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Erika Eckley Helps People Die With Dignity. Here's What She Fears About Health Care Reform

Erika Eckley Helps People Die With Dignity. Here's What She Fears About Health Care Reform
From TIME - June 30, 2017

Kelly Wilkins was 39 years old when she learned she had breast cancer, and 44 years old when the doctors told her she would not get better. She was discharged from Broadlawns Medical Center in Des Moines, Iowa, and moved back home. Hospice nurses took care of her in those final days, thanks to her Medicaid insurance.

Wilkins sister, Erika Eckley, watched how those nurses softened the blows of dying. When Wilkins was too weak to climb the stairs to her bedroom, for example, the hospice nurses installed a medical bed in her living room so family could gather around her.

Theres just a comfort level when youre in your own home versus being in a clinical hospital, Eckley says. Wilkins was able to reunite with her two cats, whom shed painfully missed. She reread her favorite books. The hospice nurses talked to Wilkins mother, who didnt move from her daughters bedside, about the grief of losing a child.

The hospice experience moved Eckley to join the field herself. Today she is the executive director of the Hospice and Palliative Care Association of Iowa. That makes her particularly well positioned to assess some of the personal and public health impact of the Senates proposed health care billwhich would slash federal Medicaid funding by $772 billion, according to the nonpartisan Congressional Budget Office.

Eckley fears that the measure will leave low-income people to die less gracefully, without the pain medicine, counseling and company that hospice care provides. Around 5% of hospice patients are covered directly by Medicaid, according to the National Hospice and Palliative Care Organization. But many patients also receive hospice care in nursing homes, which are reliant on Medicaid funding.

In her Des Moines office, Eckley spends her days preparing and sharing information about services like Medicaid to Iowas 105 hospice locations. Lately, she's been looking at how the federal cuts to Medicaid could play out in her state.

"They could reduce the number of people who qualify for Medicaid by making eligibility more restrictive, she says. The state, in looking to reduce its costs, could eliminate the hospice benefit under Medicaid.

Nursing Homes Strained

She adds a point she says is often overlooked: About 50% of the hospice beneficiaries are in nursing homes. Nursing homes are paid through Medicaid funding, she explains. Nursing homes in Iowa might close if they have more losses coming through the Medicaid funding.

And the death of those facilities could cause widespread damage, she says.

"If rural hospitals, nursing homes and hospices close, those communities are going to die as well, as those are the largest economic engines in a lot of those communities. Once those are gone, they dont come back. So this isnt just about whether or not someone can afford to be in a hospice. This is whether or not we can afford to let our communities languish, just because we dont want to pay for a Medicaid benefit.

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