The Hospice Benefit: Myths Unraveled
To many families, the word Hospice is a dreaded one to hear. Traditionally Hospice was for cancer patients, providing support during the last few weeks, days, or even hours of life. Although the concept of Hospice has greatly evolved since its inception in Europe in the 1800s, not much publicity has been brought with the changes, leaving families with the same dreaded notion, “Is my loved one going to die so soon?”
Today there are over 3600 Hospice providers in the United States alone, and Hospice is a Medicare benefit offered to qualifying individuals at absolutely zero out-of-pocket cost to the Patient and Family. Medicaid and some private insurance companies also offer Hospice benefits to beneficiaries. In addition to the program being free of out-of-pocket expenses, Hospice also actually provides additional benefits to the Patient and Family.
What does Hospice offer the Patient and Family?
- Medicare covers all services provided by Hospice at 100%, with no co-pay and no out-of-pocket expense to the Patient.
- RN Case Manager, Home Health Aide, Chaplain Services, Volunteers, and access to an On-Call RN 24-7.
- Symptom control, medications for the admitting diagnosis, wound care supplies, nutritional supplements, adult briefs, blue pads, creams, wipes, cath supplies, and we can maintain a peg tube if they come to us with it in place.
- Any durable medical equipment required, such as hospital beds, wheelchairs, bedside commodes, shower chairs, canes, walkers, oxygen, nebulizers, etc.
- We cover ALL medications for pain, nausea, constipation, sleeplessness, anxiety, and depression, regardless of diagnosis.
- Hospice is not limited to cancer patients, as was the traditional mindset for Hospice. Diagnoses can include, but are not limited to: congestive heart failure, coronary artery disease, end-stage dementia and alzheimers, COPD (emphysema), acute or chronic renal failure, stroke/coma, cancer, ALS (Lou Gehrig’s disease), liver disease, HIV and AIDS and other combinations of illnesses that would lead to a limited life expectancy.
- Bereavement support is offered to the family for a period of 13 months after their loved one has expired.
Contrary to popular belief, Medicare does not require patients to have a “do not resuscitate” order or advance directive to be admitted to a hospice program. Medicare also does not require a patient to be homebound to be eligible to receive Hospice services. Although some Hospice programs may tell you that you may not go to the emergency room while on Hospice, Patients have the right to remain in control of their plan of care and also have the right to revoke their Hospice benefit at any time and seek whatever treatment they desire. Most agencies have the capability to be somewhat flexible with Patients on these issues.
Some programs also offer something called “continuous care”, which is limited periods of continuous staffing by Hospice professionals if a crisis situation is identified (i.e. active dying process, uncontrolled pain, etc.). Of course, all agencies are regulated by the Department of Health, but some individual policies may vary. Be sure to ask what these policies are before deciding on a Hospice provider.
So What About the “Six Months to Live” Requirement?
Hospice beneficiaries are not restricted to six months of coverage. There is no limit on how long an individual can receive Hospice care, as long as they continue to meet the eligibility criteria set forth by Medicare. Medicare and Medicaid will not stop paying for a Patient to receive Hospice care as long as the Patient is still deemed appropriate. A physician still has to certify that the Patient has a 50% or greater chance of having a POOR prognosis should their disease process run its NATURAL course in the next six months. Natural is defined as no interventions of medications or physicians.
Medicare intermediaries have actually created a set of criteria for each diagnosis that could make a person appropriate for Hospice care, to aid physicians in determining what types of Patients are appropriate. These criteria are now the gold standard for Hospice appropriateness, where the gold standard previously was the “six months or less” prognosis.
Hospice care can be offered in private homes, skilled nursing facilities, personal care homes, assisted living facilities, virtually anywhere a Patient calls “home”. Hospice can even be provided in hospital settings in some circumstances. No longer is Hospice a word mentioned only when a loved one is actively dying, but a word mentioned when someone is in need of some extra TLC. Hospice today is a multifunctional organization providing care and cost savings to Patients and Families, but most importantly, a full staff of caring and compassionate individuals waiting to help you and your family cope with all aspects of a difficult time of need.
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