Once a terminal diagnosis is given, everyone in the family needs special care and that special care and support typically comes from a hospice provider. When a family member or senior receives a terminal diagnosis, everything changes for both the senior and their support structure.
What Is Hospice?
According to the National Hospice and Palliative Care Organization, hospice care provides end-of-life care for a terminal individual. The approach to hospice care is holistic meaning that it involves a team of professionals to provide this type of service. Physicians, nurse practitioners, home health providers, social workers, ministers, and family members are all typical to a hospice team.
The goal of hospice care is not to treat a patient who has been diagnosed with a serious illness or chronic condition. It is to provide compassionate care that meets a variety of needs when a person has less than six months to live. With the team's coordination hospice offers spiritual and emotional support, in addition to pain management and medical treatment. Ultimately, hospice is intended to give individuals the right to die with dignity and without pain. Therefore, when a senior elects to receive hospice services they forgo the right to receive further treatment or cures for their condition.
Hospice Care vs Palliative Care
Hospice care is often confused with palliative care, but these are not the same types of senior care. That is because both types of care involve a team of individuals working together to support an individual with serious illnesses. However, palliative care begins when a patient starts receiving treatment for a condition, such as cancer or kidney failure. With palliative care, the goal is to provide comfort with a holistic approach while the patient continues with treatment.
Hospice Care vs Comfort Care
Comfort care is just another term for hospice care that may be used by a medical doctor or nurse. They may refer to end-of-life care as comfort care because that is essentially what hospice is—providing comfort for the individual rather than treatment for their illness.
When Should Hospice Care be Considered?
Since the purpose of hospice care is to provide comfort at the end of life during a terminal illness, the decision to receive hospice services is major. Once a patient is in hospice, they are no longer eligible to receive any medical treatments or cures to help them recover from their illness or condition. The only medical treatments they will receive are those involved in pain management and patient comfort.
Admission Criteria for Hospice
In other to receive hospice care, the patient must be diagnosed as terminally ill by their medical provider. Depending on the health insurance provider, such as Medicare or private health insurance companies, there may be additional requirements for getting placed in hospice care. Seniors need to reach out to their insurers to find out if this is the case. Following such requirements is necessary; otherwise, the patient may not have full coverage for their hospice care.
Types of Hospice Care
Nursing Home Hospice Care
Nursing homes can provide hospice care services. Yet a nursing home is not a hospice care facility. Seniors living in nursing homes are provided with a place to live while receiving treatment or long-term care. In the instance that a senior is no longer responding to treatment and is determined to have fewer than six months to live, a hospice team is assembled for this end-of-life care. Therefore, individuals who are receiving hospice care can remain in a nursing home.
In-Home Hospice Care
Yes, seniors who live at home can receive hospice services where they live. The senior does not have to move into a hospice care facility. For individuals who prefer to pass away at home, this offers the greatest comfort. In fact, trying to transfer an individual at the end of their life from their home to a medical facility is typically the last resort. Instead, hospice nurses can work with home care providers to give the senior comfort in their home environment.
A team of church leaders, family members, and medical doctors will work with the hospice nurse to provide care for the patient in their home. If the senior needs emergency medical care or services that are considered vital for their comfort, they may be taken to a hospital. Depending on the medical condition the patient may pass while in the hospital. However, this is solely determined by the senior's health care needs and comfort level.
Hospice Services and Benefits
Hospice care providers offer an array of services to patients. This can include caring for the senior in their own home, as well as providing them with medical appliances and supplies in their home, such as hospital beds and wheelchairs. Hospice services may also include social services and counseling, in addition to a homemaker and home health aide to provide daily care needs. Physical therapy, speech-language pathology, and occupational therapy may also be included and covered by insurance including Medicaid. However, these therapies can only be used in the context of providing comfort to the patient and not to provide a cure or treatment.
When a senior is placed in hospice care, a team is assembled to provide comfort and care for the individual. This team includes a hospice nurse and a medical doctor, both of whom are available 24/7 for questions or in the case of assistance. There will also be someone who is with the patient all of the time. For example, a home care nurse may be with the patient from 8 am to 8 pm, after which a family member spends the night with the patient. For seniors who are living in a nursing home or hospice facility, they will be under the constant supervision of the organization staff.
Since hospice care is focused on end-of-life care, it generally focuses on managing pain for the individual. The hospice team will also do whatever they can to provide comfort to the person. For example, if the senior is struggling with their spirituality or concerned about what will happen when they pass on, a clergy leader or member of their own church will visit with them to answer their questions and provide spiritual guidance.
