215-322-5256Are all hospice services the same?
Yes, and no. According to the Medicare Hospice Benefit, all certified hospices must provide the basic level of routine care. However, the quantity and quality of the services offered at each hospice can vary significantly. It’s best to get a recommendation from someone you know and trust. Or you can call or meet with a hospice representative to inquire about services offered and to ask about the things that concern you most.
Who should make the decision about entering a hospice program?
By law, the patient should make the decision to enter a hospice program with the consent of the treating physician. However, a patient may be unable to make this decision because of his or her failing mental or physical health. In this case, a health care proxy would decide along with a referral by the patient’s personal physician
When should a patient enter a hospice program?
A patient may enter a hospice program once it has been determined that all treatments to cure an illness or disease will stop. Hospice is a philosophy focused on comfort rather than cure. A referral by the patient’s personal physician is typically presented for patients with a life expectancy of 6 months or less.
Will the treating physician suggest hospice?
Not necessarily. You and/or your family members should discuss hospice care together, with clergy, other health care professionals, and the treating physician at any point during a patient’s illness, but especially as the patient’s condition begins to decline.
How would we know it might be time for a discussion about hospice?
A conversation about hospice can happen at any time during a life-threatening illness. However, here are a few things to consider as you begin talking about options.
- Is the patient unable to do things alone such as dress, bath, or eat?
- Does the patient seem frail and failing, always fatigued and/or short of breath?
- Is the current treatment no longer working or helping the patient?
- Are the patient’s doctors out of medical options for treatment?
- Does the patient have multiple and coexisting medical problems?
- Is the patient experiencing increased pain and needing more frequent or stronger medication to control symptoms?
- Does the patient seem detached or disinterested in life/family/friends?
- Does the patient understand his or her illness and express his or her wishes as they relate to dying?
- Is the financial burden on the family increasingly difficult to carry?
If the patient shows signs of recovery, can he or she be removed from hospice and returned to regular medical treatment?
Absolutely. A patient may be discharged from hospice if his or her condition improves or appears to be in remission. If the patient’s condition should once again require hospice, Medicare and most private insurance will allow for this additional coverage.
How does a patient get admitted into hospice?
Usually a hospice company receives a referral from the patient, a family member, a friend, or the attending physician. The hospice must confirm with the patient’s physician that hospice is appropriate for that patient. Some hospices have medical staff available to help patients who don’t have a private physician. Once confirmed that hospice is appropriate, the patient must sign a consent and all related insurance forms. The forms include information such as how the Medicare hospice benefit affects other Medicare coverage.
Who provides the equipment or medications that the patient needs?
Based on an assessment of patient needs, the hospice provider will recommend, and help arrange, any equipment necessary for optimal patient care. As patient needs increase, the hospice will arrange for any additional equipment. The goal is to keep patient care convenient and as safe as possible. Hospice also provides the additional supplies needed for terminal care patients and the medications used for pain and symptom management.
How often does a hospice nurse come to a patient’s place of residence?
A hospice team will conduct an assessment of patient needs and prepare an individualized care plan. The plan will address how much care a patient requires in order to be comfortable and for symptoms to be managed. That is, frequency of home visits vary according to patient needs. However, the hospice will establish regularly scheduled nursing visits, typically 2-3 times a week.
Although hospice does not include 24/7 nursing care, a nurse is on call for emergencies 24 hours a day. If a patient requires more care than what can be provided at home, he or she may consider an inpatient (long-term care) residential facility, nursing home, or hospital with hospice care options.
Although hospice does not include 24/7 nursing care, a nurse is on call for emergencies 24 hours a day. If a patient requires more care than what can be provided at home, he or she may consider an inpatient (long-term care) residential facility, nursing home, or hospital with hospice care options.
Will the patient ever be alone?
Although family and friends offer the most care and company, hospice aims to have someone with the patient as death becomes near. Since no one can predict the exact time of a patient’s death, the hospice usually sends volunteers to provide additional support and company should the primary caregivers not be available.
Who is the hospice team?
Hospice teams generally consist of a physician, nurses, social workers, counselors, home health aides, clergy, therapists, and volunteers.
Will hospice induce death if patient or loved one requests this?
No. Hospice members work to make a patient comfortable and as free from symptoms as possible. They will not postpone or accelerate death. They are simply lending support and providing their specialized training as the dying process occurs naturally.
How does hospice manage the patient’s pain?
Along with prescription and over the counter medications, the hospice team may provide specific devices used for pain and symptom relief, as appropriate. They also consider emotional and spiritual pain as relevant and will therefore address these issues as well. Clergy, social workers, and trained volunteers focus their attention on the emotional/spiritual issues that tend to cause pain for the patient. Physical and occupational therapists are also team members offering additional pain relief through a focus on self-sufficiency and mobility, should they be needed. Most patients reach a high level of comfort and pain relief through the efforts of the hospice team.
Does the patient and/or family have to pay for hospice care?
Hospice is covered by most private insurance companies, by Medicare nationwide, and by Medicaid in at least 47 states. The medications, treatments, and services related to the patient’s diagnosis are paid by the hospice. Medicare and Medicaid always pay 100% of the cost of routine care, including the full scope of medical and support services. Additional services provided by hospice are covered by Medicare Hospice Benefit with little expense to the patient and/or family. The highest co-pay a hospice can charge under Medicaid or Medicare is $5. Most insurance plans and many of the managed care plans offer a hospice benefit, which is similar in coverage to the Medicare benefit. Families should check with their insurance provider for details on exact coverage.
What hospice costs are not covered?
Medicare, Medicaid, and most private insurance will not generally pay for:
- Medications, treatments, equipment and supplies, for conditions unrelated to the life-limiting illness.
- Care from physicians or other health care providers when not arranged by hospice.
- The patient’s room and board if living in a nursing home, or in a hospice residential facility.
- Emergency room visits, ambulance, or inpatient facility care unless arranged by the hospice medical team.
What if the patient has no insurance, Medicare or Medicaid coverage?
The hospice assists families in exploring possible avenues for coverage that they may not be aware of. Should the patient be ineligible for existing government resources, a hospice will provide care for the patient using money from charities/charity fundraisers, memorial donations, or foundation gifts. No hospice patient is denied care.
Does hospice provide any help to the family after the patient dies?
Absolutely. Hospices offer grief and bereavement support for the patient’s loved ones for at least a year after the loss. Counseling is offered to individuals or to the family as a whole. Some hospices offer bereavement support groups that include other families in the community that are grieving a loss.