Services Hospice Care
- Hospice Eligibility
- Types of Service
- Maximizing Hospice Care
A general description of the word Hospice is a program or facilities designed to meet the physical and emotional needs of people who are in the last stages of a terminal illness and are not expected to recover. It is also called palliative care or terminal, end of life care.
The term “hospice” can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948 and eventually went on to create the first modern hospice St. Christopher’s Hospice in a residential suburb of London.
Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University. Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care. This lecture launched the following chain of events, which resulted in the development of hospice care as we know it today.
Read more at http://www.nhpco.org/history-hospice-care
Generally, hospice eligibility requires two main factors.
1) Your condition is considered incurable. This is called a terminal illness.
2) Your doctor has stated that your life expectancy is 6 months or less. Generally, you’re old primary doctor, as well as the medical director or physician member of a hospice team confirm you have a short life expectancy.
It can be hard for doctors to know how long a person will live. Some people live longer than expected. If you live longer than 6 months, you can continue on hospice, if the doctor recertifies your hospice need. If your illness gets better, you can stop receiving hospice care.
Today Hospice is provided using the Hospice Insurance Benefit. It replaces all general medical insurance coverage you had before. When you enroll in a Hospice Program you automatically get dis-enrolled from your Medicare insurance. You will no longer be able to visit your own private physicians, get treated in the hospital or receive medical testing such as x- rays, blood work and restorative Home Care like physical and occupational therapies as you did before dis-enrolling from your Medicare insurance.
When you enroll in a Hospice Program it is very important to be sure you or your loved one is in the final stages of life and would not benefit from being able to utilize their traditional Medicare insurance for regular heath maintenance.
Types of Hospice Service
Hospice has brought comfort and peace of mind to many people across the world. While the idea and premise of Hospice is a good one, it is important to have a true understanding of the types and amount of services that are available through Hospice Programs and how it is paid for.
Usually, Hospice care is provided in the home setting, but it can also be provided in Residential Care Homes, Assisted Living Facilities and Retirement Communities where you may have already established a care team to provide the day to day assistance with personal care and activities of daily living (ADL’s) that Hospice does not provide. Many Hospice Programs have an in-patient unit where patients can go for short periods of time, generally less than a week, for heavy care needs that the hospice team cannot provide in the home environment.
Hospice offers the services of a registered nurse (RN), Certified Nurse Aides (CNA’s), Social Workers (SW), Spiritual Advisers, Medical Doctor (MD) and sometimes community volunteers. The services are largely coordinated by the nurse who makes weekly visits, but can visit more frequently if needed. CNA’s provide assistance with personal care, like bathing and dressing, but only for an hour or 2 per day or a few times a week. Hospices, in general, are not able to provide all of direct custodial care that a dying person needs. The family is responsible for providing the direct assistance with personal care or will need to hire additional care givers at an added expense. Often families are not able to provide the extra care services that are needed or afford to pay privately for additional in home services through an agency. In these cases they may benefit from the family atmosphere and supportive care teams often found in Residential Care Homes. Social workers and spiritual advisers are available for guidance with emotional needs and assessing if other issues need to be addressed.
All the services of a hospice program need to be approved by the Hospice Doctor, but in general the Hospice Doctor making the decisions and directing the care of the patient will infrequently meet or evaluate the patient in person. The doctor’s role is more of a distant coordinator of care. It is the nurse who provides the clinical assessments and communicates the information to the hospice doctor. In addition, it is likely that once you are on a Hospice program you will likely have to sever your relationship with your own doctor, who knows not only your health history but your personal history, as well. We believe finding the right care team who are willing and able to provide continuity of care is vital to the emotional, spiritual and physical aspects of the care and therapy that Dr. Saunders dedicated her life to developing and sharing with the world.
Hospice Care Costs
Hospice is a benefit paid and provided through part of Medicare. Other private insurance companies may or may not offer an insurance Hospice benefit. Once you sign up for the Hospice benefit, you are no longer able to use you traditional Medicare or insurance for your health care needs.
The Hospice benefit does pay for the limited services of the Registered Nurse (RN), Certified Nurses Aid (CNA), and Social worker (SW) and Spiritual Advisers. Supplies such as diapers, gloves and medical equipment are also covered.
Costs of “Comfort medications”, which are usually pain medications or medicines that provide relief of symptoms causing discomfort are paid for through the hospice benefit, but Medications for other conditions like diabetes, hypertension etc. are usually not covered. These medications continue to be covered under your Medicare part D coverage, as they were in the past.
Once you are enrolled in Hospice you no longer have access to any other health care services, such as your private doctor or specialist doctors- cardiologist, eye doctors and others. Recent changes have added in a hospice care modifier but many doctors are not familiar with this. Restorative services such as Physical Therapy, Medical testing or Laboratory testing are usually excluded as well, except in rare cases.
Hospice Programs get paid from Medicare Hospice Benefit. That turns out to be more of a fixed amount per day and a lump sum. They get paid the same amount per day regardless of the number of hospice staff that visits you. Their reimbursement in general is less dependent on the number visits than traditional Medicare, which is paid per visit or service event. The hospice company needs to provide all of the services within that budget; visits from RN, CNA’s, SW, Spiritual Advisers, Medications, supplies (diapers, gloves) and medical equipment.
Maximizing Hospice Care
Hospice can be a good choice when one has reached the last stage of life. It helps the family come to terms with the reality of their loved ones condition. But even with a Hospice program many people need more support and continuity of care.
Often Hospice programs run into similar challenges as many Home Care Agencies, being unable to provide consistency and continuity of care with staff that changes frequently, including nurses and CNA’s. Having to constantly worry about who is coming to the home and having to reeducate the worker on the intricacies, special care needs and preference related to our frail and sick patient adds a whole level of stress and anxiety during an already difficult time.
Having a consistent care team of nurses, caregivers, doctors etc. allows for the best quality and continuity of care. Building and maintaining relationships is the key to providing and receiving quality personal care assistance and continuity of care. These relationships are most important in the last chapter of life, when we are the most vulnerable and need people around us who know our likes, dislikes and what makes us feel good.
Hospice services might best be utilized, as an additional element to a well-established care team. Having a trusted, well developed care setting and team that have the ability to provide all levels of care and continuity of care, before the need for hospice arises makes the transition that much easier because the relationships and trust between the team members has already been established, reducing the amount of stress and anxiety during this difficult transition period.
We believe taking the time to set up the right care team and building trusting relationships with all members of the care team, will help to make each stage of the last chapter of life the best it can be, by providing comfort, support and peace of mind, not only to the person receiving the care but to the whole family.
We realize that most of us are never really prepared for the circumstances that arise that force us to get personal care assistance or choose Senior Care setting for our loved ones. It’s hard to know all that is involved in providing this special care in the last chapter of life.
We hope, by reading this and the other pages on our site, it might help people to stop and think about planning ahead for these most delicate moments in our lives. Having the right information and planning ahead of time is the best strategy, even if it is not needed today, it is best to have the plan in place for the future when these decisions will inevitably need to be made.
Links to care settings that serve as a base care option upon which to use the insurance hospice benefit: Assisted Living, Residential Care Homes, Home Care, Home Health Care, Dementia and Alzheimer’s Care.