10 Things You Need to Know About Hospice Care

Hospice care is a unique concept that can be difficult to understand. Hospice supports people near the end of life by:

• Developing individualized care plans focused on each patient’s goals and wihes.
• Managing symptoms and pain
• Improving quality of life
• Encouraging patients and their families to make the most of their time together

At First Choice Hospice Care, Inc., hospice care is inclusive and designed to meet the unique needs of diverse patients facing a broad array of advanced illnesses, medical conditions, and accompanying symptoms.

Once a patient is deemed eligible for hospice by their physician, the transition can start as soon as they—or the person who is designated to make healthcare decisions on their behalf—agrees to transitions from a curative focus and begin hospice services.

Whether you’re a patient, family member, or clinician who treats patients with advanced illnesses, having correct information about hospice services can help you make the best decisions about whether hospice care is appropriate.

These are some of the most important facts you should know about hospice care:

1. Hospice is for people with advanced illnesses. Hospice provides symptom and pain management for patients with serious illness, no matter their age, culture, beliefs, or cause of illness.
2. Hospice can happen anywhere. Hospice is a service that comes to the patient in the place they prefer to be for end-of-life care. Patients at home feel better surrounded by the faces and things they know and love.
3. Hospice is a choice. Patients can leave, or “revoke their hospice status,” at any time for any reason. Patients can also come back to hospice at any time, as long as they meet hospice eligibility guidelines.
4. Patients can keep taking some medicines while on hospice. Hospice patients are prescribed medicines that manage the symptoms of their advanced illness and improve quality of life.
5. Hospice gives medicines as needed to help with symptoms. Hospice doctors try to give just enough medicine to manage symptoms and ease pain.
6. Family or friends provide care with support from the hospice team. Family or friends are a hospice patient’s primary caregivers, supported and trained by an expert team that makes regular, scheduled visits. For patients who live in assisted living communities and nursing homes, the hospice team works together with the facility staff.
7. There is no limit to the time a patient can be on hospice. Hospice is for patients who have 6 months or less to live according to a doctor, and it can be extended when needed. In surveys, family members often say, “we wish we had known about hospice sooner.”
8. Hospice provides home medical equipment and supplies related to the cause of the illness. This includes shower chairs, oxygen tanks, hospital beds, toileting supplies, and more.
9. Hospice supports the family. After a patient passes, hospice addresses emotional and spiritual pain suffered by loved ones for more than a year.
10. Most hospice patients do not have any out-of-pocket expenses. Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patient’s illness, with no deductible or copayment. Private or employer-provided health coverage can vary. Check with your insurance provider for details about hospice eligibility, coverage, and out-of-pocket expenses. Medicaid provides hospice coverage, but it varies by state.

Hospice care provides the most meaningful improvement to quality of life when it begins sooner in a patient’s disease process rather than later. First Choice Hospice Care, Inc. recommends these conversations begin as soon as a serious diagnosis is made. Patients can ensure that they receive the care they want—and when they want it—by having early and ongoing discussions about their care goals and preferences with their family, physicians, or facility staff.

Physicians can help patients understand their options and identify their preferences during advance care planning sessions and goals-of-care consultations. These Medicare-reimbursed discussions result in advance directives, medically binding documents that indicate how a patient should be treated, under what circumstances they should be resuscitated, who can make medical decisions on their behalf, and more.

Everyone over the age of 18 should have an advance directive to maintain control over their care in case they become unable to speak for themselves. Advance directives include living wills, durable/medical powers of attorney, a Five Wishes document, physician/medical orders for life-sustaining treatment, and other important documents.

When considering hospice care for oneself or a loved one, understanding a potential provider’s capabilities, history, and philosophy will enable a more confident care decision. These questions can clarify whether a provider is a good fit for a patient:

• How are hospice costs covered? Does the provider accept Medicare, Medicaid, VA benefits, and private insurance?
• What levels of care are provided? How often will care team members visit that patient at home?
• What is the admissions process? How quickly can care begin?
• What happens in the case of an emergency or an episode of aggressive symptoms? Does the provider offer 24/7 support?
• Can the provider manage complex symptoms at home? Do they offer specialized services for respiratory disease, dementia, cancer, heart disease, sepsis, HIV/AIDS, etc.?
• Is population-specific care available for veterans, LGBTQ patients, religious minorities, etc.? Can the provider accommodate and honor specific religious or cultural traditions?

