WHAT IS HOSPICE?
You and your loved ones have a choice when dealing with chronic illness or a terminal diagnosis. If aggressive treatment or hospitalization is no longer your wish when suffering from qualifying long-term or life-limiting conditions, Hospice care provides you the option to approach end-of-life care with comfort, compassion and dignity in your own Home, Hospice Center, Skilled Nursing Facility or Assisted Living Facility.
Who is eligible for the Hospice Medicare Benefit and how is it obtained?
- Have a life limiting disease
- No longer receiving curative treatment
- Seek comfort measures
- Sign a statement “electing” hospice care for their medical condition
What happens if a patient lives longer than 6 months?
There is no limit on number of days one can receive hospice care. Hospice can continue to be given to a patient as long as the physician continues to re-certify the patient for hospice.
Who pays for Hospice?
- Commercial Insurers
- Managed Care
- Government (Veterans Affairs, Active Duty Military)
Many hospices also provide care to uninsured individuals. To do so, they rely on donations to cover their costs.
What is covered under the Hospice Medicare Benefit?
The following services are covered when included in the hospice plan of care (which is established by the patient, family and hospice) and when they relate to the diagnosis under hospice:
Nurses who are specially trained in pain and symptom management who make routine and emergency visits as needed to the patient
Home Health Aides to provide bathing and personal care
Social Work and counseling services to provide emotional support to patients and their family
Chaplain visits to attend to spiritual issues
Medical equipment (such as oxygen, wheelchairs) related to the life-limiting illness
Medical supplies (such as bandages and incontinence supplies)
Prescription and non-prescription related to the life-limiting illness for symptom management and pain relief
short-term inpatient care, including respite care
Bereavement services for family
Hospice benefits will not cover the following:
Treatment to cure a patient’s illness as it relates to hospice: The philosophy of hospice is to provide comfort and care, including medication, which helps control symptoms and ease pain. Patients receiving treatments to cure their disease are not eligible for hospice care.
Care from two hospice providers: Patients must elect to receive service from a single hospice care provider. However, the patient may change providers at any time.
Treatment and care for health problems not related to the hospice diagnosis: A patient’s physician can continue to treat illnesses or conditions not related to the hospice diagnosis. When the patient requires treatment for un-related conditions, the terms of the insurance or Medicare coverage will apply. For example, the patient may have to meet deductibles and coinsurance amounts
How long can a patient continue to receive hospice care under Medicare?
The Hospice Medicare benefit is structured in benefit periods. The first two periods are for 90 days each, followed by an unlimited number of subsequent periods of 60 days each. The patient may revoke the hospice benefit at any time during a benefit period. The patient may then return to their regular Insurance coverage. The patient may later re-elect the hospice benefit.
Can other Medical services be received while on the hospice benefit?
Even though the hospice team includes a physician, patients can continue to use their personal physician for the treatment of health problems related to and unrelated to the life-limiting illness. When standard benefits are used, the patient is responsible for Medicare\'s deductible and coinsurance amounts. Hospice is not responsible for treatments unrelated to the life-limiting diagnosis or treatments that are not palliative in nature.
What if the patient is currently covered under a Managed Care Plan (Secure Horizons)?
The patient may use the hospice benefit and the managed care plan will continue to pay for medical care that is unrelated to the condition for which the hospice is providing care. There is no loss of coverage.
What if the patient resides in a nursing home or an assisted living facility?
Hospice must have a written agreement (contract) with a nursing home to provide care. The hospice team and the nursing facility staff collaborate in your care. The patient will have the benefit of experts in long term care working with experts in symptom management and counseling to provide the highest level of care for the patient and family.
Will the patient need to switch Doctors if they elect Hospice Care?
No. The hospice team works with your choice of physician to provide hospice care. Most hospices will provide you with a physician should you require one
What if I decide that I no longer want hospice care?
You have the right to stop receiving hospice care at any time. A form is signed to revoke the Hospice Benefit and you go back to receiving all the benefits you had in the past from your Insurance. There is no penalty or loss of service days.
What help is provided to help the family?
There is no limit to the support Care Plus provides our patient’s and families
24 hour triage line: RN’s staff the Care Plus Hospice triage line. Nurse and Social Worker visit services are available 24/7 to meet the needs of our patients / families.
Education and counseling for family members is covered. Volunteers are available as needed to provide chore type services and to make the caregiver\'s role easier. Home health aides assist with the patient\'s personal needs. Inpatient admission to a Skilled Nursing Facility for control of acute symptoms which cannot be cared for in a home setting is included. Inpatient admissions to a contracted facility for a brief period of time for respite care if the family needs a break from their home care responsibilities. Bereavement care is available to the immediate and extended family.