• What is ‘hospice’?

    With hospice the focus of care changes from curing an illness to managing symptoms. The goal of care is to enable the highest quality of life no matter how long, or short, that life might be. Hospice is comfort care at the end of life.

    Hospice is holistic in nature. Not only is the patient’s physical body treated, but his or her emotional, social, spiritual and cultural needs are addressed as well. In addition, the needs of the whole family are considered. In order to address all of these needs, hospice uses a team approach in providing care.

    Who is eligible for hospice services?

    Hospice care can be provided to patients and their families when a doctor says that a patient most likely has six months or less to live. In addition, the patient has to be ineligible for, or is no longer seeking, aggressive treatment, and in agreement with the hospice philosophy of comfort care and symptom management. What constitutes “aggressive treatment” is often taken on a case by case basis. If you have questions about a specific treatment, such as radiation or chemotherapy, it is best to run it by your doctor or the hospice medical director.

    What are the benefits of hospice?

    Hospice emphasizes quality of life.
    Hospice tries to give back to its patients, to the greatest extent possible, independence and control.
    Hospice aims to make patients as pain-free, as alert, as comfortable, and as active as possible for as long as possible.
    Hospice’s holistic approach addresses the physical, emotional, social, spiritual and cultural needs of patients.
    Hospice supports the whole family.
    Hospice can provide on-call support 24 hours a day every day of the year.

    What does hospice cost?

    Fortunately, if the patient has Medicare A, Medicare pays for 100% of hospice services. Under the hospice benefit, Medicare provides for the services of all of the members of the hospice team. It also covers any durable medical equipment such as oxygen, a hospital bed, or even gloves and other medical supplies that the patient might need. Another part of the benefit pays for any medications that are related to the hospice diagnosis.

    Medicaid programs are operated by individual states, so if you are on Medicaid you’ll need to check on your specific state’s guidelines for hospice. However, in most states the Medicaid hospice benefit is very similar to the Medicare benefit. There can be some differences. For example, in California’s MediCal (that states Medicaid program) there is a limit of 390 days of hospice services covered by their program.

    If the patient has private insurance, you will have to check with that particular insurance company about the patient’s specific policy coverage. Many, if not most, medical insurance policies have a hospice benefit. Sometimes insurance companies that don’t have a hospice benefit, per se, will still pay for nursing, social work or home health aide services if a skilled need is identified and it’s ordered by a doctor. There is almost always someone at the hospice agency that will verify the patient’s insurance coverage and let you and your family know up front if there is going to be any cost or fee for services.

    What if the patient has no insurance? The National Hospice Organization states in their standards that “To the maximum extent possible, the hospice program will admit patients regardless of their…ability to pay for services”. Most hospice agencies will have a social worker help patients locate and apply for possible untapped resources such as Medicaid. Some can work with you on a sliding scale. Most will still send you a bill, but are flexible on what is expected to be paid. Most are willing to work with each individual’s circumstances so that the dying patient gets the care that they deserve. Many hospice agencies, especially not-for-profit agencies, have a fund to assist indigent people.

    Where is hospice provided?

    The majority of hospice care is provided wherever the patient resides, whether that is in his or her own home (or a family member’s), a board and care home, an assisted living facility or a skilled nursing facility.

    Are there different levels of care? What are they?

    The majority of hospice patients in the United States have Medicare. Medicare has recognized that not all hospice patients have the same needs. It has therefore determined four levels of care. Each level of care requires a doctor’s order. However, patients with a type of insurance other than Medicare will have to check with their particular insurance company to verify what is covered and for how long.

    Routine Home Care is by far the most common type of care provided – and the one focused on in this website. Routine home care in hospice allows people to die with dignity in their own home. This type of care is provided intermittently with hospice team member visits made per an individualized care plan that is based on the needs of the patient and family.

    Inpatient Respite Care (respite for caregivers) recognizes that people in the last stage of life commonly need someone with them all the time. Being a caregiver is draining in the best of circumstances, and can sometimes be overwhelming. Sometimes caregivers get sick or injured. Medicare provides respite for caregivers by providing temporary inpatient care for hospice patients at either a skilled nursing facility or an acute care hospital with 24 hour a day RN coverage for up to 5 days at a time. There is no limit on how many times this part of the benefit can be used. Although continuous supervision is provided by the facility that the patient is temporarily staying in, the hospice team will continue to make regular visits.

    General Inpatient Care can be provided for short-term crisis management of pain or symptoms, during active death, or during a home care giving crisis. The patient is taken care of at a skilled nursing facility or hospital with 24 hour a day nursing coverage. The need for this level of care is reassessed daily, but is short term. There are daily RN or MD evaluations, plus other team member visits as needed. A maximum of 20% of patient care days may be provided by general inpatient care.

    Continuous Level of Care provides 1-to-1 care for short-term crisis management of pain or symptoms, or when the patient is actively dying. The care is provided in the patient’s place of residence. This short term care is reassessed daily with the goal of preventing hospitalization. At least 51% of the 1-to 1 care is provided by a nurse (RN or LVN/LPN); the remainder can be provided either by a nurse or by a Home Health Aide. This type of care is provided for a minimum of 8 hours a day.

    What about medical equipment and medications?

    Hospice provides for all of a hospice patient’s medical needs related to symptom management and comfort care.

    Durable Medical Equipment is covered under the Medicare hospice benefit. If not set up prior to admission, the hospice nurse will order and arrange for delivery of whatever equipment the patient needs.

    Examples include:

    • Oxygen
    • Hospital bed
    • Alternating pressure mattress
    • Over-the-bed table
    • Walker
    • Wheelchair
    • Portable commode
    • Shower chair

    Other supplies provided by hospice can include:

    • Incontinent supplies
    • Catheter supplies
    • Mouth care supplies
    • Skin care lotions
    • Dressings and wound care supplies

    Medications: Hospice pays for any medications relating to the patient’s hospice diagnosis. These are individualized but usually include, as a minimum, pain medications, medications for anxiety, constipation or diarrhea and for shortness of breathe. Medications not covered under hospice are paid for in the same way they were paid for prior to the patient starting hospice services. Doctors and nurses arrange for medications with the patient’s own pharmacy. They do not carry medications with them.

    What about alternative therapies?

    Hospice is holistic in nature. As such, many hospices integrate different techniques and therapies outside the practice of mainstream medicine to support hospice patients and their families. Many hospice professionals, especially nurses, have trained in alternative or complimentary therapies. In addition, many people who practice these techniques professionally volunteer their services to hospice clients. Of course, these alternatives are optional for hospice patients. Also, not all the alternatives listed are offered by every hospice agency.

    The following are some of the techniques used to benefit patients:

    • Relaxation techniques – Visualization, guided imagery and
    • Biofeedback
    • Comfort touch, Reiki and Massage
    • Aromatherapy
    • Animal assisted activities
    • Music
    • Creative Expression – Art, Writing

    Do you have questions about hospice? Dawna will be happy to answer you. Please leave them in Comment space below.

    courtesy of www.AllAboutHospice.org

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    Article by: Dawna J. White, RN

    Few months after I graduated with a nursing degree from San Jose State University 24 years ago I did an unknowingly brave thing - I invited my father-in-law to live with us when he was dying. Little did I realize how that experience would impact my future. Most of my career has been in the home health field. About 4 years ago, around the time I turned 50, I became a hospice liaison nurse where I inform people about options in end of life care. I started www.AllAboutHospice.org about a year ago after talking to hundreds of potential hospice patients and their families about hospice and realized that I heard the same questions over and over. My goal is to give people the facts and information they need to make informed decisions about end of life care.

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