First Choice Hospice Care, Inc. is guided by a core value: “Patients and families come first.” Every First Choice Hospice Care, Inc. service is designed to surround patients, their families, and caregivers with support that elevates quality of life, manages their symptoms and pain, and ensures comfort and dignity during one of life’s most difficult—but meaningful—periods.

Once a patient is ready to consider hospice care, First Choice Hospice Care, Inc. can typically conduct an eligibility assessment within 24 hours and, if appropriate, begin an immediate transition to our services, day or night, even on holidays and weekends.

This always-available approach defines our entire care model. Clinical support for patients, families, and caregivers is never more than a phone call away.

A First Choice Hospice Care, Inc. interdisciplinary care team is assigned to each patient, working from an individualized care plan built around the patient’s unique needs, goals, and preferences.

Members of the team—including a physician, nurse, aide, social worker, chaplain, volunteer, bereavement counselor, and other specialists—will visit routinely to manage the patient’s clinical, psychosocial, and spiritual symptoms. Visit frequency depends on the needs of each patient and family.

Upon the patient’s death, their family is given the space and support they need to process their loved one’s passing. Spiritual staff and other members of the care team can be present to assist with end-of-life rituals, funeral home arrangements, and the challenges of grieving.

For at least 13 months after the patient’s death, First Choice Hospice Care, Inc. bereavement specialists continue to help the family navigate their loss through personal check-ins, grief support groups, and other practical measures.

Medicare Hospice Benefit coverage includes everything involved in hospice care, from visits by a nurse, physician, and other healthcare professionals, to therapy, medication, and supplies. Here is the complete list of services:

• An interdisciplinary team of hospice professionals
• Home medical equipment
• Medication
• Respite care
• Continuous care
• Inpatient care
• Routine home care
• Bereavement support

While most hospice care is covered under the Medicare Hospice Benefit, it does not include the following items:

• Curative treatment, including any prescription drugs related to curative treatment.
• Emergency department care not related to the patient’s terminal diagnosis or not arranged by their hospice provider.
• Costs associated with room fees or rent for assisted living facilities and nursing homes as well as food. This includes mortgages or rent and food for patients living at home. (These items are covered for hospice patients who are experiencing a medical crisis due to symptom exacerbation and are staying in an inpatient unit (IPU) for the short term.)

To be hospice-eligible, a patient must receive a diagnosis of a terminal illness from a physician, with a life expectancy of 6 months or less if the illness follows its normal course. However, sometimes patients live beyond this 6-month period.

If the hospice medical director/physician determines that the patient is no longer terminally ill with a prognosis of six months or less, they must discharge the patient from their care to the community.

If the patient’s terminal illness continues, they can be recertified for hospice. The Medicare Hospice Benefit covers an unlimited number of 90-90-60-day recertifications as long as the patient remains hospice eligible.

Patients’ physicians are involved in the recertification process as they continue to monitor patient status and prognosis.

The Medicare Hospice Benefit covers end-of-life services related to a patient’s terminal diagnosis in whatever setting the patient calls home, whether that’s a traditional residence, an assisted living facility, or nursing home. Wherever hospice occurs, all services related to the terminal diagnosis are covered up to 100% by Medicare Part A.

If the patient’s symptoms cannot be managed by the routine level of hospice care, additional levels of service, such as 24/7 continuous care or inpatient hospice care, will also be financed through Medicare Part A at no additional expense to the patient or family.

Yes, hospice services provided in a nursing facility are covered by Medicare. In a nursing home setting, hospice helps patients, families, and nursing home staff by providing end-of-life resources and support. The Medicare Hospice Benefit covers services, medications, supplies, and equipment that are related to life-limiting illness. It does not, however, cover expenses associated with room and board. These skilled nursing facility room-and-board expenses are often covered by Medicaid when the patient meets the state’s financial eligibility requirements.

The Medicare and Medicaid Hospice benefit also includes a provision for respite care and inpatient care, which can also be provided in a nursing facility for short stays. When the need for respite or inpatient hospice care is identified by the hospice team, the total costs associated with the care are covered under the hospice benefit.

For those not eligible for Medicare or Medicaid, payment for hospice can come from private insurance or an HMO, since these also include a hospice benefit.

Hospices employ financial specialists to help families who do not qualify for federal assistance and do not have insurance find available resources. The payment options for these families include self-pay and charitable organizations.

Facing a terminal illness brings with it many concerns. Paying for end-of-life care shouldn’t be one of them.

Source: NHPCO's Facts and Figures: Hospice Care in America