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Hospice Care Policies

Hospice care is offered through Medicare, so there are some government rules and policies involved. Medicare may review a doctor’s prognosis, especially when their patient lives for more than six months after a terminal diagnosis. The Medicare hospice program is only for the very end of life, but there are some growing pre-hospice programs for patients who are getting close to the end-of-life but aren’t quite ready for hospice. Medicare, however, does not yet cover this.

Healthcare isn’t a simple “you will live this long” or “you will live that long.” With rapidly advancing medical abilities and a more acute medical understanding, the face of medicine is constantly changing. Many diagnoses that were once terminal are now being understood and treated, and we are faced with different problems, such as Alzheimer’s or other diseases that can involve dementia. The loss of brain function is a struggle for both the patient and the family—because who are we if we don’t have our memories?

Doctors are constantly faced with difficult prognoses. Many people will develop the same medical issues, but some will live only a few weeks while others will live for several months or even longer. When struggling with the later stages of cancer or heart failure, is there any way to truly put a timeline on life expectancy?

This has led to some patients having to choose between hospital care and hospice care. Some patients may be afraid to enter hospice care too soon. At what point should a patient turn from curative care to palliative care? This is a choice that only the patient can make. If they are able and content moving ahead with curative care, then that’s what they should do.

Hospice is a great option for many terminal patients. We can’t stop death, for it’s inevitable, and what happens after death is another adventure. As one of J.R.R Tolkien’s greatest quotes ends, “all we have to decide is what to do with the time that is given us.” With family, friends, and hospice, patients can live the rest of their days to their fullest with dignity, with comfort, and hopefully with as many smiles and as much laughter as they can fit in.

 

hospice referral

When is Hospice Care Appropriate?

This is a hard question. Since palliative care revolves around comfort and caring, many terminal patients will choose to live out the rest of their lives in the comfort of their own home with the aid of friends, family, and caring hospice employees.

But while more and more people are using hospice, it can sometimes seem like an afterthought. Some patients don’t consider hospice care until they have very little time left. Part of this is disease dependent. Cancer patients, for example, tend to have a higher rate of dying at home under the care of hospice than patients with COPD. This may be partly because with some diseases, predicting the amount of time a patient has left is very uncertain.

Recognizing the many benefits of hospice care can lead to reliable home care treatment instead of living in a hospital. Most hospice care takes place in the home with a family member serving as the primary caregiver and the hospice employees visiting on a regular basis. But hospice is also available at hospitals, nursing homes, assisted living, and hospice facilities.

Therefore, the best answer as to when to begin hospice is to talk to your doctors and hospice representatives. They are trained to help you and guide you, and will understand your prognosis.

Is Hospice “Medicine”?

Hospice isn’t—and never will be—curative care. Instead, hospice care is for the patient who decides to forgo curative care for palliative care. A large variety of specialists are available for hospice care: neurologists, pulmonologists, occupational therapists, nurses, dieticians, home care employees, social workers, ministers, and more. Their job is to help with pain management, comfort care, and symptom management. They are also there to help the family. There is counseling for the patient and the family before death, and also counseling for the family after death.

Hospice care is personalized for each patient and each family. For a family faced with the death of a child who has a severe motor disorder, hospice may help with occupational therapy to help with muscular problems or to help with pain management. The hospice employees will focus their care on the child’s symptoms, both medical and psychological, while helping the family best care for the child and prepare for their child’s death.

For a family faced with a grandfather slipping into dementia, the care will be quite different. Hospice employees will focus on the aspects of life that the dementia is affecting. Since dementia is a symptom, not a disease, hospice will also focus on the origin of the problem, perhaps Alzheimer’s or perhaps another source.

Who Pays for Hospice?

Isaac Asimov said, “Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” Life, while pleasant, certainly has its hiccups and troubles. But when faced with death, instead of worrying about bills, politics, and gas prices, you may have to focus on other questions: What will your family do without you? Have you considered making funeral arrangements? Will you be able to leave your family some money? Do they want your house or should you try to sell it?

While dealing with all of this, medical bills can pile up, as well. Doctors are expensive. Tests are expensive. Medication can be expensive, too. Unfortunately, healthcare generally is just expensive.

However, being terminally ill is the one transition you have to face while living as well as dying. You have to worry about bills and rent, as well as dealing with end-of-life concerns. With so much else to focus on, medical bills shouldn’t be the forefront worry. Your family, your friends, and your health should be your primary concern.

Hospice offers a unique solution for patients with a prognosis of less then six months to live. The hospice care provides palliative care and is often paid for by federal programs.

