When a person has an illness that is terminal with a prognosis of less than 6 months to live, hospice care may be recommended to the patient and family. Hospice is more than a place, it is a special way of caring for someone with an illness that can not be cured. Hospice care comes to us from medieval times. It symbolizes a place where the travelers, pilgrims, sick, wounded, or dying could find comfort and rest.
Hospice care is appropriate when:
Treatment for a cure is no longer appropriate and palliative care (comfort and symptom control) should be offered.
The patient knows they are not going to get well and then does not actively seek treatment.
When the medical emphasis changes to comfort and symptom control in a setting that will let the person live as normal a life as possible.
The Physician believes that hospice care would be appropriate.
Hospice affirms life and views dying as part of our natural process. It neither hastens nor postpones death. Hospice care provides personalized care and services to patients and their families. The patient and family are assisted in the necessary preparation for death in a way that is satisfactory for them.
The Hospice Setting and care team:
Hospice care is usually offered at home. Hospice care offers patients and families the ability to remain in familiar surroundings often with a greater sense of peace, comfort and dignity. Hospice care is also offered in special hospital units, nursing homes and residential hospice facilities that specialize in hospice care. Some nursing facilities may contract with hospice services to come in and offer hospice care to its residents.
An interdisciplinary, medically directed team provides the hospice care. The team usually includes your physician, a nurse, a home health aide, a social worker, a chaplain and a volunteer. The hospice nurse makes regularly scheduled visits and provides pain management and symptom control techniques. The nurse keeps the primary physician informed of the patients condition and provides the complete spectrum of skilled nursing care. The nurses are on call 24 hours a day, seven days a week. The home health aide provides personal care assistance. The social worker provides assistance with financial and practical concerns, coordinates other support services, counseling, emotional support, facilitates communication, evaluates the need for volunteers, community agency support services and offers bereavement follow-up services. The chaplain provides spiritual support to the patient and family, often serving as the liaison between them and their faith communities. The chaplain can assist with the funeral or memorial services and funeral arrangements. The volunteer adds a caring presence and support, gives respite time to the family, can spend time with the patient or do chores and services that may be missed while the family enjoys the time left with their loved one.
Paying for Hospice Care:
Care recipients enrolled in Medicare or Medicaid (Title 19) must decide to enroll in the Hospice Benefit Program or maintain their traditional coverage. When Medicare beneficiaries choose hospice care they are telling Medicare that they no longer wish to have treatments for the terminal illness. They do maintain standard benefits for the treatment of health problems unrelated to the terminal illness and when these benefits are used they are responsible for Medicare deductibles and coinsurance amounts. The newly chosen hospice benefits cover care approved by the hospice team and must be related to the terminal illness, there is not a deductible for hospice services. Hospice benefits cover physician and nursing services, medical equipment and supplies, prescription drugs for symptom management and pain relief, short-term acute inpatient care which includes respite care, home health aide and homemaker services, physical therapy, occupational therapy, speech and language pathology services, medical social services, dietician services and counseling including spiritual counseling. Medicare pays the hospice program directly. When receiving hospice care outside of the home, Medicare hospice benefits do not always cover the cost of room and board. The patient does have the right to change hospice programs within a benefit period as well as leave and then re-enter hospice care. You may choose to revoke hospice care and coverage at any time. For total Medicare coverage information contact 1-800- 772-8477. If you have a Medicare HMO also contact that HMO.
Most private insurance companies now have a hospice benefit within their policies. The hospice staff will work with patients and their families to determine insurance coverage.
It is Critical:
When medical professionals recommend hospice care, it is critical to understand that 'real' hospice care is provided by an agency or an organization that is primarily engaged in providing services to the terminally ill and their families. Hospice care provided by a qualified hospice program is different than many traditional medical approaches as well as radical (physician assisted suicide) approaches to the end of life care. Legal, ethical and medical research for palliative care and end of life care services continue to be under way across this country. They are best understood and provided by qualified hospice programs.