What is Hospice?
Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury,
hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and
emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided
to the patient's loved ones as well.
The focus of hospice relies on the belief that each of us has the right to die pain-free and with dignity,
and that our loved ones will receive the necessary support to allow us to do so. The focus is on caring,
not curing and in most cases, care is provided to you in your own home. Hospice can be provided in
freestanding hospice facilities, hospitals, and nursing homes and other long-term care facilities.
Hospice is available to persons of any age, religion or race.
- Hospice focuses on caring, not curing and, in most cases; care is provided in the patient's home.
- Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities.
- Hospice services are available to patients of any age, religion, race, or illness.
- Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.
Each of us has the right to die pain-free and with dignity.
How does Hospice work?
- Hospice care is for any person who has a life-threatening or terminal illness. Most reimbursement sources require a prognosis of six months or less if the illness runs its normal course. Patients with both cancer and non-cancer illnesses are eligible to receive hospice care. All hospices consider the patient and family together as the unit of care.
- The majority of hospice patients are cared for in their own homes or the homes of a loved one. "Home" may also be broadly construed to include services provided in nursing homes, hospitals and prisons.
- Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on-call 24 hours a day, seven days a week.
Who is the Hospice Team?
- Hospice care is a family-centered approach that includes, at a minimum, a team of doctors, nurses, social workers, counselors, and trained volunteers. They work together focusing on the dying patient's needs; physical, psychological, or spiritual. The goal is to help keep the patient as pain-free as possible, with loved ones nearby until death. The hospice team develops a care plan that meets each patient's individual needs for pain management and symptom control.
- It is important to find out what the role of the patient's primary doctor will be once the patient begins receiving hospice care. Most often, hospice patients can choose to have their personal doctor involved in the medical care. Both the patient's physician and the hospice medical director may work together to coordinate the patient's medical care, especially when symptoms are difficult to manage. Regardless, a physician's involvement is important to ensure quality hospice care. The hospice medical director is also available to answer questions you or the patient may have regarding hospice medical care.
The team usually consists of:
- The patient' s personal physician;
- Hospice physician (or medical director);
- Nurses;
- Home health aides;
- Social workers;
- Clergy or other counselors;
- Trained volunteers; and
- Speech, physical, and occupational therapists, if needed.
What services does the Hospice Team provide?
Among its major responsibilities, the interdisciplinary hospice team:
- Manages the patient's pain and symptoms;
- Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
- Provides needed medications, medical supplies, and equipment;
- Coaches the family on how to care for the patient;
- Delivers special services like speech and physical therapy when needed;
- Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
- Provides bereavement care and counseling to surviving family and friends.
In many cases, family members or loved ones are the patient's primary care givers. Additionally, hospice recognizes that loved ones have their own special needs for support. As a relationship with the hospice begins, hospice staff will want to know about the primary caregiver's priorities. They will also want to know how best to support the patient and family during this time. Support can take many different forms, including visits with the patient and family members; telephone calls to loved ones, including family members who live at a distance, about the patient' s condition; and the provision of volunteers to assist with patient and family needs.
Counseling services for the patient and loved ones are an important part of hospice care. After the patient's death, bereavement support is offered to families for at least one year. These services can take a variety of forms, including telephone calls, visits, written materials about grieving, and support groups. Individual counseling may be offered by the hospice or the hospice may make a referral to a community resource.
How is Hospice paid for?
- Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, hospices will work with the person and their family to ensure needed services can be provided.
- More than 90% of hospices in the United States are certified by Medicare. Medicare defines a set of hospice core services, which means that hospices are required to provide these set of services to each person they serve, regardless of the persons insurance.
- Eighty percent of people who use hospice care are over the age of 65, and are thus entitled to the services offered by the Medicare Hospice Benefit. This benefit covers virtually all aspects of hospice care with little out-of-pocket expense to the patient or family. As a result, the financial burdens usually associated with caring for a terminally ill patient are virtually nonexistent. In addition, most private health plans and Medicaid in 47 States and the District of Columbia cover hospice services.