Hospice

Hospice offers palliative care for not only the patient but also for the family, because it is not only the patient who is suffering.  Most patients pay for hospice through Medicare, and most hospice care is given at the patient’s house, but you can also receive hospice care at places like hospitals, assisted living facilities, nursing homes, and hospice facilities.

Hospice isn’t curative care. Instead, it’s for when the patient decides to forgo curative care for palliative care, which focuses on pain and symptom management to make a patient’s final days comfortable. Many different specialists are available to help with hospice care, including neurologists, pulmonologists, occupational therapists, nurses, dieticians, home care employees, and social workers.

Hospice employees who come and care for the patient on a regular basis at your residence also counsel both the patient and the family.

A patient must qualify for hospice and use a Medicare-certified hospice program to receive all or most state or federal hospice benefits. If you are looking for certified hospice programs, we can help you find care in your area.

Paying for Hospice

There are a lot of options when it comes to paying for hospice. But there is one very important piece of information to keep in mind. Medicare law currently states that a person cannot be refused hospice care because they cannot pay. However, laws can change. Be sure to check this or talk to a Medicare employee to make sure this provision is still applicable. Laws can quickly be changed.

There are several options when it comes to paying for hospice:

  • Medicare
    • To qualify for the Medicare hospice benefit, two doctors must assess the patient and certify that the patient has only six months to live. The patient will then receive two 90-day periods of hospice. After that, the patient must be re-certified every 60 days as terminally ill to continue hospice care. During these periods, hospice covers the care related to the primary disease and may also cover some care that isn’t.
    • Diseases aren’t always predictable, and sometimes predicting the amount of time a patient has left is very uncertain, but Medicare offers one consultation with a hospice employee to talk about hospice and you.
    • You may switch providers only once during each period.
    • If you have qualified for the Medicare hospice benefit, you pay no more than $5 for medications used to manage or treat pain and the symptoms of the terminal illness. And you will only pay 5% of inpatient respite care as long as Medicare approves the payment amount.
  • Medicaid
    • Medicaid is offered for patients receiving SSI (Supplemental Security Income) payments. For the most part, Medicare and Medicaid benefits are very similar. To receive Medicaid-covered hospice care, the Medicare conditions must be met. However, Medicaid programs can vary from state to state, and there is a chance the conditions and benefits may change state to state.
  • TRICARE
    • TRICARE is a health benefits program for military and retired military personnel as well as their eligible family members. To find out whether you are eligible for TRICARE and to learn how to apply, you should contact your regional contractor.
    • TRICARE’s hospice care and structure is very similar to Medicare’s. For example, the benefit periods are the same and you can receive care in your home, a Medicare-certified hospice center, inpatient care, or nursing homes. However, there are no deductibles through TRICARE. The program covers all medical expenses that are related to the terminal illness.
  • Health Insurance
    • Private health insurance benefits often include hospice care, especially in policies acquired through an employer. Read through your policy and be sure you understand what is covered. Generally, the hospice care and benefits are the same for private insurance and Medicare, but again, read your policy and make sure.
    • Medicare also offers private Fee-for-Service plans through private insurance companies. If you have this insurance, they will cover all the hospice benefits while continuing to cover any other services laid out in the plan, such as dental or vision insurance. However, you will still pay the premiums, the coinsurance, and the copayments as written in the plan.
      • If you have a MediGap policy, your hospice drugs and respite care is covered, as well as other problems not related to your disease.
    • As with any insurance policy, read the policy carefully so you have a complete understanding of what is covered and what isn’t, what your coinsurance and co-payments will be, and other benefits or payments that are included. If you are unsure of what your policy entails, talk to the insurance provider or a lawyer.
  • Charity Organizations
    • Since hospice care currently cannot be denied to patients who qualify for hospice but cannot pay for it, a patient who does not qualify for Medicare, Medicaid, or TRICARE may be able to receive help from donations, grants, gifts, or community programs, allowing the hospice facility to offer care without any charge to the patient.
    • Most hospice facilities will have a financial specialist who will help patients find a way to receive hospice care.

Hospice has quite a few options when it comes to payment, because terminally ill patients should not have to wonder if they can pay for their care. The program is meant to comfort and assist both patients and their family. Hospice is—and should be—all about the patient and the patient’s family.

In The Curious Case of Benjamin Button, F. Scott Fitzgerald wrote, “For what it’s worth: it’s never too late . . . to be whoever you want to be.” This is just as true for patients facing death as it is for people facing life. Hospice gives patients the opportunity to live their remaining days to the fullest extent. The hospice program strives to let patients live in comfort with palliative care, but the point is to live. Because sometimes when we are faced with death, we learn to get the most out of life.

