also wanted to reassure these doctors that they would not lose the connection to their patients by referring them to hospice. The state of Florida was quick to support the project because it was clear that the expenditures are actually less when the patient is in hospice care; there is less likely to be a need for costly measures such as hospitalizations or expensive medications, and the patient load upon the doctor is reduced, because hospice is making the visits, while the attending physician continues to be paid.
(Editor's note: Learn more about HMEP.)
Q: A recent study released by the National Hospice and Palliative Care Organization (NHPCO) supports the cost-savings of the Medicaid hospice benefit. Yet the hospice benefit is threatened in many states examining the Medicaid budget. What are your concerns about this issue?
A: An extraordinary amount of Medicare and Medicaid spending (about 30% of all Medicare dollars) goes to the last year of a patient's life. It stands to reason that hospice care makes sense financially, because much of the other expenditures are then not necessary. Plus, it makes sense for the patient, who receives not only physical but also emotional and spiritual care.
As the former chair of the Appropriations committee in Florida, I find it terribly shortsighted to see legislators considering cutting the hospice benefit. When budgeting, it is critical to look not only at the immediate results of the cut but the consequences over time. Spending the money on hospice care now will save money over time.
Q: What can consumers do to convince their legislators about the importance of hospice care to their community?
A: A few months ago I read a wonderful article in a California paper about how hospice had helped a local family. I clipped it out and sent it to my state legislators to remind them about the impact that hospice has in their communities. State legislators take notice of issues like this when they receive a number of letters or articles from constituents. When the legislature is not in session, hospices should consider inviting legislators to see their programs in action or meet with families.
Another wonderful way to educate all members of a community about hospice care is to host the HFA National Bereavement Teleconference. Lawmakers and their staffs should always be included on the invitation list; hospices that are located in state capitals might even want to explore the possibility of hosting a site at their capital building. We produce the teleconference with two motives in mind-one is to provide a training tool for hospice and other health care workers and volunteers, and the other is to provide an opportunity to bring the community together around these issues. 75% of our Site Coordinators from our most recent program on Coping With Public Tragedy said that the teleconference was a powerful networking and outreach opportunity for their organization.
