Learn about hospice care — what it is, who qualifies for it, when to use it, and how to pay for it. 
The use of hospice care — services that focus on keeping a dying patient as comfortable and pain-free as possible during their last days — is becoming more and more popular. Many elderly folks and terminally ill people choose this low-fuss, low-frills medical care as their lives come to an end. If you are considering hospice care for yourself or a loved one, take the time to learn what it is, how to qualify and pay for it, and how to find hospice care services that work for your particular situation.

What is Hospice Care?
Hospice provides an alternative to the traditional medical care that hospitals and nursing facilities commonly deliver toward the end of a patient’s life. In hospice, the goal is shifted from attempting to cure an illness or performing life-saving measures to keeping a patient as comfortable and free of pain as possible. In addition to providing a seriously ill patient with care and comfort, hospice services often extend to his or her family members and friends — involving and training them in giving care, and providing breaks and counseling services to those who need them.

Hospice care has been growing in popularity in recent years. The National Hospice and Palliative Care Organization recently estimated that 1.3 million patients received services from hospice in 2006, a 162% increase in a decade. And it noted that 36% of all people that died in the United States were under the care of a hospice program.

Provided the patient meets certain criteria, Medicare and most insurance plans cover hospice care.

Where hospice care is provided. Many people think of hospice as care provided at home, and that is generally the case. But it may also be given in a hospital, nursing home, or separate hospice facility. Because hospice care is focused on easing pain rather than radical medical intervention, it usually does not require sophisticated or cumbersome machinery, such as life-support systems or dialysis devices.

Types of care included. The specific type of hospice care provided may depend on which people or what agency provides it, as well as what care is most fitting. But hospice services are generally provided by a team of caregivers and may include:

• medical care — a hospice doctor generally oversees and coordinates the care, sometimes working in tandem with a patient’s primary care physician
• nursing care — provided either around-the-clock, if needed, or sporadically for check-ups or special services, such as administering injections
• help with daily needs, such as bathing, cooking, or cleaning
• visits from a religious counselor, if requested
• counseling services, both for the patient and for family members
• social services support, such as help with insurance and financial matters
• respite care to provide breaks and rest time for caregivers, especially family members
• medical supplies and equipment — such as hospital beds, bedside commodes, wheelchairs, and oxygen
• medications to help control pain and symptoms
• physical, speech, dietary, and occupational therapists, and
• bereavement care following a death.

Qualifying for Hospice Care
To qualify for hospice care, a doctor must certify that a patient has a terminal illness and will probably have six months or less to live.

In reality, of course, it is often difficult or impossible for doctors to put a specific timeline on a patient’s life. But most insurers and all Medicare administrators will require this diagnosis before they will cover the cost of hospice care, as discussed below.

Patients may also switch in and out of hospice care as a medical condition worsens or improves. For example, a person whose cancer goes into remission may switch out of hospice care, but enter it again if symptoms recur. It’s also acceptable for a patient to move in or out of hospice care simply because he or she has a change of heart or is anxious to try a new type of medical treatment.

Finding Hospice Care Providers
There are several Internet sources available to help locate hospice care in your area. The National Hospice and Palliative Care Organization at www.nhpco.org and the Hospice Association of America at www.nahc.org/HAA are good starting points for a search.

Friends, neighbors, and relatives who have had good experiences with a particular hospice provider may also be invaluable resources. Or, you can check with your local Office on Aging. Staff members may be able to direct you to reputable hospice care providers. To find your local Office on Aging, do an Internet search using your state name and “office on aging” as the search words.

However, for older people who are already enmeshed in the medical system or who are receiving care through a hospital or skilled nursing facility, often the best way to find appropriate hospice care is to talk with medical and other personnel who are already involved with the patient, including:

Treating physicians. A doctor who has practiced medicine in one place for a while will likely be familiar with one or more hospice agencies in the locale. One caveat is that primary care physicians often bow out of the caretaking picture once hospice care begins. So if a treating physician recommends an agency, ask for a description of the experience behind that recommendation.

Discharge planners. If a patient is in a hospital or skilled nursing facility, the hospital or facility discharge planner should have contact information for area hospice services. Some medical facilities have a contract with and refer to only one hospice service, so find out whether this is the case.

Long-term care facilities. Assisted living and other types of long-term care facilities usually have relationships with one or more hospice providers. A person who is a resident in such a facility will often experience the smoothest transition in care by taking up with a familiar hospice, because the staffs at both spots most likely have an established working relationship.

Whatever method you use to find hospice service, be sure to investigate a few and comparison shop before making a final decision.

Paying for Hospice Care
Some of the costs of hospice care are inevitably paid with personal family assets and insurance. These days, however, the vast majority of hospice care is paid for by Medicare, the federal health insurance program that covers some younger people with disabilities and adults who:

• are age 65 and older
• receive Social Security payments, or
• are diagnosed with end-stage renal disease.

Medicare Part A, which generally covers hospital costs, has covered hospice care since 1983.

However, Medicare Part A will only pay for care provided by a Medicare-certified program and does not allow patients to receive care from more than one hospice program at the same time. That may mean, for example, that a person who was regularly receiving home health care from a specific agency may have to receive it instead from a more complete hospice service that offers the same type of care.

In addition, to get hospice care coverage by Medicare Part A:

• a doctor and the hospice medical director must verify that the patient has a terminal illness and probably has less than six months to live, and
• the patient must sign a statement choosing hospice care instead of standard Medicare-covered benefits — although Medicare will continue to cover health problems that are not related to the terminal illness.

If hospice care will be received at home, caregivers should find out the amount of services that will be provided before agreeing to give up standard medical benefits; sometimes nursing and other services provided in the home environment are quite limited, such as one hour every other day.

Hospice Services Covered by Medicare
Medicare pays a fixed amount for most hospice services, including:

• nursing services (amount depends on patient’s needs)
• medical equipment, such as wheelchairs or walkers
• medical supplies, such as bandages and catheters
• drugs for symptom control and pain relief
• short-term hospital care, including respite care to give caregivers a break from their duties
• home health aide and housekeeping services
• physical, occupational, and speech therapy
• social worker services
• nutritional counseling, and
• grief counseling for both the patient and the family.

Patients may be personally responsible for paying for:

• the difference between what Medicare will pay and what the hospice service charges
• treatments designed to cure a terminal illness
• treatment or services not related to comfort care, and
• room and board — except for temporary respite care.

Length of Time Covered by Medicare
Medicare generally covers a total of 210 days of hospice care, broken into two 90-day periods of benefits, followed by a 30-day period. Each of the periods may be extended, but only when a doctor recertifies that the patient’s condition remains terminal. In some rare circumstances, coverage may be extended indefinitely.