Hospice

 

What is Hospice?

Hospice is a philosophy of care, with a focus on quality, compassionate care for individuals facing a life-limiting illness, disease or injury. The heart of this care is on the caring of the person, not the curing of the disease or illness. This form of care provides a team-oriented approach to expert medical care in addition to emotional, social and spiritual support that is individualized for the specific person and family. Hospice provides comfort, support and care during one of life’s most challenging times. Hospice is there to walk alongside patient and loved ones.

Concepts of Hospice include…

  • Hospice supports the belief that we are all entitled to die in peace with dignity and comfort.
  • Hope, love and comfort is provided so that people can live as fully as possible for the rest of their lives.
  • Loved ones need care and support as well through this process. Care can be provided in any setting, such as nursing home, assisted living facility, free-standing hospice facility, but is usually provided in the person’s home.
  • Hospice is for anyone of any age, illness, race, religion or culture.
  • Hospice is paid for through many options such as Medicare, Medicaid, most private insurance plans, HMOs, etc. Many hospice providers offer support through a charitable foundation if no other funding source is available. Most funding sources follow the Medicare Eligibility Criteria as well as the guidelines as to what is covered but the patient/family should ask the payor re: the specifics of their plan coverage if it is not MediCare.

The Medicare Hospice Benefit

The Medicare Hospice Benefit was initiated in 1983 and hospice is covered under Part A (hospital insurance). Beneficiaries receive a wide range of services under this coverage for the life limiting illness. This benefit is extremely flexible. For example, the recipient may stop the services at any time for any reason. Sometimes a person’s health may improve so that he/she does not meet the criteria for hospice services any more (i.e. prognosis is no longer 6 months). The individual would return to the type of Medicare coverage that was utilized before receiving hospice care. At a later time, if the patient becomes eligible again, he or she can go back to hospice care

Who is Eligible for Medicare Hospice Benefits?

An individual is eligible for Medicare hospice benefits when the following conditions are met:

  • Eligible for Medicare Part A (Hospital Insurance), and
  • physician and hospice medical director certify that the individual has a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less to live, and
  • The individual, or if not competent the signing authority, signs a statement choosing hospice care instead of routine Medicare covered benefits, and
  • Care is received from a Medicare-approved hospice program.

It is important to realize that Medicare will continue to pay for covered benefits for any health needs that are not related to the hospice diagnosis (i.e. the life limiting illness).

What Does Medicare Cover?

The following lists the hospice services paid for by Medicare:

  • Nursing care
  • Physician Services
  • Social work services
  • Hospice Aide services
  • Medical equipment (for example, hospital bed, bed-side table, commode chair, etc.)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Physical, Occupational and Speech therapy
  • Dietary counseling
  • Grief and Bereavement Counseling
  • Respite care
  • Short-term Inpatient level of care for symptom management
  • Continuous Home Care for symptom management

Medicare Advantage Plans

All Medicare-covered services received on hospice care are covered under Original Medicare, even if the patient is enrolled in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan. However, the plan will continue to cover the patient for any extra services not covered by Original Medicare (like dental and vision benefits). If the patient chooses to stay on the Medicare Advantage Plan while receiving hospice care, the patient must continue to pay the plan’s monthly premium.

 

By: Lee-Anne Godfrey, RN, BsN.

Lee-Anne is a Registered Nurse specialized in the area of Hospice, Dementia and End of Life Care.