Hospice Care Basics

Dealing with death is a scary prospect. When faced with a life-threatening illness, a patient is dealing with both medical and emotional difficulties. This is what hospice is truly for, to help patients and families make it through this difficult time with care, friendship, and hopefully a lot of smiles.

Hospice is unlike any other type of medical care because it’s palliative medicine, which is comfort medicine. A hospice worker is unlikely to be able to save a patient—the very nature of hospice care means tending for those who are facing death. Instead hospice employees do as much as possible to relieve and prevent any suffering and make the last days, weeks, months, or years of a patient’s life as promising and fruitful as possible.

Dame Cicely Saunders was one of the pioneers of modern palliative care. While studying nursing in England during WWII, she saw a lot of pain and death. She realized that terminal patients needed an approach that dealt with both the medical and psychological issues while keeping the patients’ dignity intact. She opened the first hospice hospital with a well-trained medical and palliative care staff. Hospice care quickly grew, becoming the huge field we know today.

So, when it comes to considering hospice care, there are three questions to ask early. Who can apply? What is it really for? When should people contact a hospice provider?

Hospice care plays an important role in our society, especially for the elderly and their families, and palliative care is an important resource for those who need it.

Hospice Terms

Advance Directive

An advance directive tells your doctors and your family what you want for your end-of-life care. Advance directives sometimes take the form of two particular legal documents—a living will or a medical power of attorney. A living will explains what treatments or medical care you want to receive if you are dying or unconscious. A medical power of attorney allows you to name a health care proxy who will make health decisions for you if you are unable.

Animal Therapy

Animal therapy, also known as pet therapy, brings animals to patients to help with social, emotional, or cognitive functioning. This type of therapy is exceptionally good at reducing anxiety, reducing depression, and increasing activity.

Art Therapy

Art therapy can help reduce stress and pain while giving patients a creative outlet.

Bereavement

Bereavement is the state of sorrow when grieving for the death of a loved one.

Capacity

When dealing with end-of-life issues, capacity often refers to the patient’s mental capacity. For example, do they comprehend the care they are receiving and any choices that may be available to them?

Caregivers

A caregiver can be anyone within the support group helping a patient during their illness. Caregivers can include family, friends, and hospice employees.

Curative Care

Curative care is care aimed at curing an illness, such as radiation, chemotherapy, and antibiotics.

Depression

Depression is a mood disorder that is often accompanied by feelings of hopelessness, pessimism, inadequacy, or worthlessness. A depressed patient may suffer from persistent sadness or anxiety.

Do Not Resuscitate (DNR) Order

A DNR is a legal document instructing healthcare providers not to provide CPR in case of cardiac or respiratory arrest.

Healthcare Agent

A healthcare agent is a person who is either named in an Advance Directive or permitted under state law to make medical decisions for a patient who can no longer make competent medical decisions.

Hospice

Hospice provides palliative care aimed at relieving pain and providing comfort for patients facing a terminal illness.

Hospice care providers

Hospice care providers offer palliative care aimed at helping patients in the final phases of a terminal illness. Providers focus on pain management, comfort, and quality of life, rather than curative care. With a team including nurses, doctors, and social workers, hospice providers work to offer patients the possibility of living the rest of their lives to the fullest.

Living Will

A living will is a type of advance directive that details the patient’s treatment desires if they are dying or unconscious.

Medical Power of Attorney

A medical power of attorney is a type of advance directive that appoints one person as the patient’s proxy. This allows the proxy to make medical decisions for the patient if the patient is no longer able to make decisions for themselves.

Music therapy

Music therapy can help with cognitive functioning and motor skills, as well as emotional and social challenges. This type of therapy can lower stress levels, help with depression, and lessen pain. Music therapy can sometimes help Alzheimer’s patients focus and become more responsive.

Palliative Care

Palliative care is aimed at giving the patient the best chance to live life to the fullest by relieving as much pain, suffering, and discomfort as possible. This type of care is not aimed at curing a patient. Instead, palliative care is aimed at making a patient as comfortable as possible.

Respite Care

Respite care allows primary caregivers to take a little time off from their responsibilities. The patient may be institutionalized for a set period of time, or arrangements may be made to provide short-term care at home.

Quality of life

Quality of life refers to a patient’s ability to do what they love and live to the fullest. Some medical procedures can severely hamper quality of life, but palliative care is aimed at making quality of life the first and foremost goal. By focusing on relieving pain and suffering, hopefully the patient can do many of the things they love for as long as possible.

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