If the patient wants to see all of their family members before they die, the team will do whatever they can to make this happen. For instance, they may provide video conferencing or telephone calls to accommodate communications with individuals who are out of town or unable to come to where the senior is living. The hospice team is focused on meeting any of the needs that the patient has to insure they are comfortable and able to die with dignity.
The Cost of Hospice
According to Medicare, hospice care cost an average of $153 a day in 2010. As noted, hospice services are provided for individuals with less than six months to live. Based on that information, the maximum average a person's hospice care would cost is $27,540. However, the American Hospice Foundation states that most individuals do not have to pay for hospice care.
The cost of hospice care is covered by Medicare, Medicaid, or the Veteran's Administration depending on the individual. There are exceptions including if the individual is under 65 and not yet on Medicare. In this case, if they are low income they may apply for Medicaid. In addition, private health insurance benefits typically cover hospice services.
For individuals who do not have adequate benefits or health care coverage, there is another option to pay for care. Contact the hospice care providers in your area to see if they will offer discounted or no-cost care. It is typical that many hospice care facilities have charitable funds or sliding scales that help reduce the amount patients' families have to pay for this type of care.
Does Medicare Cover Hospice?
Yes, Medicare will cover all hospice care costs if the senior meets the requirements. They must be diagnosed as terminal and have less than six months to live. In addition, a senior must be at least 65 years old in order to qualify for Medicare. They will also need to be enrolled in Medicare coverage to use these benefits for hospice care.
There are also specifications about how to proceed with hospice services so they are covered by Medicare. For starters, if your hospice provider determines the patient needs to go the hospital, the hospice care nurse or doctor has to contact the hospital to arrange for care. Then the hospice provider works with the hospital to receive their payment via a contract. If you go to the hospital without the consultation of the hospice administrator, then you may have to pay for the care out of pocket. Find out the details about how Medicare provides coverage before you make any medical decisions that are to be paid for with your benefits.
Does Medicaid Cover Hospice?
Yes, Medicaid does cover the costs of hospice care. Medicaid is a social health insurance benefit that is available to low-income seniors who would otherwise be unable to afford health insurance, such as Medicare. When using Medicaid, benefits pay for hospice care according to various levels of care. These include:
- Routine home care
- Continuous home care covers nursing care during a medical crisis
- Inpatient respite care for short-term care that provides relief to family members or loved ones taking care of the individual
- General inpatient care, which also includes short-term care but covers pain management services not covered by other insurance benefits
Medicaid also pays for a service intensity add-on, which was introduced in 2016. This service add-on is to cover nurse and medical care for the last seven days of a patient's life.
The amount that Medicaid pays for regarding hospice care varies each year. The Medicaid hospice rate for 2018 is as follows for the daily rate of coverage:
- Routine home care $193.03 for the first 60 days and $151.61 for the days following
- Continuous home care $976.80, which breaks down to $40.70 an hour for 24 hours
- Inpatient respite care $181.87
- General inpatient care $743.55
- Service add-on $40.70
This amount will vary if the hospice service provider has not provided quality data to the Medicaid office in the previous year. Among those service providers, the amount of reimbursement is decreased by $1 to $4 per day.
To find out if Medicaid will cover hospice costs, find out how much the care will cost for hospice per day throughout the maximum six month period. In the instance that Medicaid does not cover all of the costs per day, request financial assistance for the remaining amount from the hospice facility.
How Long are Patients in Hospice For?
As noted, hospice is only available to patients who are diagnosed as terminal and with less than six months to live. As a result, the typical time frame is anywhere from one day to six months.
Can a Patient be Released From Hospice Care?
In some instances, patients may be placed in hospice and then they begin to see improvements without treatment. It is possible to be released from hospice care in this situation. In that case, the patient will need to report to their insurance provider that they are no longer receiving hospice care. Depending on their health situation, they may return to receiving treatment that is covered by their insurance.
How Do I Find Hospice Care Near Me?
It is easy to find a hospice care provider near you. Here are two reputable sites that offer hospice locator tools to aid you in your search:
- National Hospice and Palliative Care Organization
Search for hospice services according to location or by the name of the provider. When you use the NHPCO search tool to find hospice care you get an extensive profile of each organization. This includes program information, facility details, and palliative care options. Medicare provides survey results from patients of the hospice care providers.
For example, you can see how well the care provider scored on how prompt they gave patients treatment when short of breath. A good idea is to choose a hospice care service and search for it using both the Medicare and the NHPCO tools. Then you can get a wealth of information to help you make the most confident choice in deciding which hospice provider to use.