A growing number of home care agencies are claiming to provide hospice care without being credentialed hospice agencies. Hospice is a very important service during an important time of life. To receive actual hospice care, it is vital that families receive service from a real hospice agency.
How to Know if an Agency is a Real Hospice Agency
One of the easiest ways to know if an agency is a credentialed hospice agency is to see if the agency is listed in Medicare’s Hospice Compare. Medicare pays for the majority of hospice care, so most hospice agencies are Medicare certified. If you have Medicare, this test will be all you need. Even if you are not paying with Medicare, Medicare certification is a reliable credential when choosing a hospice agency.
A few credentialed hospice agencies are not Medicare certified. If you are not paying with Medicare, one of these agencies may be okay for you. In these cases, one option would be to ask for the agency’s state license number and then check that license number on the website of the state department of health. You may find that the agency is actually licensed as a different provider type.
Who Claims to Provide Hospice Care When They Do Not?
One of the biggest areas of concern is non-medical home care agencies or private-duty nursing agencies listing “hospice care” among their services. Only agencies licensed for hospice care actually provide hospice care. In fact, it may be a violation of state law for a non-medical home care agency to claim it provides hospice care when it is not licensed for that service. A non-medical home care agency may be providing in-home aide services for clients with a terminal disease, but aide services are only one part of hospice care. This falls very short of a full hospice program and should not be described as hospice care or even palliative care.
Tell tale signs that a non-medical home care agency is incorrectly listing hospice care among their services:
- They ask families to pay directly for care. Actual hospice agencies bill Medicare or health insurance for services, and Medicare pays certified hospice agencies 100% of allowable charges.
- In their list of services, they list primarily non-medical supportive services such as bathing, medication reminders, cooking, and cleaning.
Palliative Care Does Not Mean Hospice Care
All hospice is palliative care, but not all palliative care is hospice. Another area of confusion may be when Medicare-certified home health agencies offer palliative care programs. These are very important programs that can help people who don’t qualify for hospice because they are still receiving curative treatments. However, they should not be conflated or confused with hospice. Medicare-certified home health agencies are very professional operations. They generally do not use the word “hospice” incorrectly in their marketing, but there is still room for confusion between a home health palliative care program and true hospice.
Signs that your home health program is not hospice:
- Care is available during treatments intended to cure the disease.
- The patient has to meet homebound criteria. Medicare’s hospice benefit does not require homebound status.
- The agency is not offering help from volunteers or chaplain services.
Not All Hospice Agencies Have the Word “Hospice” in the Name
All agencies with the word “hospice” in the business name will be credentialed hospice agencies, but not all hospice agencies will have the word hospice in the name. Occasionally, a very good, Medicare-certified agency will have home health, home care, or palliative care in the company name.
Why It’s Important to Receive Care from a Medicare-Certified Hospice Agency
The Medicare hospice benefit and true hospice agencies are designed specifically for the needs of both patients with advanced terminal disease and their families. While there is overlap between some services in the hospice benefit and services from other home care provider types, the hospice program is unique. Here are some of the important advantages associated with a true hospice program.
- A hospice program is prepared for the unique emotional and spiritual support related to end-of-life care.
- Unlike non-medical home care agencies, hospice will provide direct medical care including nursing, speech therapy, occupational therapy, medication administration, etc.
- Medicare pays 100% of allowable charges for hospice care. There are no direct expenses to the family for covered services. That means no copays and no deductibles.
- The hospice benefit covers not just nursing and therapy services but also medications, supplies, and equipment related to the hospice diagnosis. The home health benefit does not cover medications or equipment. These items will be subject to normal cost sharing under the home health benefit.
- Hospice programs commonly incorporate the services of volunteers to help with companion care and other services to improve quality of life.
- Hospice programs commonly have a chaplain available if wanted.
- Hospice nurses are highly experienced in the management of pain and other symptoms related to end-of-life care. Unlike home health, in hospice, patients are often allowed to increase their symptom-relieving medications.
- Hospice provides bereavement support for families after a patient passes.