17. Q - Does Tidewell only take patients with cancer?

Even though a majority of our patients have cancer, each potential admission is individually assessed for appropriateness for our program. We routinely have patients with end-stage congestive heart failure, COPD (Chronic Obstructive Pulmonary [lung] Disease), ALS (Lou Gehrig's Disease), Alzheimer's and other diseases. The key here is the individual assessment and prognosis.

17. Q - What does the Hospice Medicare cover?

The Medicare Hospice Benefit covers nursing care, social services, medical equipment, medications used for pain and symptom control, and consulting physicians' fees relative to the terminal illness and planned by the Tidewell interdisciplinary team. It also covers hospitalization if under the hospice plan of care. The key is relativity to the terminal illness.

17. Q - What's the difference between regular Medicare and Hospice Medicare?

Through the Medicare Hospice Benefit, Tidewell assumes full responsibility for treatment related to the terminal illness. The patient is not billed for these goods and services, and there is no deductible or co-payment.

17. Q - What relationship does Tidewell have with the Hemlock Society?

We do not affiliate with or subscribe to the Hemlock Society or any other similar organization. The essence of the Tidewell philosophy is quality of life. By seeking Tidewell services, patients and families indicate a desire to spend their last days together with dignity, control over their situation and with the patient as free from pain as possible. Tidewell makes this possible. We neither hasten death nor prolong life.

17. Q - Does Tidewell admit patients with AIDS?

We do have AIDS patients whose admission to our program is based on our standard criteria: 1) Residency in Sarasota, Manatee, Charlotte or DeSoto counties, 2) Seeking pain and symptom control rather than curative care, 3) Prognosis of six months or less.

17. Q - Is a living will or Do Not Resuscitate Order (DNRO) needed to be admitted?

Neither is necessary for admission. We do, however, encourage our families to have advance directives. They are also asked not to call 911, but to allow the care of the patient to be guided by Tidewell. This does not mean that the patient can't go into the hospital, but only that it be at the recommendation of the Tidewell team. Heroic efforts to save lives through artificial means are generally not a part of the care program. We do cover the costs of hospital admissions for any Tidewell patient, regardless of ability to pay, when they are related to the terminal diagnosis and within our plan of care.

17. Q - Is Tidewell a religious organization?

Tidewell is not a religious organization, but the nature of our philosophy encompasses spiritual issues. The issue of addressing spirituality is a personal decision, reached by the patient or family. Tidewell always respects the rights of our patients and families on this and all other issues.

17. Q - What's the difference between "curative" and "palliative" measures?

Curative measures are those intended to cure; palliative measures are those that offer pain or symptom control, without curing capabilities. When a patient enters Tidewell, he/she acknowledges that curative measures are no longer appropriate and palliative care is required for comfort.

17. Q - Does Tidewell have patients in nursing homes?

Tidewell does provide services to persons with advanced illnesses who are living in nursing homes. These patients may either be homebound patients who transfer to nursing homes or nursing home patients who are admitted to our program. Tidewell has contracts with more than 40 nursing homes. Patients receive care regardless of ability to pay.

17. Q - What is bereavement support?

Tidewell has a strong bereavement program with full-time grief specialists who facilitate a network of bereavement follow-up for all families. Our practice is to maintain contact with Tidewell families for a year following the death of a patient. Regular phone contact, as well as support groups, are available for any who choose to participate. More intensive one-on-one counseling is also available and all services are free and open to the community.

17. Q - Can Tidewell admit patients who do not have a physician?

Although this situation rarely occurs, there are times when we have a referral of a patient who does not have a physician. Tidewell has two choices at this point: we encourage the patient to seek a physician through physician referral services, or the patient can come under the care of one of Tidewell's physicians.

17. Q - Does Florida have a Hospice Medicaid benefit?

Yes, the state supports Medicaid benefits that mirror the Federal Hospice Medicare benefits.

17. Q - Where does Tidewell get its operating funds?

Tidewell's services are financially supported by Medicare and Medicaid reimbursement, as well as that of some private insurance carriers. Although we depend on third-party payors for the majority of our operating funds, we do have approximately 4% unreimbursed services each year. This deficit is addressed through our fund-raising efforts.

17. Q - Does Tidewell take away the patient's hope?

To the contrary: Tidewell affirms life and regards dying as a natural process. We do not encourage false hopes of cures, but validate the hope of living each day to its fullest with emphasis on human dignity and preservation of the quality and sanctity of life.

17. Q - What if the patient doesn't admit they are dying?

Many patients are not ready to talk about their illness or impending death and that's okay. The patient or family has acknowledged the reality of the advanced illness by seeking Tidewell's services. Tidewell allows each person to establish his/her own level of outward acceptance with the assurance of a strong support system, with or without discussion of death. Rather, they may choose to address their immediate needs as they present themselves.

17. Q - Are all patients over 65 years of age?

Although the majority of our patients are over 65, we do have many patients well under that age. In fact, we have a Children's Program that includes children from birth into their 20s. Individuals of any age who meet admission criteria are eligible for hospice care.

17. Q - Does Tidewell have an in-patient facility?

We are currently in the process of converting all of our hospice house beds to in-patient licensure, which is similar to a hospital inpatient unit, except for the intensity of the services being provided. Patients who have symptoms that can't be managed in their current settings are appropriate for the General Inpatient Unit. Once pain and other symptoms such as nausea, vomiting and delirium are under control, the patient may be returned to his/her home or another suitable facility.

In addition, we have contracts with area hospitals that enable us to provide care for our patients when they are admitted to these hospitals for a problem related to the terminal illness and with our prior knowledge and approval. Patients may also be admitted to Tidewell while in the hospital. We currently have Hospice Houses in Venice, Ellenton, Bradenton, Sarasota, Englewood, Arcadia and Port Charlotte.