Ancillary Services for Your Loved One: When Is Time to Stop?

Ancillary services

Some years ago, an elderly man asked me to do an assessment of his partner’s language ability after he suffered a stroke. It was a reasonable request, but it had a twist. The man was in a hospice and was expected to live for only a few months.

The Role of Ancillary Services

In an era when government officials and medical ethicists question interventions for both ethical and monetary reasons, caregivers are often forced to determine what’s important and what’s excessive.

The dilemma is not just related to end-of-life interventions, but also ones considered “not critical to vital care,” such as the above communication problem.

We often think of ancillary services (e.g., speech-language therapy, physical therapy, occupational therapy, etc.) as ones that take a secondary position in health care. Medical services are considered primary, followed by critical care, then on-going care and a distant last are ancillary services.

Thinking Short-Term

Some insurance companies and Medicare might not see the value of ancillary services when a person goes into hospice or whose life expectancy is limited. The problem is they are viewing these services in terms of long-range goals. For example, will speech-language therapy enable the person to regain necessary abilities to function outside of the home? What is the purpose of occupational therapy knowing within a few months the patient won’t be ambulatory?

The use of long-range goals in accessing ancillary services is short-sighted and ignores the present needs of loved ones. In my thirty years as a speech-language pathologist and eight years as a bedside hospice volunteer, my goal was always to end a session or a hospice visit with answering the question, “Did I do anything today that will make this person’s life better tomorrow?”

The Ethics of Ancillary Services

Framed as a short-term question, ancillary services become ethically and financially acceptable.  For the man who suffered a stroke and was in hospice, I developed strategies the staff and his partner could use to enhance communication. They were essential tools that focused on specific problems.

For example, although he experienced pain, he had no way to indicate to staff members when the pain was increasing or had become unbearable. We used a simple board that depicted a range of pain from “0” to “10” with ten being unbearable. On the “0” area was a picture of a smiling man. On the “10” was a picture of a man howling in pain.

Deciding When to Use Ancillary Services

The strategy worked beautifully for about two weeks until he became comatose. An insurance adjustor may not see the benefit of providing the service given the short amount of time the patient used it. Even though I didn’t charge anything for the service, some might question the practical value of what I did.

For me, the real measure of the intervention was the daily affect it had on the patient.

Ask your loved one what she needs daily that could be helped by the skilled use of ancillary services. For example, being confined to a bed may result in muscle or joint stiffness. Having a physical therapist  work with your loved one might be beneficial even though you know she’ll never walk. Consider the DAILY physical and psychological needs of your loved one.

We often focus more on medical rather than the psychological needs of loved ones. Both should be considered equally important. Ask yourself the question when you face a decision regarding ancillary services,  If I do this, will it help her feel more comfortable, accepting, more joyful, etc. TODAY than if it wasn’t done?  That’s the yardstick to use. 

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