- Sometimes a terminally ill patient's health improves or their illness goes into remission. If that happens, your doctor may feel that you no longer need hospice care and won't recertify you at that time. Also, as a hospice patient, you always have the right to stop getting hospice care, for any reason. If you stop your hospice care, you will receive the type of Medicare coverage that you had before electing hospice. If you are eligible, you can go back to hospice care at any time.
The Medicare Hospice Benefit, initiated in 1983, is covered under Medicare Part A (hospital insurance). Medicare beneficiaries who choose hospice care receive a full scope of non-curative medical and support services for their terminal illness. Hospice care also supports the family and loved ones of the patient through a variety of services, enhancing the value of the Medicare Hospice Benefit.
Who is eligible for Medicare Hospice benefits?
Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions:
- You are eligible for Medicare Part A (Hospital Insurance), and
- Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live, and
- You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness*, and
- You receive care from a Medicare-approved hospice program.
Please note: Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness.
What does Medicare cover?
Medicare covers these hospice services and pays nearly all of their costs:
- Doctor services
- Nursing care
- Medical equipment (like wheelchairs or walkers)
- Medical supplies (like bandages and catheters)
- Drugs for symptom control and pain relief
- Short-term care in the hospital, including respite and inpatient for pain and symptom management
- Home health aide and homemaker services
- Physical and occupational therapy
- Speech therapy
- Social work services
- Dietary counseling
- Grief support to help you and your family
Please note: You will only have to pay part of the cost for outpatient drugs and inpatient respite care.
Respite Care and Medicare?
Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person who takes care of you every day, like a family member. Sometimes your caregiver needs someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice residential facility, hospital, or nursing home.
The Medicare Hospice Benefit does not cover the following:
- Treatment intended to cure your terminal illness. As a hospice patient, you will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services. Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit. Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Under the hospice benefit, Medicare won't pay for treatment to cure your illness. You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, you always have the right to stop getting hospice care and receive the "traditional" Medicare coverage you had before electing hospice.
- Care from another provider that is the same care that you are getting from your hospice. All care that you receive for your illness must be given by your hospice team. You can't get the same type of care from a different provider unless you change your hospice provider.
- Nursing Home Room and Board. Room and board aren't covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.
What will I have to pay for hospice care?
Medicare pays the hospice for your hospice care.
You will have to pay:
- No more than $5 for each prescription drug and other similar products: The hospice can charge up to $5 for each prescription for outpatient drugs or other similar products for pain relief and symptom control.
- 5% of the Medicare payment amount for inpatient respite care: For example, if Medicare pays $100 per day for inpatient respite care, you may pay $5 per day. You can stay in a Medicare-approved hospital or nursing home up to five days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.
Can I keep my Medicare health plan?
Yes. You should use your Medicare health plan (like the Original Medicare Plan or a Medicare+Choice Plan) to get care for any health problems that aren't related to your terminal illness. You may be able to get this care from your own doctor, who isn't a part of the hospice, or from the hospice doctor. When you use your Medicare health plan, you must pay the deductible and coinsurance amounts or the co- payment.
Resource: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. Publication No. CMS 02154. Revised July 2003
How do I begin receiving hospice services?
Anyone can inquire about hospice services. You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice.
Hospice can begin as soon as a 'referral' is made by the person's doctor. The hospice staff will then contact the person referred to set up an initial meeting to review the services the hospice will offer and sign the necessary consent forms for care to begin. Usually, care is ready to begin within a day or two of a referral. However, in urgent situations, service may begin sooner.
When is the right time to ask about hospice?
Now is the best time to learn more about hospice care and ask questions about what to expect. Although end-of-life care may be difficult to discuss, it is best for loved ones and family members to share their wishes long before it becomes a concern. This can greatly reduce stress when the time for hospice becomes apparent. By having these discussions in advance, uncomfortable situations can be avoided. Instead, educated decisions can be made that include the advice and input of loved ones.
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