Sleep Is a Sign of the Dying Process

By Barbara Karnes | August 09, 2023

We tend to forget that life is a terminal illness. We are born, we experience, and then we die. All of living is on the road to death. How is that for a downer?  

The thing is dying is a part of living. Like living, it has stages - a road to travel. The road from birth to death passes through infancy, childhood, adolescence, young adulthood, middle age, old age, and ends at death. This is the normal dying pattern. However, not everyone “plays by the rules” so death can occur anywhere along the life road. Disease can occur anywhere along the life road also.  

Then there is fast death. Fast death is just that: fast, unplanned, no warning, no pattern. Life just ends. No patterns or rules played.

Dying patterns are centered around food, sleep, and socialization. Assess those three areas and you can track the dying process.

In this blog I will focus on sleep. 

Part of the natural dying process from disease is a person begins sleeping more. Starting two to four months before death from disease occurs, a person begins taking an afternoon nap. This progresses to both morning and afternoon naps. Then to both naps plus sleeping in front of the TV in the evening. Before you know it the person is in bed all day, just doesn’t get out of bed, is asleep more than they are awake.  

In a person who is just old with no disease process, the sleep patterns are the same only instead of occurring over a period of months it slowly happens over a period of years. Remember dying can be from just being old. The body is wearing out and is slowly ceasing to function.

As family and caregivers we tend to push our loved one to be active, to get out of bed, to stay awake. Our belief, which is true in most of life, is if we don’t use our body, don’t exercise and stay active, we will become weaker and less able to function. This is not true for someone who has entered the dying process. We have to change our thinking, new rules apply.

Sleep becomes our friend. Our body is like a battery that is losing its charge. Sleep recharges our battery. It doesn’t fix the problem, but for a while it can allow the body to be a little more active. A nap before and after a planned activity may give a bit more energy to enjoy that activity. However, there will come a time in the dying process when the body is simply letting go of the need for being awake. It is letting go if its hold on this planet, of its need for the energy that sleep provides.

The Future of Homecare: Insights from the 2023 HCP Benchmarking Report HHAeXchange

August 15, 2023 (11:00 a.m. MT)

The 14th Annual HCP Benchmarking Report for Home Care, Home Health, and Hospice revealed several opportunities and threats homecare providers are facing today.  Join us on Tuesday, August 15 at 1 PM ET for a discussion with Josh Kondik, VP of Sales at HCP, to unpack the findings and what it all means for you.

NHPCO Regulatory Alert: FY 2024 Hospice Wage Index and Quality Reporting Final Rule has Been Posted

Summary at a Glance

In the 4:15 posting of the Federal Register for July 28, 2023 the FY 2024 Hospice Wage Index and Quality Reporting final rule was posted to the public inspection part of the Federal Register. The rule for fiscal year 2024 includes the following:

Final FY 2024 rate increase: 3.1% which is a 0.3 percentage point increase from the FY 2024 proposed rule. Rates for each level of care are available in the full analysis of the final rule.

• Cap amount: The hospice cap amount for the FY 2024 cap year is $33,494.01, which is equal to the FY 2023 cap amount ($32,486.92) updated by the FY 2024 hospice payment update percentage of 3.1 percent.
• HOPE Tool: CMS states it will provide additional information on the HOPE Tool test results on the HQRP website in fall 2023.
• Update on Future Quality Measure (QM) Development: CMS appreciated the comments on future QM development and will continue to engage stakeholders in the development of measures.
• CAHPS Hospice Survey Experiment: CMS provided an update on a survey-mode experiment and stated any new modes for completion of the survey would be released with detailed information.
• Hospice Certifying Physician Medicare Enrollment or Valid Opt-Out: On May 1, 2024, hospice certifying physicians, including hospice physicians and hospice attending physicians, will be required to be enrolled in Medicare or validly opted-out.

The CMS Fact Sheet on the final rule describes additional details of the rule. Final FY 2024 Hospice Wage Index values were also posted. The FY 2024 Final State/County Rate Charts are available and can now be used for FY 2024 budget purposes. CMS accepted and responded to many of the recommendations NHPCO advocated for in our comment letter.

A full analysis of the Final Rule is available for NHPCO members.

• Any questions can be directed to [email protected] with “FY 2024 Hospice Final Rule” in the subject line.

Bipartisan House Lawmakers Introduce Preserving Access to Home Health Act to Protect Patients from Harmful Home Health Program Cuts

PQHH-NAHC Press Statement
 
New report underscores need for policies to ensure timely patient transition to home health following hospitalization 
 
Washington, D.C. – The Partnership for Quality Home Healthcare (PQHH) and the National Association for Home Care & Hospice (NAHC) today commended Representatives Terri Sewell (AL-7) and Adrian Smith (NE-3) for introducing the Preserving Access to Home Health Act of 2023 in the U.S. House of Representatives. If enacted, the bill would safeguard access to essential, home-based, clinically advanced healthcare services by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing cuts as high as $20 billion over the next decade.
 
“The Medicare home health community strongly supports this legislation and thanks Representatives Sewell and Smith for their leadership on a Medicare issue that truly threatens access to care for the more than 3 million beneficiaries who rely on this care,” said William A. Dombi, President of the National Association for Home Care & Hospice. “The home health community calls on Congress to ensure the stability that patients and providers urgently need. Since Medicare has again proposed deep cuts to home health in 2024, Congress must act to protect the care their constituents prefer and want.”
 
Specifically, the bill is designed to address cuts made to home health by CMS during the implementation of Medicare’s Patient Driven Groupings Model (PDGM) by making the following policy changes:

1. Repealing permanent and temporary Medicare payment adjustments. The bill would repeal the requirement that CMS make determinations related to the impact of behavior changes on estimated aggregate expenditures. The legislation would eliminate CMS’s authority to adjust home health payments based on such determinations under PDGM. This change would take effect, and be implemented, as if it were included in the Bipartisan Budget Act of 2018, which included home health provisions that led to PDGM implementation.
2. Instructing MedPAC to analyze the Medicare Home Health Program. The bill instructs MedPAC to review and report on aggregate trends under Medicare Advantage, Medicaid, and other payers and consider the impact of all payers on access to care for Medicare home health beneficiaries. To verify MedPAC’s calculations, the Commission would be required to make its calculations public. This provision would also add requirements for Medicare home health cost reports to include data on visit utilization and total payments by program.

Read Full Article